asc German machine maker LSW Maschinenfabrik switches to SolidWorks software By www.solidworks.com Published On :: Wed, 15 Feb 2006 00:00:00 -0500 Company purchases 80 licenses of SolidWorks after benchmark testing demonstrates 3x to 7x performance advantage Full Article
asc Waves of prayer envelop Madagascar By www.om.org Published On :: Thu, 01 Dec 2011 11:29:24 +0000 The OM Madagascar team mobilises the Malagasy church for prayer through radio programmes and SMS messages. Full Article
asc ASCD's Deborah Delisle to Depart in 2019 By blogs.edweek.org Published On :: Wed, 12 Dec 2018 00:00:00 +0000 The resignation of the former U.S. Department of Education staffer, who has led ASCD since mid-2015, follows a long run of membership declines for the organization. Full Article Professionaldevelopment
asc Display MessageBox using JavaScript in HTML By aspsnippets.com Published On :: Tue, 12 Nov 2024 00:00:00 GMT Here Mudassar Khan has explained Full Article
asc ASP.Net Core Razor Pages: Display MessageBox using JavaScript By aspsnippets.com Published On :: Tue, 12 Nov 2024 00:00:00 GMT Here Mudassar Khan has explained Full Article
asc ASP.Net Core: Display MessageBox using JavaScript By aspsnippets.com Published On :: Tue, 12 Nov 2024 00:00:00 GMT Here Mudassar Khan has explained Full Article
asc ASP.Net MVC: Display MessageBox using JavaScript By aspsnippets.com Published On :: Tue, 12 Nov 2024 00:00:00 GMT Here Mudassar Khan has explained Full Article
asc ASP.Net MVC: Disable Browser Back Button after Logout using JavaScript By aspsnippets.com Published On :: Tue, 12 Nov 2024 01:22:27 GMT Here Mudassar Khan has explained with an example, how to disable Browser Back Button after Logout using JavaScript in ASP.Net MVC. Full Article
asc OHS Partners with NASCAR Driver Ross Chastain to Bring Awareness to the Dangers of Impaired Driving By news.delaware.gov Published On :: Wed, 26 Apr 2023 14:44:00 +0000 DOVER, Del. (April 26, 2023) The Delaware Office of Highway Safety is teaming up with NASCAR Drivers Ross Chastain and Chad Chastain to encourage Delawareans to “Use Your Melon” and Drive Sober. On Friday, April 28th, OHS and Ross will be at the Buffalo Wild Wings in Dover 680 S Bay Rd, Dover, DE 19901 […] Full Article Alcohol Tobacco Enforcement Department of Safety and Homeland Security Impaired Driving News Office of Highway Safety
asc United States Ambassador-At-Large Dyer's Travel to Madagascar and South Africa By allafrica.com Published On :: Mon, 11 Nov 2024 17:30:26 GMT [State Department] U.S. Ambassador-at-Large to Monitor and Combat Trafficking in Persons Cindy Dyer will travel to Madagascar November 13-16 and South Africa November 17-21. Full Article Africa East Africa External Relations Madagascar South Africa Southern Africa United States Canada and Africa
asc Ascent: Training Insights: DE-HDL Libraries in Allegro X System Capture By community.cadence.com Published On :: Thu, 24 Oct 2024 05:46:00 GMT Allegro X System Capture offers a complete ecosystem for library development. This post introduces the latest DE-HDL Library Development using System Capture course in which you learn how to create different library objects. As a librarian, you often work with numerous libraries. Your tasks include creating or modifying symbols for libraries. To use Allegro X System Capture to create a library, you can follow the steps in the following flowchart: Let’s go through each step in detail. Setting the CDS_SITE Variable Before you start library development for a new project, set the CDS_SITE system environment variable. This step is required to access libraries and other configuration files. Creating a Project in Allegro X System Capture The next step is to create a project in Allegro X System Capture. Adding a Library to the Project Symbol development consists of creating symbol graphics, electrical data, and properties used by different tools in the PCB design flow. To add a library to a project, first create a library in the Libraries pane of the Project e xplorer. Creating Library Symbols The library development process supports the creation of various types of symbols. Creating a Symbol with Multiple Views You can generate multiple views of the same symbol using the Duplicate command. For example, a discrete symbol, such as a resistor, can have multiple views, as shown in the following image: Creating a Split Symbol For advanced designs, you often need to create library symbols and break them into multiple sections to support the