An actuarial analysis of the risks and benefits of repeated courses of intravesical bacillus Calmette-Guerin therapy for superficial bladder cancer was performed for 100 consecutive patients treated for carcinoma in situ (29), prophylaxis against recurrent tumor (51) or residual superficial papillary tumor (21). The risk-to-benefit ratio at entry into bacillus Calmette-Guerin therapy (7 per cent risk of invasive cancer developing, 5 per cent risk of metastases and 77 per cent prospect for status free of tumor) and in patients who had failed only 1 course of bacillus Calmette-Guerin therapy (11 per cent invasive cancer, 14 per cent metastases and 58 per cent free of tumor) were highly favorable. However, among patients who had failed 2 or more courses of bacillus Calmette-Guerin therapy the risks of invasive (30 per cent) or metastatic (50 per cent) cancer developing exceeded the prospects for eradicating the superficial tumor present (20 per cent) with further therapy. The results suggest that patients who have failed 2 courses of bacillus Calmette-Guerin therapy (as given in our treatment protocol) should be considered for alternative treatment.

Surgical adjuvant intravesical bacille Calmette-Guerin (BCG) therapy is an effective method of treating superficial transitional cell carcinoma of the bladder. The role of the immune response in the antitumor activity of intravesical BCG is not known. We investigated the requirement of a thymus-dependent immune response for the inhibition of the growth of the intravesically implanted mouse bladder tumor, MBT-2. Intravesical BCG had no antitumor activity when administered to athymic nude mice bearing MBT-2 tumors. In two experiments tumor outgrowth in control and BCG-treated mice was identical. Adoptive transfer of BCG sensitized splenocytes (one spleen equivalent per mouse injected intravenously immediately prior to the first BCG treatment) syngeneic to the MBT-2 tumor transferred delayed hypersensitivity reactivity to BCG antigens and restored the antitumor activity of intravesical BCG. In two separate experiments mice receiving splenocytes plus BCG had 0 and 20% tumor outgrowth compared with 100% in control mice (p less than .02 and p less than .05, respectively). These results demonstrate that the antitumor activity of intravesical BCG therapy requires a thymus-dependent immune response.

A total of 42 patients with recurrent superficial bladder tumors or carcinoma in situ entered a prospective, randomized trial to compare the efficacy of bacillus Calmette-Guerin therapy with and without quarterly maintenance instillations of bacillus Calmette-Guerin. Maintenance therapy did not reduce further bladder tumor recurrence rates or the interval to recurrence in patients who responded to the initial course of therapy. However, prolongation of toxicity was observed with maintenance bacillus Calmette-Guerin therapy.

We evaluated 104 patients with superficial bladder tumors for response to intravesical bacillus Calmett-Guerin therapy. Patients received 6 weekly intravesical bacillus Calmette-Guerin instillations and they were followed for response every 3 months with urinary cytology, cystoscopy and bladder biopsy. Patients were considered treatment failures if either the cytology studies or biopsies were positive for tumor. Of 65 patients who failed the initial treatment course 57 were given an additional 6-week course of therapy. One 6-week course of bacillus Calmette-Guerin was successful in 20 of 55 patients (36 per cent) treated for prophylaxis, 12 of 32 (37 per cent) treated for carcinoma in situ and 7 of 17 (41 per cent) treated for residual tumor. The response rate for the total patient population treated with 1, 6-week course was 37.5 per cent (39 of 104). A second 6-week course was successful in 19 of 29 patients (65 per cent) treated for prophylaxis, 11 of 18 (71 per cent) treated for carcinoma in situ and 4 of 10 (40 per cent) treated for residual tumor. The response rate for all patients receiving a second course of bacillus Calmette-Guerin was 59.6 per cent (34 of 57). Of 6 patients who refused another 6-week course of bacillus Calmette-Guerin 4 had additional recurrences and 3 of these 4 suffered invasive disease. The over-all therapeutic response rate for patients treated with either 6 or 12 weeks of therapy was 70 per cent. These results suggest that 6 weeks of intravesical bacillus Calmette-Guerin do not provide optimal therapy for superficial bladder tumors. The data further suggest that more intensive regimens may increase therapeutic efficacy.

