Army Supplies in the Forward Area and the Tumpline System: A First World War Canadian Logistical Innovation

Editor’s Note: In British Logistics on the Western Front, 1914–1919 (Praeger, 1998), Ian M. Brown documents the problems of maintaining an army in the field; throughout that war, supply lines were strained to get food, equipment and ammunition forward. Early problems of adequate supplies were replaced by an inability to get the items from depots to where they were required. Some of these latter problems were blamed on “establishments” and other force-structure problems caused by stripping logistical-support units to meet the manpower needs of the fighting units. The decision to dramatically reduce the size of the BEF divisions in France helped reduced pressures. By stripping a battalion out of each brigade, and using the men freed as replacements, the BEF maintained its paper strength in divisions (though, in fact, the strength went considerably down) and, more importantly, also reduced its overall logistical requirements. But, as Brown writes: The Canadian Corps successfully resisted this “downsizing” as its commander opposed the reduction vehemently. In fact, he managed to increase the effective size and strength of his divisions by using the manpower from the two [sic] Canadian divisions forming in Britain. This gave Haig a single very strong corps—four overstrength divisions amounting to some one hundred thousand men (forty-eight thousand infantry)—but it also gave his administration a supply problem, since the standard divisional pack could not supply a Canadian division. In spite of this trouble, it did not appear to cause great difficulty on the lines of communication. Indeed, it gets no mention in either the QMG’s or AG’s diaries.... (pp.165-166) Buried in this passage lay two secrets. The four-battalion brigades perhaps (too simply?) explain the use of the Canadian Corps as Haig’s “shock troops.” But as Brown notes, how the Canadians maintained these larger formations is not clear from British sources (p. 177). The answer to this secret must be sought elswhere. One answer in F.R. Phelan’s “tumpline.

Interobserver agreement in dysplasia grading: toward an enhanced gold standard for clinical pathology trials

Objective: Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. Study Design: Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. Results: Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. Conclusions: The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis

‘Cytology-on-a-chip’ based sensors for monitoring of potentially malignant oral lesions

Despite significant advances in surgical procedures and treatment, long-term prognosis for patients with oral cancer remains poor, with survival rates among the lowest of major cancers. Better methods are desperately needed to identify potential malignancies early when treatments are more effective. Objective To develop robust classification models from cytology-on-a-chip measurements that mirror diagnostic performance of gold standard approach involving tissue biopsy. Materials and methods Measurements were recorded from 714 prospectively recruited patients with suspicious lesions across 6 diagnostic categories (each confirmed by tissue biopsy -histopathology) using a powerful new ‘cytology-on-a-chip’ approach capable of executing high content analysis at a single cell level. Over 200 cellular features related to biomarker expression, nuclear parameters and cellular morphology were recorded per cell. By cataloging an average of 2000 cells per patient, these efforts resulted in nearly 13 million indexed objects. Results Binary “low-risk”/“high-risk” models yielded AUC values of 0.88 and 0.84 for training and validation models, respectively, with an accompanying difference in sensitivity + specificity of 6.2%. In terms of accuracy, this model accurately predicted the correct diagnosis approximately 70% of the time, compared to the 69% initial agreement rate of the pool of expert pathologists. Key parameters identified in these models included cell circularity, Ki67 and EGFR expression, nuclear-cytoplasmic ratio, nuclear area, and cell area. Conclusions This chip-based approach yields objective data that can be leveraged for diagnosis and management of patients with PMOL as well as uncovering new molecular-level insights behind cytological differences across the OED spectrum