Aggressive Schedule Research Articles

Follow-up of stage B and C colorectal cancer in the United States and France.

The optimal postoperative follow-up strategy for patients with resected Dukes' Stage B and C colorectal cancer is controversial. Recently published guidelines support a minimal regimen of carcinoembryonic antigen measurements every 2 to 3 months for at least 2 years, history and physical examination every 3 to 6 months for 3 years, then annually, and colonoscopy every 3 to 5 years. Based on documented practice on the part of surgeons, this regimen would be regarded as intensive. Analyses of relapses following adjuvant therapy support an even more aggressive schedule, with the goal of maximizing the proportion of patients who may be operated on with curative intent (currently about 20% of those who relapse). Additional considerations that may influence the approach to such patients include the identification of second primary tumors (2% over 7 years observation), and the known improvement in quality of life and survival associated with early versus delayed initiation of chemotherapy. However, with the annual investment of resources estimated to be as high as 175 million dollars in the United States alone, a systematic study of such interventions is needed to provide support survival, quality of life, and economic evidence.

Instrumentation and Construction Performance Monitoring for I-15 Reconstruction Project in Salt Lake City, Utah

The I-15 reconstruction project in Salt Lake City, Utah, involves the widening and rebuilding of 27 km of urban Interstate on alluvial and lacustrine deposits. In some locales, these soils have low shear strength and require up to 2 to 3 years to complete primary consolidation settlement. The aggressive 4-year construction schedule required much of the embankment and foundation work to be completed in the first 12 to 18 months, including the time required to complete primary settlement. To meet these rigorous schedule constraints, the geotechnical construction made extensive use of prefabricated vertical drains, ground modification, staged embankment construction, lightweight fill, mechanically stabilized earth walls, and pile foundations. Also, because of rigid time constraints, initial foundation treatments and embankment construction proceeded as parallel activities with the geotechnical design. Instrumentation and construction performance monitoring played a vital role in affirming initial design assumptions and developing a better understanding of strength, deformation, and consolidation characteristics of the foundation soils. Discussed are the instrumentation program and how performance monitoring was implemented to control construction processes and improve the geotechnical design.

Increased Withdrawal Volume per Deposit for Pre–Operative Autologous Blood Donation in Adolescents

Objectives: This study was undertaken to assess the feasibility, tolerance, haemodynamic and haematologic effects of an aggressive phlebotomy schedule for autologous blood donation (ABD) in adolescents undergoing major orthopaedic surgery. Methods: Twenty adolescents were studied prospectively; 10 patients in group A donated 20% of the circulating blood volume on 2 occasions, whereas 10 patients in group B donated 10% on 4 occasions. Results: The amount of blood donated, subjective tolerance, cardiovascular changes during the procedure and pre–operative haemoglobin level did not differ between the study groups (group A 111±16 vs. group B 106±10 g/l). The increase in erythropoietin was greater and occurred sooner in group A than in group B. Conclusion: In adolescents ABD is feasible with a reduced number of appointments as they demonstrate tolerance to phlebotomies with a volume which is double the standard per deposit.

Increased Withdrawal Volume per Deposit for Pre‐Operative Autologous Blood Donation in Adolescents

Abstract Objectives: This study was undertaken to assess the feasibility, tolerance, haemodynamic and haematologic effects of an aggressive phlebotomy schedule for autologous blood donation (ABD) in adolescents undergoing major orthopaedic surgery. Methods: Twenty adolescents were studied prospectively; 10 patients in group A donated 20% of the circulating blood volume on 2 occasions, whereas 10 patients in group B donated 10% on 4 occasions. Results: The amount of blood donated, subjective tolerance, cardiovascular changes during the procedure and pre‐operative haemoglobin level did not differ between the study groups (group A 111±16 vs. group B 106±10 g/l). The increase in erythropoietin was greater and occurred sooner in group A than in group B. Conclusion: In adolescents ABD is feasible with a reduced number of appointments as they demonstrate tolerance to phlebotomies with a volume which is double the standard per deposit.

