226 research outputs found
Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer
Background
Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival.
Methods
In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L).
Results
In the emergency group, tumor stage was greater (P < 0.01), more patients received adjuvant therapy (P < 0.01) more patients had an elevated mGPS (P < 0.01), and more patients died of their disease (P < 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P < 0.01), in both males and females (P < 0.05), in the deprived (P < 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P < 0.01), in those who received no adjuvant therapy (P < 0.01), and in the mGPS 0 and 1 groups (P < 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P < 0.05) and mGPS (P < 0.05) were independently associated with cancer-specific survival.
Conclusions
These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients
The impact of age, sex and socioeconomic deprivation on outcomes in a colorectal cancer screening programme
<p>Background: Population-based colorectal cancer screening has been shown to reduce cancer specific mortality and is used across the UK. Despite evidence that older age, male sex and deprivation are associated with an increased incidence of colorectal cancer, uptake of bowel cancer screening varies across demographic groups. The aim of this study was to assess the impact of age, sex and deprivation on outcomes throughout the screening process.</p>
<p>Methods: A prospectively maintained database, encompassing the first screening round of a faecal occult blood test screening programme in a single geographical area, was analysed.</p>
<p>Results: Overall, 395 096 individuals were invited to screening, 204 139 (52%) participated and 6 079 (3%) tested positive. Of the positive tests, 4 625 (76%) attended for colonoscopy and cancer was detected in 396 individuals (9%). Lower uptake of screening was associated with younger age, male sex and deprivation (all p<0.001). Only deprivation was associated with failure to proceed to colonoscopy following a positive test (p<0.001). Despite higher positivity rates in those that were more deprived (p<0.001), the likelihood of detecting cancer in those attending for colonoscopy was lower (8% most deprived vs 10% least deprived, p = 0.003).</p>
<p>Conclusion: Individuals who are deprived are less likely to participate in screening, less likely to undergo colonoscopy and less likely to have cancer identified as a result of a positive test. Therefore, this study suggests that strategies aimed at improving participation of deprived individuals in colorectal cancer screening should be directed at all stages of the screening process and not just uptake of the test.</p>
Using Flow Specifications of Parameterized Cache Coherence Protocols for Verifying Deadlock Freedom
We consider the problem of verifying deadlock freedom for symmetric cache
coherence protocols. In particular, we focus on a specific form of deadlock
which is useful for the cache coherence protocol domain and consistent with the
internal definition of deadlock in the Murphi model checker: we refer to this
deadlock as a system- wide deadlock (s-deadlock). In s-deadlock, the entire
system gets blocked and is unable to make any transition. Cache coherence
protocols consist of N symmetric cache agents, where N is an unbounded
parameter; thus the verification of s-deadlock freedom is naturally a
parameterized verification problem. Parametrized verification techniques work
by using sound abstractions to reduce the unbounded model to a bounded model.
Efficient abstractions which work well for industrial scale protocols typically
bound the model by replacing the state of most of the agents by an abstract
environment, while keeping just one or two agents as is. However, leveraging
such efficient abstractions becomes a challenge for s-deadlock: a violation of
s-deadlock is a state in which the transitions of all of the unbounded number
of agents cannot occur and so a simple abstraction like the one above will not
preserve this violation. In this work we address this challenge by presenting a
technique which leverages high-level information about the protocols, in the
form of message sequence dia- grams referred to as flows, for constructing
invariants that are collectively stronger than s-deadlock. Efficient
abstractions can be constructed to verify these invariants. We successfully
verify the German and Flash protocols using our technique
SMT-based Model Checking for Recursive Programs
We present an SMT-based symbolic model checking algorithm for safety
verification of recursive programs. The algorithm is modular and analyzes
procedures individually. Unlike other SMT-based approaches, it maintains both
"over-" and "under-approximations" of procedure summaries. Under-approximations
are used to analyze procedure calls without inlining. Over-approximations are
used to block infeasible counterexamples and detect convergence to a proof. We
show that for programs and properties over a decidable theory, the algorithm is
guaranteed to find a counterexample, if one exists. However, efficiency depends
on an oracle for quantifier elimination (QE). For Boolean Programs, the
algorithm is a polynomial decision procedure, matching the worst-case bounds of
the best BDD-based algorithms. For Linear Arithmetic (integers and rationals),
