A University of Greenwich Case Study of Cloud Computing – Education as a Service

This paper proposes a new Supply Chain Business Model in the Education domain and demonstrates how Education as a Service (EaaS) can be delivered. The implementation at the University of Greenwich (UoG) is used as a case study. Cloud computing business models are classified into eight of Business Models, this classification is essential to the development of EaaS. A pair of the Hexagon Models is used to review Cloud projects against success criteria; one Hexagon Model focuses on Business Model and the other on IT Services. The UoG case study demonstrates the added value offered by Supply Chain software deployed by private cloud, where an Oracle suite and SAP supply chain can demonstrate supply chain distribution and is useful for teaching. The evaluation shows that students feel more motivated and can understand their coursework better

Urethral recurrence in patients with orthotopic ileal neobladders

[[abstract]]Purpose We identified the risk of urethral recurrence following cystectomy for transitional cell bladder carcinoma, stratified by pathological characteristics of the bladder tumor and type of urinary diversion. Materials and Methods The pathological characteristics and clinical courses of 174 men with a Kock ileal neobladder and 262 with a cutaneous urinary diversion were analyzed for time to urethral recurrence. Results Urethral recurrence was identified in 34 patients at a median of 1.6 years after cystectomy, for an overall 7.9 percent 5-year risk of recurrence. Carcinoma in situ (p = 0.71) and multifocality (p = 0.17) did not independently confer an increased risk of recurrence. Prostatic urethral involvement, particularly stromal invasion, significantly increased the probability of recurrence (p less than 0.001). Patients with a Kock ileal neobladder had a significantly lower probability of recurrence compared to those with cutaneous diversion (p = 0.015), even when associated with prostatic urethral involvement. Conclusions Patients with a Kock ileal neobladder have a lower risk of urethral recurrence than those with cutaneous urinary diversion, even when associated with a high risk pathological condition predicting increased risk of urethral recurrence

Radical retropubic prostatectomy and postoperative adjuvant radiation for pathological stage C prostate cancer 1976-1989: intermediate findings.

[[abstract]]Between 1976 and 1989, 114 patients undergoing radical retropubic prostatectomy and bilateral pelvic lymph node dissection for prostatic adenocarcinoma were found to have stage PcNO lesions. Postoperative adjuvant radiation therapy without hormonal treatment was given to 95 of these patients (83%): 26 (27%) with stage Cl, 37 (39%) with stage C2 and 32 (34%) with stage C3 disease. The median radiation dose was 45 Gy. given at 180 cGy. daily. Median followup was 4.4 years (range 1.4 to 13.3). The overall 5 and 10-year actuarial survival rates for the patients were 94% and 70%, respectively. Disease-specific 5 and 10-year actuarial survival rates were 99% and 78%, respectively. At 5 and 10 years the chance of clinical recurrence was estimated as 6% and 13%, respectively, and the chance of recurrence (clinical or indicated by prostate specific antigen levels) was estimated to be 34% and 46%, respectively. Patients with high Gleason scores (8 to 10) and seminal vesicle involvement (stage C3) fared worst. There were 5 patients with clinical distant metastases, 1 with a clinical local recurrence and 1 with both conditions. Detectable elevation of prostate specific antigen without clinically evident recurrence was noted in 25 patients. Radiation therapy was well tolerated with minimal morbidity. Disease-specific survival and survival without clinical recurrence were improved over historical control in patients with stage PcNO prostate cancer treated by radical prostatectomy alone. These data support a role for adjuvant radiation therapy in stage PcNO prostate adenocarcinoma following radical prostatectomy

Radical cystectomy for high risk patients with superficial bladder cancer in the era of orthotopic urinary reconstruction

[[abstract]]Background. Many patients with aggressive clinically superficial bladder cancer ultimately die of their cancer, due in part to resistance to undergo radical cystectomy. Radical cystectomy is usually curative for patients with pathologic superficial tumors. Orthotopic urinary reconstruction has lessened the morbidity and life‐style changes in patients after cystectomy, and may increase patient acceptance of cystectomy as therapy for high risk superficial tumors. Methods. A retrospective analysis was performed on 182 patients with clinically superficial bladder cancer (Ta, Tis, T1) who had radical cystectomy between 1971 and 1989, to determine the incidence of pathologic upstaging and to assess overall survival, cause‐specific survival, and recurrence free survival. Indications for cystectomy included failure of intravesical chemo‐ or immunotherapy, high grade lamina propria invasive tumors, presence of bladder diverticulae, spread of superficial tumors into the prostatic urethra, and endoscopically uncontrollable tumors. Results. Pathologic upstaging to muscle‐invasive or metastatic tumors occurred in 34% of patients, and of these, only half remained organ confined. Metastases were present in 8% of patients at the time of cystectomy. Mucosa‐confined tumors were upstaged only 19% of the time, whereas tumors demonstrating lamina propria invasion (T1) were upstaged 40% of the time. Pathologic upstaging to muscle‐invasive or metastatic disease was significantly associated with a decreased probability of survival (P = 0.042). With a median follow‐up of 7.2 years, overall survival was estimated to be 86%, 72%, and 47%, and recurrence free survival 90%, 83%, and 77% at 2, 5, and 10 years, respectively. Conclusions. Pathologic upstaging to muscle‐invasive or metastatic tumors occurs in one third of highly selected patients with clinically superficial bladder cancer who have had radical cystectomy, half of whom have extravesical disease. Survival is significantly decreased in this group of upstaged patients. With the alternative of orthotopic urinary diversion available to most men and women requiring cystectomy, radical cystectomy should be considered a viable alternative to continued conservative measures for selected patients with aggressive superficial bladder tum

Incidence of occult lymph node metastases in pathologic stage (pT3N0) prostate cancer

[[abstract]]Purpose To determine the incidence of occult lymph node metastases in patients with stage pT3NO prostate cancer. Materials and Methods Lymph nodes from 95 patients with stage pT3NO prostate cancer were analyzed by immunohistochemistry for extrinsic epithelial cells using epithelial-specific monoclonal antibodies. The extrinsic epithelial cells were also tested for prostate specific antigen expression. Results Occult lymph node metastases were identified in 15 cases (16 percent) and were more frequent in patients with high primary Gleason grade tumors and seminal vesicle invasion (p = 0.03). In all cases the extrinsic cells were of prostate origin based on prostate specific antigen expression. Conclusions Occult lymph node metastases can be detected in a substantial proportion of patients with stage pT3NO prostate cancer, are associated with known predictors of disease progression, and may be useful in identifying patients at risk for recurrence and progression