Five-Year Survival Results of Subcutaneous Low-Dose Immunotherapy with Interleukin-2 Alone in Metastatic Renal Cell Cancer Patients

After the discovery of its essential role in anticancer immunity, IL-2 cancer immunotherapy has shown that comparable results may be obtained with different schedules, including intravenous high-dose IL-2 as a bolus or as a 24-hour intravenous infusion or prolonged subcutaneous injection of low-dose IL-2 with or without IFN-α. This study shows the long-term results obtained in 92 metastatic renal cell cancer (RCC) patients with low-dose subcutaneous IL-2, which was given at 3 million IU twice/day for 5 days/week for 6 consecutive weeks. In nonprogressing patients, a second cycle was planned after a 21-day rest period, followed by maintenance therapy consisting of 5 days of treatment every month until disease progression. Complete response (CR) was achieved in only 2/92 (2%) patients, and partial response (PR) was observed in 19 patients (21%). Therefore, the response rate (CR + PR) was 21/92 (23%), with a median duration of response of 25 months. Stable disease (SD) occurred in 37 patients (40%), whereas the other 34 (37%) had a progressive disease (PD). The response rate was significantly higher in patients with a disease-free interval of >1 year than in those with a lower interval, in patients with a high performance status (PS) than in those with a low PS, and in patients with sites of disease other than the liver. A 5-year survival was obtained in 9/92 (9%) patients, and the percent of survival was significantly higher in patients with a response or SD than in those with PD. The treatment was well tolerated in all patients. This study confirms that low-dose subcutaneous IL-2 alone in an effective and well tolerated therapy of metastatic RCC, with results comparable to those described with more aggressive and toxic IL-2 schedules.

2 The Transition from Spacecraft Development to Flight Operations: Human Factor Considerations

AbstractIn the field of aeronautics and astronautics, a paradigm shift has been witnessed by those in academia, research and development, and private industry. Long development life cycles and the budgets to support such programs and projects has given way to aggressive task schedules and leaner resources to draw from – all the while challenging assigned individuals to create and produce improved products or processes. However, this “faster, better, cheaper” concept cannot merely be applied to the design, development, and test of complex systems such as earth‐orbiting or interplanetary robotic spacecraft. Full advantage is not possible without due consideration and application to mission operations planning and flight operations. Equally as important as the flight system, the mission operations system consisting of qualified personnel, ground hardware and software tools, and verified and validated operational processes, should also be regarded as a complex system requiring personnel to draw upon formal education, training, related experiences, and heuristic reasoning in engineering an effective and efficient system.

1 Installing and Maintaining a System Engineering Culture Across Distributed Teams

The natural behavior of most project teams is ad hoc. Ad hoc is fun for the participants in that the pain of planning, the embarrassment of accountability, the tedium of metrics, and the results of broken promises are avoided and instead, are replaced by a flurry of disjointed activity determined on the run by the individuals involved. In sharp contrast to ad hoc, System Engineering, along with its inseparable process mate Project Management, requires that the team deliver to difficult requirements, to an aggressive schedule, and with controlled funds, and does so by replacing ad hoc freedom with plans, process discipline, and “make a promise, keep a promise” behavior.The drive for efficiency demands that the processes used be integrated. However, the industry practice is to separate System Engineering (technical management) from Project Management, treating them as separate disciplines. This fact is confirmed by the separateness of the two corresponding professional organizations, INCOSE (International Council on System Engineering) and PMI (Project Management Institute). It is interesting to note that neither organization sponsors the other's conferences. It is also noteworthy that the System Engineering tools of INCOSE are distinctly different from the Project Management tools of PMI, even though the processes are co‐dependent.Most published system engineering or hardware/software development process models are non‐intuitive, inaccurate representations of what is actually required to manage technically challenging projects. When project teams attempt to follow them, they quickly discover that they are not realistic and provide little added value, and the team soon abandons them, reverting to the unstructured ad‐hoc approach. (Figure 1)System Engineering and Project Management reference books, handbooks, and Bodies of Knowledge typically present their subject matter as non‐connected specialty disciplines rather than by interrelated processes, and sub‐processes. (Figures 2&3) For instance, Requirements Management is usually absent or superficially addressed. Scheduling is usually treated separately from Network Development, ignoring the fact that schedules are derived from the network and both are part of Tactical Planning. Planning is shown as a discreet phase with a start and end, when in reality planning and replanning are continual, to adjust to the daily reality of the project events. Risk Management tutorials almost always ignore Opportunity Management, even though they are interdependent and the opportunity pursued must justify the risk assumed. Sections on Project Control typically deal with data gathering, plotting, and performance measurement (actually project status), none of which is Project Control. Contracting is treated separately from Configuration Management even though both are Control Techniques. Project Control of the technical baseline by using buyer/seller control gates is usually absent. These are just a sample of the blurred understandings that exist in System Engineering and Project Management.