we give an efficient instantiation of the algorithm by applying QE "lazily". We
use existing interpolation techniques to over-approximate QE and introduce
"Model Based Projection" to under-approximate QE. Empirical evaluation on
SV-COMP benchmarks shows that our algorithm improves significantly on the
state-of-the-art.Comment: originally published as part of the proceedings of CAV 2014; fixed
typos, better wording at some place
Variable Reuse for Efficient Image Computation
Image computation, that is, computing the set of states reachable from a given set in one step, is a crucial component in typical tools for BDD-based symbolic reachability analysis. It has been shown that the size of the intermediate BDDs during image computation can be dramatically reduced via conjunctive partitioning of the transition relation and ordering the conjuncts for facilitating early quantification. In this paper, we propose to enhance the effectiveness of these techniques by reusing the quantified variables. Given an ordered set of conjuncts, if the last conjunct that uses a variable u appears before the first conjunct that uses another variable v, then v can be renamed to u, assuming u will be quantified immediately after its last use. In general, multiple variables can share the same identifier so the BDD nodes that are inactive but not garbage collected may be activated. We give a polynomial-time algorithm for generating the optimum number of variables that are required for image computation and show how to modify the image computation accounting for variable reuse. The savings for image computation are demonstrated on ISCAS\u2789 and Texas\u2797 benchmark models
Role of dipolar and exchange interactions in the positions and widths of EPR transitions for the single-molecule magnets Fe8 and Mn12
We examine quantitatively the temperature dependence of the linewidths and
line shifts in electron paramagnetic resonance experiments on single crystals
of the single-molecule magnets Fe and Mn, at fixed frequency, with
an applied magnetic field along the easy axis. We include inter-molecular
spin-spin interactions (dipolar and exchange) and distributions in both the
uniaxial anisotropy parameter and the Land\'{e} -factor. The temperature
dependence of the linewidths and the line shifts are mainly caused by the
spin-spin interactions. For Fe and Mn, the temperature dependence of
the calculated line shifts and linewidths agrees well with the trends of the
experimental data. The linewidths for Fe reveal a stronger temperature
dependence than those for Mn, because for Mn a much wider
distribution in overshadows the temperature dependence of the spin-spin
interactions. For Fe, the line-shift analysis suggests two competing
interactions: a weak ferromagnetic exchange coupling between neighboring
molecules and a longer-ranged dipolar interaction. This result could have
implications for ordering in Fe at low temperatures.Comment: published versio
Complementarity in classical dynamical systems
The concept of complementarity, originally defined for non-commuting
observables of quantum systems with states of non-vanishing dispersion, is
extended to classical dynamical systems with a partitioned phase space.
Interpreting partitions in terms of ensembles of epistemic states (symbols)
with corresponding classical observables, it is shown that such observables are
complementary to each other with respect to particular partitions unless those
partitions are generating. This explains why symbolic descriptions based on an
\emph{ad hoc} partition of an underlying phase space description should
generally be expected to be incompatible. Related approaches with different
background and different objectives are discussed.Comment: 18 pages, no figure
Subsumer-First: Steering Symbolic Reachability Analysis
Abstract. Symbolic reachability analysis provides a basis for the veri-fication of software systems by offering algorithmic support for the ex-ploration of the program state space when searching for proofs or coun-terexamples. The choice of exploration strategy employed by the anal-ysis has direct impact on its success, whereas the ability to find short counterexamples quickly and—as a complementary task—to efficiently perform the exhaustive state space traversal are of utmost importance for the majority of verification efforts. Existing exploration strategies can optimize only one of these objectives which leads to a sub-optimal reach-ability analysis, e.g., breadth-first search may sacrifice the exploration ef-ficiency and chaotic iteration can miss minimal counterexamples. In this paper we present subsumer-first, a new approach for steering symbolic reachability analysis that targets both minimal counterexample discovery and efficiency of exhaustive exploration. Our approach leverages the re-sult of fixpoint checks performed during symbolic reachability analysis to bias the exploration strategy towards its objectives, and does not require any additional computation. We demonstrate how the subsumer-first ap-proach can be applied to improve efficiency of software verification tools based on predicate abstraction. Our experimental evaluation indicates the practical usefulness of the approach: we observe significant efficiency improvements (median value 40%) on difficult verification benchmarks from the transportation domain.
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