design process. When a symbol shows all the logical pins in the physical package, it is called a single-section or flat symbol. Many large ICs have several pins and the symbols need to fit on a single schematic page. One workaround is to use vector pin names on a symbol to reduce its size, although manufacturers prefer schematics that show each pin. You can divide these high-pin count devices into smaller pieces, where each piece is a separate version of the part. Such parts are referred to as split parts or multi-section symbols. For multi-section symbols, you can create two types of split parts—symmetrical and asymmetrical. Symmetrical Split Symbols A symmetrical split symbol has only one symbol graphic, which holds two or more identical logic symbols, each with its own unique physical pin numbers. You can create a symmetrical split symbol using the Duplicate Section icon in the canvas window. Each symbol section contains the same set of pins but different pin numbers, as shown in the following image: Asymmetrical Split Symbols An asymmetrical split symbol is a symbol whose physical package contains one or more unique schematic symbols. You can create an asymmetrical split symbol by clicking the New Section icon in the canvas window. Asymmetrical symbols have a unique set of logical pins, as shown in the following image: Creating Symbols Using the Spreadsheet Interface To simplify the development of large symbols, Allegro X System Capture has a Spreadsheet Interface . You can copy from a spreadsheet into the interface. This saves time and helps minimize errors introduced by manual entry. In conclusion, the DE-HDL library development using Allegro X System Capture course involves several critical steps and supports various symbol creation techniques. This course helps librarians create and modify symbols effortlessly and deepens their understanding of library development within Allegro X System Capture. To learn more about this topic, enroll in the DE-HDL Library Development using Allegro X System Capture course on the Cadence Support portal . Click the training byte link now or visit Cadence Support and search for training bytes under Video Library. If you find the post useful and want to delve deeper into training details, enroll in the following online training course for lab instructions and a downloadable design: DE-HDL Library Development using Allegro X System Capture (Online). You can become Cadence Certified once you complete the course. Cadence Training Services now offers free Digital Badges for all popular online training courses. These badges indicate proficiency in a certain technology or skill and give you a way to validate your expertise to managers and potential employers. You can add the digital badge to your email signature or any social media channels, such as Facebook or LinkedIn, to highlight your expertise. To find out more, see the blog post Take a Cadence Masterclass and Get a Badge . You might also be interested in the training Learning Map that guides you through recommended course flows as well as tool experience and knowledge-level training modules. To find information on how to get an account on the Cadence Learning and Support portal, see here . SUBSCRIBE to the Cadence training newsletter to be updated about upcoming training, webinars, and much more. If you have any questions about courses, schedules, online training, blended/virtual live training, or public, or onsite live training, reach out to us at Cadence Training . Full Article
asc No windows cascading in OrCAD Capture 17.4 By community.cadence.com Published On :: Tue, 21 Dec 2021 08:02:37 GMT Hello All, I'm a novice to this forum and probably this subject has been already discussed here. My company has purchased OrCAD Capture 17.4 tools that have a new GUI if compared to my earlier used OrCAD Capture 9.2. I have been using Capture 9.2 for ~18 years and its GUI is really convenient. The GUI of 17.4 looks to be a modern one with new icons and really has improved features and new capabilities. However, my main complain about GUI 17.4 is that the schematic windows cannot be cascaded. Although they can be set floating, this is even more annoying because all toolbars remain in the Capture window and when you select a tool, the Capture window pops over already open schematic window and you need a lot of useless extra clicks to return back to the currently edited schematic page. I always used cascading of schematic windows before because my complex designs includes many pages, not speaking about the library windows that are typically open simulatneously. My view is that the lack of CASCADING in Capture GUI 17.4 is critical and unacceptable for complex projects, and I would very highly appreciate if the Cadence guys will return back the CASCADING capability for schematic pages. In case this will be done, this will make the GUI really great and comfortable to use. Does anybody have opinion on this issue? Many thanks, Pavel Full Article