An Infrared Technique for Evaluating Turbine Airfoil Cooling Designs

An experimental approach is used to evaluate turbine airfoil cooling designs for advanced gas turbine engine applications by incorporating double-wall film-cooled design features into large-scale flat plate specimens. An infrared (IR) imaging system is used to make detailed, two-dimensional steady-state measurements of flat plate surface temperature with spatial resolution on the order of 0.4 mm. The technique employs a cooled zinc selenide window transparent to infrared radiation and calibrates the IR temperature readings to reference thermocouples embedded in each specimen, yielding a surface temperature measurement accuracy of ±4°C. With minimal thermocouple installation required, the flat plate/IR approach is cost effective, essentially nonintrusive, and produces abundant results quickly. Design concepts can proceed from art to part to data in a manner consistent with aggressive development schedules. The infrared technique is demonstrated here by considering the effect of film hole injection angle for a staggered array of film cooling holes integrated with a highly effective internal cooling pattern. Heated free stream air and room temperature cooling air are used to produce a nominal temperature ratio of 2 over a range of blowing ratios from 0.7 to 1.5. Results were obtained at hole angles of 90 and 30 deg for two different hole spacings and are presented in terms of overall cooling effectiveness. [S0889-504X(00)01901-2]

Preoperative Chemoradiation for Extraperitoneal T3 Rectal Cancer: Acute Toxicity, Tumor Response, and Sphincter Preservation

Purpose: To evaluate whether or not an intermediate dose of preoperative external radiation therapy intensified by systemic chemotherapy could improve the tumor response, sphincter preservation, and tumor control. Methods and Materials: Between March 1990 and December 1995, 83 consecutive patients with resectable extraperitoneal adenocarcinoma of the rectum were treated with preoperative chemoradiation: bolus i.v. mitomycin C (MMC), 10 mg/m 2, Day 1 plus 24-h continuous infusion i.v. 5-fluorouracil (5FU) 1000 mg/m 2, Days 1–4, and concurrent external beam radiotherapy (37.8 Gy). All but 2 patients had T3 disease. Surgery was performed 4–6 weeks after the end of chemoradiation. Results: Total Grade 3–4 acute toxicity during chemoradiation was observed in 11 (13%) patients: hematological Grade 3 toxicity was recorded in 8 (10%) patients, and Grade 4 toxicity was recorded in 2 (2%) patients. Grade 3 diarrhea was seen in 2 (2%) patients. No patient had major skin or urological acute toxicity. Two patients had no surgery: 1 died before surgery from septic complications after Grade 4 hematological toxicity; 1 refused surgery and is still alive after 6 years. There was no postoperative mortality and the overall perioperative morbidity rate was 25%. The analysis of tumor response involved 81 patients. Overall, 9% [7]of 81 patients had a complete pathologic response. Comparing the stage at the diagnostic workup with the pathologic stage, tumor downstaging was observed in 46 (57%) patients. We had 7 (9%) pT0, 5 (6%) pT1, 33 (41%) pT2, and 36 (44%) pT3. Nodal status downstaging was detected in 46 patients (57%). No evidence of nodal involvement was observed in 59 patients (73%). The incidence of tumor response was affected significantly by the number of quarters of rectal circumference involved ( p = 0.03) and, marginally, by the length of the tumor ( p = 0.09). The distance between the lower pole of the tumor and the anorectal ring had no influence. Of the patients, 63 (78%) had a sphincter-saving surgical procedure. In 12 (44%) of 27 patients candidate for an APR, the sphincter was preserved, as it was in 19 (95%) of 20 probable candidates. Lengthening of the distance between the anorectal ring and the lower pole of the tumor > 20 mm was observed in 21 patients (26%). Of 63 patients, 4 (6%) had moderate soilage after the sphincter-saving procedure. Conclusion: Preoperative combined modality therapy seems to afford some potential advantages in nonrandomized trials: patients are able to tolerate higher chemotherapy doses and they experience a lower acute toxicity. Tumor downstaging and resectability rates are high; sphincter preservation is feasible. Larger T3 tumors remained less influenced by this treatment; thus, taking into account the low toxicity rate recorded, a more aggressive schedule should be applied in these resectable tumors.

