Implementation of supportive care and best supportive care interventions in clinical trials enrolling patients with cancer†.

BACKGROUND: With the growing and evolving role of palliative care in oncology, we examined how supportive care (SC) and best supportive care (BSC) are implemented in clinical trials when used as a comparison treatment arm. METHODS: We conducted a systematic review of the literature for clinical trials published between 1980 and 2012 in which systemic anticancer therapy was compared with an SC-only arm and compared SC implementation with World Health Organization (WHO) published guidelines. RESULTS: Our search identified 189 articles, 73 of which met our inclusion criteria with the following cancer types: 29 lung, 7 colorectal, 6 pancreatic, 5 gastric and 26 others. Fifty-five studies (75%) provided some definition of SC, and 48 studies (66%) used the term BSC. Twenty-one of the 55 studies that provided a definition described the use of palliative therapies as being 'at the discretion of the treating physician' without standardization. Only two studies provided SC that incorporated routine physical, psychological and social assessments including rapid referral to SC specialists. SC interventions most commonly included analgesics (47%) and radiotherapy (44%). Trials using the term BSC versus SC were more likely to include blood transfusions (P = 0.002) and antibiotics (P = 0.033), but less likely to include steroids (P = 0.05) and palliative specialists (P = 0.047). CONCLUSIONS: The implementation of SC in clinical trials in this systematic review is highly variable. The vast majority of the studies did not meet the WHO guidelines on SC because palliative care therapies were not recommended or integrated into care. Future clinical trials utilizing a SC intervention arm should define these interventions in a standardized approach that meets current guidelines such as the WHO recommendations.

Scalable wavelet video coding using aliasing-reduced hierarchical motion compensation.

We describe a spatially scalable video coding framework in which motion correspondences between successive video frames are exploited in the wavelet transform domain. The basic motivation for our coder is that motion fields are typically smooth and, therefore, can be efficiently captured through a multiresolutional framework. A wavelet decomposition is applied to each video frame and the coefficients at each level are predicted from the coarser level through backward motion compensation. To remove the aliasing effects caused by downsampling in the transform, a special interpolation filter is designed with the weighted aliasing energy as part of the optimization goal, and motion estimation is carried out with low pass filtering and interpolation in the estimation loop. Further, to achieve robust motion estimation against quantization noise, we propose a novel backward/forward hybrid motion compensation scheme, and a tree structured dynamic programming algorithm to optimize the backward/forward mode choices. A novel adaptive quantization scheme is applied to code the motion predicted residue wavelet coefficients, Experimental results reveal 0.3-2-dB increase in coded PSNR at low bit rates over the state-of-the-art H.263 standard with all enhancement modes enabled, and similar improvements over MPEG-2 at high bit rates, with a considerable improvement in subjective reconstruction quality, while simultaneously supporting a scalable representation.

Multiple description wavelet based image coding.

We consider the problem of coding images for transmission over error-prone channels. The impairments we target are transient channel shutdowns, as would occur in a packet network when a packet is lost, or in a wireless system during a deep fade: when data is delivered it is assumed to be error-free, but some of the data may never reach the receiver. The proposed algorithms are based on a combination of multiple description scalar quantizers with techniques successfully applied to the construction of some of the most efficient subband coders. A given image is encoded into multiple independent packets of roughly equal length. When packets are lost, the quality of the approximation computed at the receiver depends only on the number of packets received, but does not depend on exactly which packets are actually received. When compared with previously reported results on the performance of robust image coders based on multiple descriptions, on standard test images, our coders attain similar PSNR values using typically about 50-60% of the bit rate required by these other state-of-the-art coders, while at the same time providing significantly more freedom in the mechanism for allocation of redundancy among descriptions.

A low-complexity region-based video coder using backward morphological motion field segmentation.

We introduce a novel region-based video compression framework based on morphology to efficiently capture motion correspondences between consecutive frames in an image sequence. Our coder is built on the observation that the motion field associated with typical image sequences can be segmented into component motion subfield "clusters" associated with distinct objects or regions in the scene, and further, that these clusters can be efficiently captured using morphological operators in a "backward" framework that avoids the need to send region shape information. Region segmentation is performed directly on the motion field by introducing a small "core" for each cluster that captures the essential features of the cluster and reliably represents its motion behavior. Cluster matching is used in lieu of the conventional block matching methods of standard video coders to define a cluster motion representation paradigm. Furthermore, a region-based pel-recursive approach is applied to find the refinement motion field for each cluster and the cluster motion prediction error image is coded by a novel adaptive scalar quantization method. Experimental results reveal a 10-20% reduction in prediction error energy and 1-3 dB gain in the final reconstructed peak signal-to-noise ratio (PSNR) over the standard MPEG-1 coder at typical bit rates of 500 Kb/s to 1 Mb/s on standard test sequences, while also requiring lower computational complexity.

Inverse halftoning using wavelets.