asc Angular Removing Unused CSS and Obfuscate JavaScript in Post Build Process By www.9lessons.info Published On :: Thu, 6 Oct 2022 00:12:00 -0400 Nowadays most applications are developed based on large CSS libraries like Bootstrap, Tailwind CSS, etc.. and sometimes multiple frameworks. But your application components are not using all of the styles and it adds more weight to the application performance. This post will explain the Angular post-build process to remove unused CSS and hidden JavaScript files that enhance the application security and definitely improve the app loading time and save the overall bandwidth cost. Full Article angular Build CSS javascript Obfuscate
asc React Removing Unused CSS and Obfuscate JavaScript in Post Build Process By www.9lessons.info Published On :: Sun, 9 Oct 2022 19:45:00 -0400 This is continues of my previous post about how to remove unused CSS and convert unclear JavaScript to protect your source code in the post-build process. If you are using CSS libraries like Bootstrap, Tailwind CSS, etc.. and sometimes multiple frameworks. But your application components are not using all of the styles and it adds more weight to the application performance. This post will explain how to configure the React post-build process to remove unused CSS and hidden JavaScript files that enhance the application security and definitely improve the app loading time and save the overall bandwidth cost. Full Article Build CSS javascript Obfuscate reactjs
asc 'Gladiator II' review: Ridley Scott grapples with modern masculinity in ancient Rome By mashable.com Published On :: Mon, 11 Nov 2024 14:00:00 +0000 Paul Mescal, Denzel Washington, and Pedro Pascal face off in Ridley Scott's "Gladiator II." Review. Full Article
asc Why the Ascension Matters (Selected Scriptures) By feeds.gty.org Published On :: Sun, 16 Apr 2017 00:00:00 Check here each week to keep up with the latest from John MacArthur's pulpit at Grace Community Church.Click the icon below to listen. Full Article
asc La armadura de Dios: El casco de la salvación A By feeds.gracia.org Published On :: Thu, 05 Sep 2024 00:00:00 PST La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.Click the icon below to listen. Full Article
asc La armadura de Dios: El casco de la salvación B By feeds.gracia.org Published On :: Fri, 06 Sep 2024 00:00:00 PST La enseñanza bíblica en profundidad de John MacArthur lleva la verdad transformadora de la Palabra de Dios a millones de personas cada día.Click the icon below to listen. Full Article
asc This Is Not a Drill. Fascism Is on the Ballot. But… By www.ipsnews.net Published On :: Tue, 29 Oct 2024 08:12:24 +0000 The conclusion that Donald Trump is a fascist has gone mainstream, gaining wide publicity and affirmation in recent weeks. Such understanding is a problem for Trump and his boosters. At the same time, potentially pivotal in this close election, a small proportion of people who consider themselves to be progressive still assert that any differences […] Full Article Democracy Global Global Governance Headlines Human Rights IPS UN: Inside the Glasshouse TerraViva United Nations IPS UN Bureau
asc Syria says seven civilians killed in Israeli strike near Damascus By www.jpost.com Published On :: Sun, 10 Nov 2024 14:18:10 GMT Sayeda Zainab, a stronghold of Hezbollah and the site of a major Shi’ite shrine, has been the target of previous strikes. Full Article Hamas Hezbollah Syria Damascus Gaza Strip
asc Tiny chameleon spotted by tourists in Madagascar is new to science By www.newscientist.com Published On :: Mon, 16 Sep 2024 11:26:26 +0100 A species of leaf chameleon newly named Brookesia nofy was discovered in a patch of coastal rainforest, a highly threatened habitat in Madagascar Full Article
asc The fascinating truth about why common sense isn't really that common By www.newscientist.com Published On :: Tue, 24 Sep 2024 17:00:00 +0100 New research is revealing that common sense is a lot more idiosyncratic than we thought, with important implications for tackling political polarisation and the future of AI Full Article