Association between strong inflammatory response and low risk of developing visual loss and other cranial ischemic complications in giant cell (temporal) arteritis.

To identify clinical and biochemical parameters that have good predictive value for identifying giant cell (temporal) arteritis (GCA) patients who are at high or low risk of developing cranial ischemic events. In this multicenter study, records of patients at 3 university hospitals in Barcelona were reviewed retrospectively. Two hundred consecutive patients with biopsy-proven GCA were studied. Thirty-two patients developed irreversible cranial ischemic complications. The duration of clinical symptoms before diagnosis was similar in patients with and those without ischemic events. Patients with ischemic complications less frequently had fever (18.8% versus 56.9%) and weight loss (21.9% versus 62%) and more frequently had amaurosis fugax (32.3% versus 6%) and transient diplopia (15.6% versus 3.6%). Patients with ischemic events had lower erythrocyte sedimentation rates (ESR) (82.7 mm/hour versus 104.4 mm/hour) and higher concentrations of hemoglobin (12.2 gm/dl versus 10.9 gm/dl) and albumin (37.4 gm/liter versus 32.7 gm/liter). Clinical inflammatory status and biologic inflammatory status were defined empirically (clinical: fever and weight loss; biologic: ESR > or =85 mm/hour and hemoglobin < 11.0 gm/dl). Patients not showing a clinical and biologic inflammatory response were at high risk of developing ischemic events (odds ratio [OR] 5, 95% confidence interval [95% CI] 2.05-12.2). The risk was greatly reduced among patients with either a clinical (OR 0.177, 95% CI 0.052-0.605) or a biologic (OR 0.226, 95% CI 0.076-0.675) inflammatory reaction. No patient with both a clinical and a biologic response developed ischemic events. The presence of a strong acute-phase response defines a subgroup of patients at very low risk of developing cranial ischemic complications. Our findings provide a rationale for testing less aggressive treatment schedules in these individuals. Conversely, a low inflammatory response and the presence of transient cranial ischemic events provide a high risk of developing irreversible ischemic complications and require a prompt therapeutic intervention.

Prognostic significance of dysplastic features of hematopoiesis in patients with de novo acute myelogenous leukemia.

The detection of dysplastic features of hematopoiesis in de novo acute myeloid leukemia (AML) by light microscopy is defined as AML with trilineage myelodysplasia (AML/TLMD). The prognostic relevance of these dysplastic features for patients with de novo AML remains unclear. In order to evaluate the role of dysplasia in de novo AML, bone marrow aspirates from 69 patients were analyzed prospectively and investigated separately for erythropoiesis, granulopoiesis and megakaryopoiesis by three independent investigators. The overall complete remission (CR) rate was 48.8% and partial remission (PR) or nonresponders constituted 52.2% of the patients investigated. The median overall survival time was 5 months with a disease-free interval of 3.5 months for all patients. Dysgranulopoiesis (DysG) was observed in 30.4%, dysmegakaryopoiesis (DysM) in 50.7%, and dyserythropoiesis (DysE) in 43.5%. Of all patients, 26.0% showed trilineage dysplastic features and were thus classified as AML/TLMD. A significantly worse prognosis (Kaplan-Meyer plot, Student's t-test) was calculated for those patients with detection of only DysG (p = 0.002), DysM (p = 0.02), DysE (p = 0.04) as compared with patients without any dysplastic signs. An unfavorable karyotype was correlated with patients showing DysG (P = 0.02) and DysM (P = 0.04). For these patients with an unfavorable karyotype, the occurrence of any dysplastic features had no additional prognostic impact. Dysplastic features (DysG, DysM, DysE) seem to be an important prognostic factor in de novo AML correlating with short overall survival. DysG and DysM correlated well with the appearance of unfavorable chromosomal abnormalities. It may be reasonable to assume that patients with dysplastic features should be considered for more aggressive treatment schedules at the time of diagnosis.