IntroductionThe Americans with Disabilities Act (ADA) mandates that U.S. institutions of higher education provide "reasonable accommodations" to students with disabilities to ensure equal educational opportunities. However, despite the key role of physics as a gateway to Science, Technology, Engineering and Mathematics (STEM) studies, only limited resources exist for teaching physics to students who are blind or visually impaired. Here we share lessons from our experience creating an accessible physics curriculum for a blind physics major. The authors include the student himself, a blind physics B.S. who graduated from a different institution, a PhD chemist and consultant on STEM accessibility who is himself blind, and several sighted educators and course assistants who worked regularly with the students. This article focuses on issues for which instructors are responsible: how to make class meetings, curricular materials, tutorials and demonstrations accessible (as opposed to accommodations determined at an administrative level, 2 such as additional time on tests). An online appendix provides additional resources and specifics to guide actual implementation of these ideas, including a guide to further reading.Once an institution learns that a blind student will enroll in a physics course, the course instructor and the institutional disabilities coordinator should meet to discuss course logistics well before the semester begins (ideally, over a month or two in advance to allow sufficient lead time). They should begin the process of creating an effective instructional and support team, ensuring key assistive technologies are in place, making all class meetings accessible, and preparing accessible course materials [1].The most fundamental decision is whether to use individualized instruction, in which the student and instructor meet in separate one-on-one tutorials, or mainstreaming, in which the student attends regular class meetings with other students. We primarily used mainstreaming, supplemented with one-on-one instruction. Instructors should work with the student in question to determine which approach is most suitable given their students' individual needs and the available institutional resources. Assembling the instructional teamA blind student who participates in mainstreamed class meetings should have access to one or more persons who act as an in-class assistant and a tutor outside of class. The in-class assistant ensures all class materials are accessible to the student in real-time while also playing the traditional role of a course tutor when appropriate. For example, they might clarify mathematical notation in a complex equation, describe figures drawn on a chalkboard, or explain visual 3 elements in an interactive demonstration. The tutor provides accessibility help as well as playing the traditional role of a course tutor when appropriate. Neither of these roles can be filled by students currently taking the course, since both positions require advanced familiarity with the course material. We had...

The problem being addressed is how to best find and engage an unknown number of targets in unknown locations (some moving) using multiple autonomous wide area search munitions. In this research cooperative behavior is being investigated to improve the overall mission effectiveness. A computer simulation was used to emulate the behavior of autonomous wide area search munitions and measure their overall expected performance. This code was modified to incorporate the capability for cooperative engagement based on a parameterized decision rule. Using Design of Experiments (DOE) and Response Surface Methodologies (RSM), the simulation was run to achieve optimal decision rule parameters for given scenarios and to determine the sensitivities of those parameters to the precision of the Autonomous Target Recognition (ATR) algorithm, lethality and guidance precision of the warhead, and the characteristics of the battlefield.

This article describes a tool that can be used by blind and visually impaired students in phonetics and phonology classrooms: a tactile International Phonetic Alphabet (IPA) magnet-board system. This tool consists of IPA magnets and phonological rule symbols that are printed and embossed, so as to be readable by both sighted and visually impaired individuals. A user of the tool can lay out phonetic and phonological data on the magnet board for communicative, organizational, or problem-solving purposes. Since the magnet board can be read both visually and tactually, it can serve as a collaborative space that can be used by both sighted and visually impaired members of the classroom. Potential uses include group work in class and as an augmentation to chalkboard problem-solving demonstrations. The tool can complement already extant options for blind and visually impaired students and facilitate collaboration between sighted and visually impaired students. Here, we describe the tool, exemplify some potential uses, and offer suggestions for further improvement.

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