asc Dazzling images illuminate research on cardiovascular disease By www.newscientist.com Published On :: Tue, 05 Nov 2024 15:00:25 +0000 The British Heart Foundation’s Reflections of Research competition showcases beautiful images captured by researchers studying heart and circulatory disease Full Article
asc The fascinating truth about why common sense isn't really that common By www.newscientist.com Published On :: Tue, 24 Sep 2024 17:00:00 +0100 New research is revealing that common sense is a lot more idiosyncratic than we thought, with important implications for tackling political polarisation and the future of AI Full Article
asc Health Tip: Do You Have Plantar Fasciitis? By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Health Tip: Do You Have Plantar Fasciitis?Category: Health NewsCreated: 8/31/2012 8:05:00 AMLast Editorial Review: 8/31/2012 12:00:00 AM Full Article
asc Men Who Feel Less Masculine May Be More Violent, Study Finds By www.medicinenet.com Published On :: Mon, 29 Aug 2022 00:00:00 PDT Title: Men Who Feel Less Masculine May Be More Violent, Study FindsCategory: Health NewsCreated: 8/25/2015 12:00:00 AMLast Editorial Review: 8/25/2015 12:00:00 AM Full Article
asc AHA News: New Report Details What to Know About Cardiovascular Disease Symptoms By www.medicinenet.com Published On :: Fri, 19 Aug 2022 00:00:00 PDT Title: AHA News: New Report Details What to Know About Cardiovascular Disease SymptomsCategory: Health NewsCreated: 8/18/2022 12:00:00 AMLast Editorial Review: 8/19/2022 12:00:00 AM Full Article
asc Delays in Cardiovascular Emergency Responses in Africa: Health System Failures or Cultural Challenges? By ghspjournal.org Published On :: 2024-10-29T12:28:39-07:00 Full Article
asc Nitric Oxide Signaling and Regulation in the Cardiovascular System: Recent Advances [75th Anniversary Celebration Collection Special Section] By pharmrev.aspetjournals.org Published On :: 2024-10-16T07:40:25-07:00 Nitric oxide (NO) from endothelial NO synthase importantly contributes to vascular homeostasis. Reduced NO production or increased scavenging during disease conditions with oxidative stress contribute to endothelial dysfunction and NO deficiency. In addition to the classical enzymatic NO synthases (NOS) system, NO can also be generated via the nitrate-nitrite-NO pathway. Dietary and pharmacological approaches aimed at increasing NO bioactivity, especially in the cardiovascular system, have been the focus of much research since the discovery of this small gaseous signaling molecule. Despite wide appreciation of the biological role of NOS/NO signaling, questions still remain about the chemical nature of NOS-derived bioactivity. Recent studies show that NO-like bioactivity can be efficiently transduced by mobile NO-ferroheme species, which can transfer between proteins, partition into a hydrophobic phase, and directly activate the soluble guanylyl cyclase-cGMP-protein kinase G pathway without intermediacy of free NO. Moreover, interaction between red blood cells and the endothelium in the regulation of vascular NO homeostasis have gained much attention, especially in conditions with cardiometabolic disease. In this review we discuss both classical and nonclassical pathways for NO generation in the cardiovascular system and how these can be modulated for therapeutic purposes. Significance Statement After four decades of intensive research, questions persist about the transduction and control of nitric oxide (NO) synthase bioactivity. Here we discuss NO signaling in cardiovascular health and disease, highlighting new findings, such as the important role of red blood cells in cardiovascular NO homeostasis. Nonclassical signaling modes, like the nitrate-nitrite-NO pathway, and therapeutic opportunities related to the NO system are discussed. Existing and potential pharmacological treatments/strategies, as well as dietary components influencing NO generation and signaling are covered. Full Article