The role of two-cycle simulation in the S/390 verification process

Microprocessor design techniques have evolved to a point where large systems, such as S/390® servers, can be constructed using relatively few, but very complex, application-specific integrated circuits (ASICs). Delivery of a quality design in a timely fashion requires that several design activities progress simultaneously, with different types of verification used within the various design disciplines. This paper discloses a simulation method capable of functionally verifying a physical implementation of the design at a system level. The aggressive design schedule undertaken on the S/390 Parallel Enterprise Server G4 program required additional advances in simulation beyond those employed in the development of the IBM Enterprise System/9000® (ES/9000®) processor family. A new type of cycle simulation was developed to supplement the incumbent strategy of using conventional cycle simulation to verify system function combined with Boolean equivalence tools to perform logical-to-physical comparisons. This two-cycle simulation method was invented to verify areas such as logic built-in self-test (LBIST), array built-in self-test (ABIST), clock trees, firmware level-sensitive scan design (LSSD) rings, and large custom arrays, which are typically omitted by existing system verification methods. The creation of the two-cycle simulation model is discussed, along with several uses of the model and the types of errors uncovered.

Phase II trial of paclitaxel and granulocyte colony-stimulating factor in patients with pancreatic carcinoma: a Southwest Oncology Group study.

Pancreatic cancer is difficult to treat, with most patients surgically unresectable at the time of diagnosis. Radiotherapy and chemotherapy can offer palliation, but more effective therapy is needed. This trial evaluated the effects of an aggressive schedule of paclitaxel given with granulocyte colony-stimulating factor (G-CSF) to patients with advanced pancreatic cancer. All patients were required to have a histologic diagnosis of pancreatic adenocarcinoma with measurable disease and no prior chemotherapy or radiation therapy. Patients had to have performance status of 0 to 2, pretreatment absolute granulocyte count > or = 1,500/microL, and platelet count greater than or equal to the institutional lower limit of normal. Following pretreatment with dexamethasone, diphenhydramine, and cimetidine, patients received paclitaxel at a dose of 250 mg/m2 by 24-hour infusion on day 1, repeated every 21 days. G-CSF was given at a dose of 5 microg/kg/d on days 3 to 18 or until two consecutive absolute neutrophil counts (ANCs) > or = 10,000/microL were obtained. Doses of paclitaxel were modified depending on nadir counts. Forty-five patients were entered onto this study, with six ineligible. For the 39 eligible patients, there was one complete response (CR) and two partial responses (PRs), five stable/no responses, 23 increasing disease, two early deaths, and six patients whose assessment was inadequate to determine response. The response rate was therefore three of 39 or 8% (95% confidence interval [CI], 2% to 21%). The median survival time for the 39 eligible patients was 5 months. The most common toxicities were anemia, leukopenia/granulocytopenia, malaise/fatigue, nausea/vomiting, alopecia, thrombocytopenia, paresthesias, and liver function abnormalities. There was one death due to sepsis. Single-agent paclitaxel in this dose and schedule has minimal activity in pancreatic adenocarcinoma patients.

Developing the 777 airplane information management system (AIMS): a view from program start to one year of service

The 777 Airplane Information Management System (AIMS) has successfully completed its first year of airline revenue service. This in-service success follows a development and integration program that was an exceptional challenge, primarily due to the system size, technical innovation, and aggressive program schedule. Honeywell and Boeing had to work closely together to complete the design and development of AIMS in a time frame that supported the 777 early extended twin operations (ETOPS) goal and the initial 777 airplane certification. With teams from the two companies working as one unit, redundant activities were eliminated, technical and program problems were identified and solved rapidly, and schedule time was saved by both teams helping with tasks that were traditionally considered to be the other team's job. In service, airline maintenance personnel are finding that the AIMS Central Maintenance Computer System is a tremendous asset in maintaining the 777, and AIMS reliability is exceeding predictions.