This work introduces a new approach to inverse halftoning using nonorthogonal wavelets. The distinct features of this wavelet-based approach are: 1) edge information in the highpass wavelet images of a halftone image is extracted and used to assist inverse halftoning, 2) cross-scale correlations in the multiscale wavelet decomposition are used for removing background halftoning noise while preserving important edges in the wavelet lowpass image, and 3) experiments show that our simple wavelet-based approach outperforms the best results obtained from inverse halftoning methods published in the literature, which are iterative in nature.

Image coding based on a morphological representation of wavelet data.

In this paper, an experimental study of the statistical properties of wavelet coefficients of image data is presented, as well as the design of two different morphology-based image coding algorithms that make use of these statistics. A salient feature of the proposed methods is that, by a simple change of quantizers, the same basic algorithm yields high performance embedded or fixed rate coders. Another important feature is that the shape information of morphological sets used in this coder is encoded implicitly by the values of wavelet coefficients, thus avoiding the use of explicit and rate expensive shape descriptors. These proposed algorithms, while achieving nearly the same objective performance of state-of-the-art zerotree based methods, are able to produce reconstructions of a somewhat superior perceptual quality, due to a property of joint compression and noise reduction they exhibit.

Wavelet packet image coding using space-frequency quantization.

We extend our previous work on space-frequency quantization (SFQ) for image coding from wavelet transforms to the more general wavelet packet transforms. The resulting wavelet packet coder offers a universal transform coding framework within the constraints of filterbank structures by allowing joint transform and quantizer design without assuming a priori statistics of the input image. In other words, the new coder adaptively chooses the representation to suit the image and the quantization to suit the representation. Experimental results show that, for some image classes, our new coder gives excellent coding performance.

Joint thresholding and quantizer selection for transform image coding: entropy-constrained analysis and applications to baseline JPEG.

Striving to maximize baseline (Joint Photographers Expert Group-JPEG) image quality without compromising compatibility of current JPEG decoders, we develop an image-adaptive JPEG encoding algorithm that jointly optimizes quantizer selection, coefficient "thresholding", and Huffman coding within a rate-distortion (R-D) framework. Practically speaking, our algorithm unifies two previous approaches to image-adaptive JPEG encoding: R-D optimized quantizer selection and R-D optimal thresholding. Conceptually speaking, our algorithm is a logical consequence of entropy-constrained vector quantization (ECVQ) design principles in the severely constrained instance of JPEG-compatible encoding. We explore both viewpoints: the practical, to concretely derive our algorithm, and the conceptual, to justify the claim that our algorithm approaches the best performance that a JPEG encoder can achieve. This performance includes significant objective peak signal-to-noise ratio (PSNR) improvement over previous work and at high rates gives results comparable to state-of-the-art image coders. For example, coding the Lena image at 1.0 b/pixel, our JPEG encoder achieves a PSNR performance of 39.6 dB that slightly exceeds the quoted PSNR results of Shapiro's wavelet-based zero-tree coder. Using a visually based distortion metric, we can achieve noticeable subjective improvement as well. Furthermore, our algorithm may be applied to other systems that use run-length encoding, including intraframe MPEG and subband or wavelet coding.

Space-frequency quantization for wavelet image coding.

A new class of image coding algorithms coupling standard scalar quantization of frequency coefficients with tree-structured quantization (related to spatial structures) has attracted wide attention because its good performance appears to confirm the promised efficiencies of hierarchical representation. This paper addresses the problem of how spatial quantization modes and standard scalar quantization can be applied in a jointly optimal fashion in an image coder. We consider zerotree quantization (zeroing out tree-structured sets of wavelet coefficients) and the simplest form of scalar quantization (a single common uniform scalar quantizer applied to all nonzeroed coefficients), and we formalize the problem of optimizing their joint application. We develop an image coding algorithm for solving the resulting optimization problem. Despite the basic form of the two quantizers considered, the resulting algorithm demonstrates coding performance that is competitive, often outperforming the very best coding algorithms in the literature.

Joint space-frequency segmentation using balanced wavelet packet trees for least-cost image representation.

We examine the question of how to choose a space varying filterbank tree representation that minimizes some additive cost function for an image. The idea is that for a particular cost function, e.g., energy compaction or quantization distortion, some tree structures perform better than others. While the wavelet tree represents a good choice for many signals, it is generally outperformed by the best tree from the library of wavelet packet frequency-selective trees. The double-tree library of bases performs better still, by allowing different wavelet packet trees over all binary spatial segments of the image. We build on this foundation and present efficient new pruning algorithms for both one- and two-dimensional (1-D and 2-D) trees that will find the best basis from a library that is many times larger than the library of the single-tree or double-tree algorithms. The augmentation of the library of bases overcomes the constrained nature of the spatial variation in the double-tree bases, and is a significant enhancement in practice. Use of these algorithms to select the least-cost expansion for images with a rate-distortion cost function gives a very effective signal adaptive compression scheme. This scheme is universal in the sense that, without assuming a model for the signal or making use of training data, it performs very well over a large class of signal types. In experiments it achieves compression rates that are competitive with the best training-based schemes.

Adaptive transforms for image coding using spatially varying wavelet packets.