asc Optimal Endovascular Therapy Technique for Isolated Intracranial Atherothrombotic Stroke-Related Large-Vessel Occlusion in the Acute-to-Subacute Stage [CLINICAL PRACTICE] By www.ajnr.org Published On :: 2024-11-07T15:14:12-08:00 BACKGROUND AND PURPOSE: Reocclusion after treatment is a concern in endovascular therapy for isolated intracranial atherothrombotic stroke-related large-vessel occlusion (AT-LVO). However, the optimal endovascular therapy technique for AT-LVO has not yet been investigated. This study evaluated the optimal endovascular therapy technique for AT-LVO in a real-world setting. MATERIALS AND METHODS: We conducted a historical, multicenter registry study at 51 centers that enrolled patients with AT-LVO. We divided the patients into 3 groups based on the endovascular therapy technique: mechanical thrombectomy alone, percutaneous transluminal angioplasty (PTA), and stent deployment. Mechanical thrombectomy alone was classified into the mechanical thrombectomy-only group; PTA and mechanical thrombectomy–PTA, into the PTA group; and mechanical thrombectomy–stent deployment, mechanical thrombectomy–PTA–stent deployment, PTA–stent deployment, and stent deployment–only into the stent group. The primary outcome was incidence of reocclusion of the treated vessels within 90 days of endovascular therapy completion. RESULTS: We enrolled 770 patients and analyzed 509 patients. The rates in the mechanical thrombectomy-only, PTA, and stent deployment groups were 40.7%, 44.4%, and 14.9%, respectively. Incidence rate of residual stenosis >70% of final angiography was significantly higher in the mechanical thrombectomy-only group than in the PTA and stent deployment groups (mechanical thrombectomy-only versus PTA versus stent deployment: 34.5% versus 26.3% versus 13.2%, P = .002). Reocclusion rate was significantly lower in the PTA group than in the mechanical thrombectomy-only group (adjusted hazard ratio, 0.48; 95% CI, 0.29–0.80). Of the patients, 83.5% experienced reocclusion within 10 days after endovascular therapy. Alarmingly, a substantial subset (approximately 62.0%) of patients experienced reocclusion within 2 days of endovascular therapy. Incidence of mRS scores of 0–2 ninety days after endovascular therapy was not significantly different among the 3 groups. Incidences of symptomatic intracranial hemorrhage, any other intracranial hemorrhage, and death were not significantly different. CONCLUSIONS: Incidence rate of reocclusion was significantly lower in the PTA group than in the mechanical thrombectomy-only group. We found no meaningful difference in reocclusion rates between the stent deployment and mechanical thrombectomy-only groups. In Japan, glycoprotein IIb/IIIa inhibitors are not reimbursed. Therefore, PTA might be the preferred choice for AT-LVOs due to the higher reocclusion risk with mechanical thrombectomy-only. Reocclusion was likely to occur within 10 days, particularly within 2 days post-endovascular therapy. Full Article
asc High-Resolution MRA Cerebrovascular Findings in a Tri-Ethnic Population [CLINICAL PRACTICE] By www.ajnr.org Published On :: 2024-11-07T15:14:12-08:00 BACKGROUND AND PURPOSE: Incidental findings on brain MRI and variations of the circle of Willis (CoW) are relatively common among the general population. Ethnic differences have been described before, but few studies have explored the prevalence of incidental intracranial cerebrovascular findings and CoW variants in the setting of a single multiethnic cohort. The purpose of this investigation was to describe both incidental cerebrovascular findings and the morphology of the CoW on high-resolution 3T TOF-MRA in a UK tri-ethnic population-based cohort and to present updated prevalence estimates and morphologic reference values. MATERIALS AND METHODS: We studied participants from the UK Southall and Brent REvisited study who underwent 3T brain MRI between 2014 and 2018. TOF-MRA images were assessed for the presence of incidental cerebrovascular findings and used to determine CoW anatomy. RESULTS: Seven hundred fifty participants (mean age, 71.28 [SD, 6.46] years; range, 46–90 years; 337 women), 322 White Europeans, 253 South Asians, and 175 African Caribbeans were included. Incidental cerebrovascular findings were observed in 84 subjects (11.2%, 95% CI, 9.0%–13.7%; 36 women; 42.86%, 95% CI, 32.11%–54.12%), with cerebral aneurysms being the most frequent followed by intracranial arterial stenoses with the highest prevalence among South Asians compared with White European (OR: 2.72; 95% CI, 1.22–6.08; P = .015) and African Caribbean subjects (OR: 2.79; 95% CI, 1.00–7.82; P = .051). Other findings included arteriovenous malformations and infundibula. The CoW was found to be more often complete in women than in men (25.22% compared with 18.41%, P = .024) and in African Caribbean (34.86%) compared with White European (19.19%) and South Asian (14.23%) subjects (P < .001 each). CONCLUSIONS: Intracranial arterial stenoses were independently associated with ethnicity after adjusting for vascular risk factors, having the highest prevalence among South Asians. The prevalence of aneurysms was higher than that in previous population-based studies. We observed anatomic differences in the CoW configuration among women, men, and ethnicities. Full Article