Treatment of childhood Hodgkin’s disease with COPP or COPP-ABV (hybrid) without radiotherapy in Nicaragua

Childhood Hodgkin's disease (HD) in low-income countries has been reported to have distinct presenting features, including a high prevalence of the mixed cellularity subtype, which also seems to be associated with poorer prognosis. Further investigations are needed to evaluate these issues. Another controversial aspect of childhood HD is the use of radiotherapy (RT) in its treatment and the growing concern about its serious adverse side effects. In this paper, data on the diagnosis and outcome of children treated without RT in a low-income country (Nicaragua) are reported. Forty-eight consecutive children aged 0-15 years, diagnosed at 'La Mascota' Hospital of Managua (Nicaragua) from January 1990 to October 1995. entered this study. Follow-up was updated in May 1996. Clinical and histopathological staging was performed according to Ann Arbor and Rye criteria, respectively. Treatment consisted of COPP (six cycles) for stages I or IIA, or COPP-ABV hybrid): eight cycles for stages IIB or III, and ID cycles for stage IV. Total cumulative doses of adriamycin and bleomycin in this protocol are, respectively, 200 and 80 mg:sqm for stages II B or III and 250 and 100 mg/sqm for stage IV. The median age of the 48 patients at diagnosis was seven years, and the mean age was 7.9 years (range 3-15 years). Clinical stages were IA in 5, IIA in 9, IIB in 6, IIIA in 5, IIIB in 14, and IVB in 9. Histopathologically, 25 cases presented with mixed cellularity, 15 with nodular sclerosis, 5 with lymphocytic predominance and 3 with lymphocytic depletion. Four patients did not proceed with treatment and were lost to follow-up. Two patients (stages IIIB and IVB), who never achieved complete remission (CR) during treatment, presented progressive disease at the end of the scheduled chemotherapy. The remaining 42 patients were in complete remission at the end of chemotherapy. Following discontinuation of therapy, one patient (stage IA) was lost to follow-up and two patients with stage IIIB, who were in CR after the second chemotherapy cycle, relapsed 20 and 9 months following the diagnosis. EFS at three years is 100% for the 25 patients with stages I, II, IIIA and 74.9% for the 23 patients with stages IIIB or IV. The presenting features found in these patients are similar to those reported from other low-income countries. In our experience, however, the high prevalence of the mixed cellularity subtype was not associated with poorer prognosis. Satisfactory results have been achieved in patients with stages I, II or IIIA HD using COPP or COPP-ABV (hybrid) regimens without RT. The treatment was also well tolerated and can thus be recommended for these patients in low-income countries, where RT facilities may be scarce or unavailable. The use of more aggressive treatment schedules and/or RT on involved fields in front-line treatment may, however, be needed for the more advanced stages IIIB or IV. Large studies with adequate follow-up are needed to evaluate whether, if RT is omitted, higher cumulative doses of more toxic drugs are required and thus compare the long-term toxic effects of different treatment modalities.

Alpha 21164 testability strategy

A custom DFT strategy solved specific testability and manufacturing issues for this high performance microprocessor. Hardware and software assisted self test and self repair features helped meet aggressive schedule and manufacturing quality and cost goals.