We introduce a novel, adaptive image representation using spatially varying wavelet packets (WPs), Our adaptive representation uses the fast double-tree algorithm introduced previously (Herley et al., 1993) to optimize an operational rate-distortion (R-D) cost function, as is appropriate for the lossy image compression framework. This involves jointly determining which filter bank tree (WP frequency decomposition) to use, and when to change the filter bank tree (spatial segmentation). For optimality, the spatial and frequency segmentations must be done jointly, not sequentially. Due to computational complexity constraints, we consider quadtree spatial segmentations and binary WP frequency decompositions (corresponding to two-channel filter banks) for application to image coding. We present results verifying the usefulness and versatility of this adaptive representation for image coding using both a first-order entropy rate-measure-based coder as well as a powerful space-frequency quantization-based (SPQ-based) wavelet coder introduced by Xiong et al. (1993).

Optimal trellis-based buffered compression and fast approximations.

The authors formalize the description of the buffer-constrained adaptive quantization problem. For a given set of admissible quantizers used to code a discrete nonstationary signal sequence in a buffer-constrained environment, they formulate the optimal solution. They also develop slightly suboptimal but much faster approximations. These solutions are valid for any globally minimum distortion criterion, which is additive over the individual elements of the sequence. As a first step, they define the problem as one of constrained, discrete optimization and establish its equivalence to some of the problems studied in the field of integer programming. Forward dynamic programming using the Viterbi algorithm is shown to provide a way of computing the optimal solution. Then, they provide a heuristic algorithm based on Lagrangian optimization using an operational rate-distortion framework that, with computing complexity reduced by an order of magnitude, approaches the optimally achievable performance. The algorithms can serve as a benchmark for assessing the performance of buffer control strategies and are useful for applications such as multimedia workstation displays, video encoding for CD-ROMs, and buffered JPEG coding environments, where processing delay is not a concern but decoding buffer size has to be minimized.

Bit allocation for dependent quantization with applications to multiresolution and MPEG video coders.

We address the problem of efficient bit allocation in a dependent coding environment. While optimal bit allocation for independently coded signal blocks has been studied in the literature, we extend these techniques to the more general temporally and spatially dependent coding scenarios. Of particular interest are the topical MPEG video coder and multiresolution coders. Our approach uses an operational rate-distortion (R-D) framework for arbitrary quantizer sets. We show how a certain monotonicity property of the dependent R-D curves can be exploited in formulating fast ways to obtain optimal and near-optimal solutions. We illustrate the application of this property in specifying intelligent pruning conditions to eliminate suboptimal operating points for the MPEG allocation problem, for which we also point out fast nearly-optimal heuristics. Additionally, we formulate an efficient allocation strategy for multiresolution coders, using the spatial pyramid coder as an example. We then extend this analysis to a spatio-temporal 3-D pyramidal coding scheme. We tackle the compatibility problem of optimizing full-resolution quality while simultaneously catering to subresolution bit rate or quality constraints. We show how to obtain fast solutions that provide nearly optimal (typically within 0.3 dB) full resolution quality while providing much better performance for the subresolution layer (typically 2-3 dB better than the full-resolution optimal solution).

Rate-distortion optimal fast thresholding with complete JPEG/MPEG decoder compatibility.

We show a rate-distortion optimal way to threshold or drop the DCT coefficients of the JPEG and MPEG compression standards. Our optimal algorithm uses a fast dynamic programming recursive structure. The primary advantage of our approach lies in its complete compatibility with standard JPEG and MPEG decoders.

Best wavelet packet bases in a rate-distortion sense.

A fast rate-distortion (R-D) optimal scheme for coding adaptive trees whose individual nodes spawn descendents forming a disjoint and complete basis cover for the space spanned by their parent nodes is presented. The scheme guarantees operation on the convex hull of the operational R-D curve and uses a fast dynamic programing pruning algorithm to markedly reduce computational complexity. Applications for this coding technique include R. Coefman et al.'s (Yale Univ., 1990) generalized multiresolution wavelet packet decomposition, iterative subband coders, and quadtree structures. Applications to image processing involving wavelet packets as well as discrete cosine transform (DCT) quadtrees are presented.

Prostaglandin E2 (PGE2) vaginal gel for cervical ripening.

Cervical ripening prior to oxytocin stimulation is highly desirable to ensure a successful induction. Prostaglandin E2 has been administered by intracervical, intravaginal and extra-amniotic routes with successful ripening of the cervix. The dose of PGE2 administered is under investigation. Use of 3 or 4 mg of PGE2, although effective, has been reported to be accompanied by uterine hypertonus or fetal heart changes. Lower dose of PGE2 at 0.2 mg and 0.4 mg do not have the above-mentioned side effects but necessitate multiple applications. This randomized double-blinded study incorporated the use of 2 mg of PGE2 administered by intravaginal route in a hydroxyethyl cellulose gel medium. A significant increase in Bishop score (40% higher) was achieved in patients receiving PGE2 as compared to placebo patients. There were no adverse side effects, indicating application of 2 mg of PGE2 as a safe method of cervical ripening prior to induction of labor.