asc Pericarotid Fat as a Marker of Cerebrovascular Risk [RESEARCH] By www.ajnr.org Published On :: 2024-11-07T15:14:12-08:00 SUMMARY: Vascular inflammation is widely recognized as an important factor in the atherosclerotic process, particularly in terms of plaque development and progression. Conventional tests, such as measuring circulating inflammatory biomarkers, lack the precision to identify specific areas of vascular inflammation. In this context, noninvasive imaging modalities can detect perivascular fat changes, serving as a marker of vascular inflammation. This review aims to provide a comprehensive overview of the key concepts related to perivascular carotid fat and its pathophysiology. Additionally, we examine the existing literature on the association of pericarotid fat with features of plaque vulnerability and cerebrovascular events. Finally, we scrutinize the advantages and limitations of the noninvasive assessment of pericarotid fat. Full Article
asc Cardiovascular disease — risk assessment and reduction: NICE 2023 update for GPs By bjgp.org Published On :: 2024-10-31T16:05:26-07:00 Full Article
asc Nosferatu‘s Take on Count Orlok Sounds Fascinatingly Disgusting By gizmodo.com Published On :: Tue, 12 Nov 2024 19:01:22 +0000 Robert Eggers' re-imagining of the legendary vampire has his fangs out for prey in a very unusual manner. Full Article Movies Nosferatu
asc Documentary tells the fascinating story of a man wired to hear colour By www.newscientist.com Published On :: Wed, 11 Sep 2024 19:00:00 +0100 Cyborg: A documentary tells the intriguing story of Neil Harbisson, who wears an antenna to “hear” colour, but it is lacking in depth and should have probed its subject more, says Simon Ings Full Article
asc Barbara Slater to quit as head of BBC Sport, six months after Gary Lineker fiasco By www.telegraph.co.uk Published On :: Wed, 06 Sep 2023 10:53:44 GMT Full Article topics:organisations/bbc storytype:standard
asc Dazzling images illuminate research on cardiovascular disease By www.newscientist.com Published On :: Tue, 05 Nov 2024 15:00:25 +0000 The British Heart Foundation’s Reflections of Research competition showcases beautiful images captured by researchers studying heart and circulatory disease Full Article
asc Editor of Scientific American Apologizes to Young Voters for 'Fascist' Gen X Electing Trump By twitchy.com Published On :: Tue, 12 Nov 2024 22:00:10 -0500 Full Article <![CDATA[deleted tweets]]> <![CDATA[election]]> <![CDATA[endorsement]]> <![CDATA[Scientific American]]>
asc Your Guide To Enjoying Transmasculine Sex By www.starobserver.com.au Published On :: Sun, 04 Aug 2024 02:40:01 +0000 I could be biased, but sex with transmasculine people is fantastic. A warning up front: this article is not safe for work, unless it’s your very first day at the ... The post Your Guide To Enjoying Transmasculine Sex appeared first on Star Observer. Full Article Healthy Living Life Life + Style News Bottom clitoris Consent intimacy non-binary Penis sex Trans Sex transmasculine Transmasculine sex Vagina
asc Ascaris Lumbricoides: The Stomach Worm Nobody Wants By science.howstuffworks.com Published On :: Wed, 06 Nov 2024 10:20:02 -0500 We're about to dive into the world of parasitology, taking a close look at one of the most common parasitic worms infecting humans: Ascaris lumbricoides. This large roundworm is responsible for a type of intestinal nematode infection that affects millions of people worldwide, especially in areas with poor sanitation. Full Article
asc Trump est fasciste, mais c’est le Canada qui protège les nazis! By www.journaldemontreal.com Published On :: Tue, 12 Nov 2024 05:10:00 EST Les progressistes s’inquiètent de voir les États-Unis basculer dans le fascisme depuis l’élection de Donald Trump. Full Article
asc «ALPHAS»: le masculiniste Joël McGuirk déplore la décision de le «désinviter» de «Tout le monde en parle» By www.journaldemontreal.com Published On :: Mon, 11 Nov 2024 18:15:00 EST Joël McGuirk a dénoncé son retrait imprévu du dernier plateau de «Tout le monde en parle», lundi, au micro de Sophie Durocher, à QUB radio. Full Article