Assessing the Impact of Trajectory on Wells Drilled in an Overthrust Region

Abstract Drilling in the Cusiana Field, which is located in the tectonically active foothills of the Casanare region of Colombia, has proved to be extremely difficult. The geological setting has provided a most challenging drilling environment where all aspects of drilling have been tested to the limit. One major contributor to the operational difficulties is poor hole conditions often leading to stuck pipe. However, experience has shown that performance improves when drilling up-dip of the major faults and bedding, with down-dip and cross-dip well trajectories being the most problematic. Computational stress modelling of the geological cross sections indicates that the principal stresses in the Cusiana Field may be rotated significantly from the vertical and horizontal. After adjusting a conventional wellbore stability analysis to allow for stress rotation, a reasonable match is obtained between prediction and field experience on the issue of stability variation with hole trajectory for wells drilled in the region. Introduction In partnership with ECOPETROL, TOTAL and TRITON, BP has been drilling in the foothills of the Casanare region of Colombia (Figure 1) since the late eighties. Both the Cusiana and Cupiagua Fields have now been declared commercial. Development well drilling in Cusiana commenced in late 1993. Appraisal wells are currently being drilled in Cupiagua. An aggressive drilling schedule is now being pursued with ten rigs active. From the earliest well, operational difficulties were encountered. Possibly the biggest problem associated with drilling wells in this region has been wellbore instability. Considerable effort has gone into tackling the problems and improvements have been made, as reported in a companion paper. Here the particular aspect of instability variation with well trajectory is discussed. Background to Wellbore Stability Wellbore instability (Figure 2) can result in lost circulation where tensile failure has occurred, and spalling and/or hole closure in the case of compressive failure of the rock. In severe cases hole instability can lead to stuck pipe and eventually loss of the open hole section. Due to the large costs associated with wellbore instability it has received considerable attention, as is apparent from the number of publications on the subject. No more so is the extent of the problem greater realised than the drilling experiences encountered in the foothills of the Casanare region of Colombia. For example, Figures 3a and 3b show the caliper traces from a Cusiana development well. Figure 3a shows a hole drilled with a 12 1/4" bit that has enlarged to nearly 45" in places. The in-gauge section is a sand interval. Also, as seen in Figure 3b, the large over-gauge reading in one caliper pair accompanied by a relatively in-gauge reading of the other pair suggests that the stresses may be highly anisotropic. Selection of mud types and weights to eliminate hole instability of wells drilled in Cusiana has been found to be impossible. There are frequent occurrences of loss zones, which necessitate a low mud weight, being adjacent to collapse zones, which require a high mud weight. It is not realistic to incorporate sufficient intermediate casing strings to isolate each individual problem zone. Hence, mud weight selections are made in an attempt to minimise the problems, without eliminating them, and it has been necessary to live with a certain degree of hole instability. Wellbore stability theory shows there are many factors, other than mud weight, that are likely to influence the competency of the wellbore wall. Examples are formation pressure, depth, formation strength, stress state, mud cake efficiency and time. Of parameters that can be controlled by the operator, theory shows that well trajectory has a significant influence on stability. Field experience from wells in the Cusiana Field also indicates that trajectory has a significant influence on hole stability. In cases where optimising mud weights cannot alone reduce instability to acceptable levels, then attention to optimising well trajectory to further reduce or at least limit the extent of problems is necessary.

Systems integration of the 777 airplane information management system (AIMS)

The systems integration of the 777 Airplane Information Management System (AIMS), both within the AIMS system and with the other systems on the airplane, represented the most complex system integration effort ever undertaken at Honeywell Air Transport Systems Division. The technological innovations in the AIMS design, coupled with an aggressive program schedule were major factors in the AIMS challenge. Honeywell and Boeing had to work closely together to complete the design and development of AIMS in a time frame that supported the 777 Early ETOPS goal. With teams from the two companies working as one unit, redundant activities were eliminated, technical and program problems were identified and solved rapidly, and schedule time was saved by both teams helping with tasks that were traditionally considered to be the other team's job.

A phase II trial of fotemustine and cisplatin in central nervous system metastases from non-small cell lung cancer

A phase II study was conducted in order to determine the feasibility and toxicity of cisplatin combined with the nitrosourea fotemustine in central nervous system metastases from non-small cell lung cancer. 31 chemotherapynaive patients were included between November 1990 and April 1993. Computed tomography scan-documented tumour regression in brain metastases was observed in 7 of the 25 evaluable patients, but only 4 of these (16%) lasted more than 4 weeks. In 2 of these 4 patients, the response on central nervous system metastases was considered as complete. The median duration of response was 20.5 weeks and the median survival was 16 weeks overall and 28.5 weeks for responding patients. The limiting toxicity of this regimen was haematological. 2 patients died from infectious pneumonitis while in neutropenia. Treatment delays due to haematological toxicity occurred in 57% of patients. Despite the rather encouraging response rate, such toxicity appears too high when compared to the overall bad prognosis of this population of patients. Cranial radiotherapy remains the standard treatment in this setting and should only be compared in the future to less aggressive schedules.

The AT&amp;T Switching Evolution Challenge

The 1B processor represents one of the largest single investments in new network technology ever made by AT&T. The effort to make the 1B processor a reality encompassed organizations throughout AT&T, requiring, from all involved, the highest levels of commitment and teamwork to meet an aggressive schedule. This paper provides an overview of the scope and complexity of the entire project, from requirements through field deployment. It focuses on the significant role that the 1B processor plays in the long distance network, the stringent reliability requirements imposed on it, and the technical and organizational challenges that were successfully met. Also included are a high-level summary of the 1B processor's capabilities, and a discussion of the business directions that helped to define them. Finally, this paper sets the stage for the detailed papers that follow, providing perspective on how each effort fits into the overall scheme.