asc Clinical Trial Enrollment, ASCO 2013 Edition By www.placebocontrol.com Published On :: Thu, 30 May 2013 17:43:00 +0000 Even by the already-painfully-embarrassingly-low standards of clinical trial enrollment in general, patient enrollment in cancer clinical trials is slow. Horribly slow. In many cancer trials, randomizing one patient every three or four months isn't bad at all – in fact, it's par for the course. The most commonly-cited number is that only 3% of cancer patients participate in a trial – and although exact details of how that number is measured are remarkably difficult to pin down, it certainly can't be too far from reality. Ultimately, the cost of slow enrollment is borne almost entirely by patients; their payment takes the form of fewer new therapies and less evidence to support their treatment decisions. So when a couple dozen thousand of the world's top oncologists fly into Chicago to meet, you'd figure that improving accrual would be high on everyone’s agenda. You can't run your trial without patients, after all. But every year, the annual ASCO meeting underdelivers in new ideas for getting more patients into trials. I suppose this a consequence of ASCO's members-only focus: getting the oncologists themselves to address patient accrual is a bit like asking NASCAR drivers to tackle the problems of aerodynamics, engine design, and fuel chemistry. Nonetheless, every year, a few brave souls do try. Here is a quick rundown of accrual-related abstracts at this year’s meeting, conveniently sorted into 3 logical categories: 1. As Lord Kelvin may or may not have said, “If you cannot measure it, you cannot improve it.” Abstract e15572: Inadequate data availability on clinical trial accrual and its effect on progress in cancer research Probably the most sensible of this year's crop, because rather than trying to make something out of nothing, the authors measure exactly how pervasive the nothing is. Specifically, they attempt to obtain fairly basic patient accrual data for the last three years' worth of clinical trials in kidney cancer. Out of 108 trials identified, they managed to get – via search and direct inquiries with the trial sponsors – basic accrual data for only 43 (40%). That certainly qualifies as “terrible”, though the authors content themselves with “poor”. Interestingly, exactly zero of the 32 industry-sponsored trials responded to the authors' initial survey. This fits with my impression that pharma companies continue to think of accrual data as proprietary, though what sort of business advantage it gives them is unclear. Any one company will have only run a small fraction of these studies, greatly limiting their ability to draw anything resembling a valid conclusion. Abstract TPS6645: Predictors of accrual success for cooperative group trials: The Cancer and Leukemia Group B (Alliance) experience CALGB investigators look at 110 trials over the past 10 years to see if they can identify any predictive markers of successful enrollment. Unfortunately, the trials themselves are pretty heterogeneous (accrual periods ranged from 6 months to 8.8 years), so finding a consistent marker for successful trials would seem unlikely. And, in fact, none of the usual suspects (e.g., startup time, disease prevalence) appears to have been significant. The exception was provision of medication by the study, which was positively associated with successful enrollment. The major limitation with this study, apart from the variability of trials measured, is in its definition of “successful”, which is simply the total number of planned enrolled patients. Under both of their definitions, a slow-enrolling trial that drags on for years before finally reaching its goal is successful, whereas if that same trial had been stopped early it is counted as unsuccessful. While that sometimes may be the case, it's easy to imagine situations where allowing a slow trial to drag on is a painful waste of resources – especially if results are delayed enough to bring their relevance into question. Even worse, though, is that a trial’s enrollment goal is itself a prediction. The trial steering committee determines how many sites, and what resources, will be needed to hit the number needed for analysis. So in the end, this study is attempting to identify predictors of successful predictions, and there is no reason to believe that the initial enrollment predictions were made with any consistent methodology. 2. If you don't know, maybe ask somebody? Abstract 8592: Strategies to overcome barriers to accrual (BtA) to NCI-sponsored clinical trials: A project of the NCI-Myeloma Steering Committee Accrual Working Group (NCI-MYSC AWG) Abstract 1596: Rapid online feedback to improve clinical trial accrual: CODEL anaplastic glioma (AG) (NCCTG/Alliance N0577) as a model With these two abstracts we celebrate and continue the time-honored tradition of alchemy, whereby we transmute base opinion into golden data. The magic number appears to be 100: if you've got 3 digits' worth of doctors telling you how they feel, that must be worth something. In the first abstract, a working group is formed to identify and vote on the major barriers to accrual in oncology trials. Then – and this is where the magic happens – that same group is asked to identify and vote on possible ways to overcome those barriers. In the second, a diverse assortment of community oncologists were given an online survey to provide feedback on the design of a phase 3 trial in light of recent new data. The abstract doesn't specify who was initially sent the survey, so we cannot tell response rate, or compare survey responders to the general population (I'll take a wild guess and go with “massive response bias”). Market research is sometimes useful. But what cancer clinical trial do not need right now are more surveys are working groups. The “strategies” listed in the first abstract are part of the same cluster of ideas that have been on the table for years now, with no appreciable increase in trial accrual. 3. The obligatory “What the What?” abstract Abstract 6564: Minority accrual on a prospective study targeting a diverse U.S. breast cancer population: An analysis of Wake Forest CCOP research base protocol 97609 The force with which my head hit my desk after reading this abstract made me concerned that it had left permanent scarring. If this had been re-titled “Poor Measurement of Accrual Factors Leads to Inaccurate Accrual Reporting”, would it still have been accepted for this year’s meeting? That's certainly a more accurate title. Let’s review: a trial intends to enroll both white and minority patients. Whites enroll much faster, leading to a period where only minority patients are recruited. Then, according to the authors, “an almost 4-fold increase in minority accrual raises question of accrual disparity.” So, sites will only recruit minority patients when they have no choice? But wait: the number of sites wasn't the same during the two periods, and start-up times were staggered. Adjusting for actual site time, the average minority accrual rate was 0.60 patients/site/month in the first part and 0.56 in the second. So the apparent 4-fold increase was entirely an artifact of bad math. This would be horribly embarrassing were it not for the fact that bad math seems to be endemic in clinical trial enrollment. Failing to adjust for start-up time and number of sites is so routine that not doing it is grounds for a presentation. The bottom line What we need now is to rigorously (and prospectively) compare and measure accrual interventions. We have lots of candidate ideas, and there is no need for more retrospective studies, working groups, or opinion polls to speculate on which ones will work best. Where possible, accrual interventions should themselves be randomized to minimize confounding variables which prevent accurate assessment. Data needs to be uniformly and completely collected. In other words, the standards that we already use for clinical trials need to be applied to the enrollment measures we use to engage patients to participate in those trials. This is not an optional consideration. It is an ethical obligation we have to cancer patients: we need to assure that we are doing all we can to maximize the rate at which we generate new evidence and test new therapies. [Image credit: Logarithmic turtle accrual rates courtesy of Flikr user joleson.] Full Article ASCO ethics oncology trials patient recruitment trial delays trial design
asc NASCAR Icons Goodyear, Dale Earnhardt Jr., Expand Relationship - Goodyear�s �Made� Commercial By www.multivu.com Published On :: 18 Feb 2016 12:10:00 EST When it comes to performance under pressure, Dale Jr. and Goodyear are forged from the same fire. Like Goodyear, the Earnhardt name has a long history in NASCAR and we�re proud to say we�re Driven Like Jr. Full Article Advertising Auto Sports Transportation Trucking Railroad Broadcast Feed Announcements MultiVu Video
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