Patient selection for oncology phase I trials: a multi-institutional study of prognostic factors.

PURPOSE The appropriate selection of patients for early clinical trials presents a major challenge. Previous analyses focusing on this problem were limited by small size and by interpractice heterogeneity. This study aims to define prognostic factors to guide risk-benefit assessments by using a large patient database from multiple phase I trials. PATIENTS AND METHODS Data were collected from 2,182 eligible patients treated in phase I trials between 2005 and 2007 in 14 European institutions. We derived and validated independent prognostic factors for 90-day mortality by using multivariate logistic regression analysis. Results The 90-day mortality was 16.5% with a drug-related death rate of 0.4%. Trial discontinuation within 3 weeks occurred in 14% of patients primarily because of disease progression. Eight different prognostic variables for 90-day mortality were validated: performance status (PS), albumin, lactate dehydrogenase, alkaline phosphatase, number of metastatic sites, clinical tumor growth rate, lymphocytes, and WBC. Two different models of prognostic scores for 90-day mortality were generated by using these factors, including or excluding PS; both achieved specificities of more than 85% and sensitivities of approximately 50% when using a score cutoff of 5 or higher. These models were not superior to the previously published Royal Marsden Hospital score in their ability to predict 90-day mortality. CONCLUSION Patient selection using any of these prognostic scores will reduce non-drug-related 90-day mortality among patients enrolled in phase I trials by 50%. However, this can be achieved only by an overall reduction in recruitment to phase I studies of 20%, more than half of whom would in fact have survived beyond 90 days.

I can't get a breath: experiences of living with advanced chronic obstructive pulmonary disease

This study aims to explore the potential for palliative care among people living with advanced chronic obstructive pulmonary disease (COPD). Individual semi-structured interviews (n=13) were conducted with people who had a diagnosis of advanced COPD and were on optimal tolerated drug therapy, with their breathing volume (forced expiratory volume at less than 30%) or were on long-term oxygen therapy or non-invasion ventilation. Participants raised concerns about the uncertain trajectory of the illness and reported unmet palliative care needs with poor access to palliative care services. For most people, palliative care was associated with end of life; therefore, they were unwilling to discuss the issue. There was a wide acceptance that, medically, nothing more could be done. Findings also suggest that patients had unmet palliative care needs, requiring information and support. The research suggests the need for palliative care to be extended to all (regardless of diagnosis), with packages of care developed to target specific needs.

'When I Land in Islamabad I Feel Home and When I Land in Heathrow I Feel Home': Gendered Belonging and Diasporic Identities of South Asian British Citizens in London, in Leicester and in North England

According to Deleuze and Guattari (1987) ‘de-territorialization’ is followed by a moment of re-territorialization. This moment, however, has to be regarded as a continuing educational process that becomes a different spatial site of social practices. It is argued in this chapter that regional, local as well as global identification override national and mono-ethno cultural identities, while shaping particular notions of gendered belonging and creating specific diasporic practices. Based on a sample of interviews with professional and academic South Asian British citizens in London, in Leicester, and in a number of Northern English cities gendered and generational patterns in terms of local diasporic identities are explored. Apart from multiple cultural belonging, foremost, territorial bonds and notions of group loyalty collapse at a point where temporary migration and settlement alternate in individual biographies.

L'accord sujet-verbe en français contemporain: une étude de cas – <i>la/une foulei>

This article presents an analysis of synchronic variation and diachronic change in verbal agreement with the French noun <i>foulei>. This noun, like many collective nouns in French and other languages, can show variation between singular and plural verbal agreement (<i>la foule des habitants exultei>_SING<i> de joie dans les ruesi> vs. <i>une foule de gens pressés s'attardenti>_PLU). A novel combination of data, including data from sociolinguistic interviews, a gap-fill exercise, and a corpus of written French, is used to investigate this variation and change, to elucidate some of the factors that play a role in this type of agreement, and to examine the differences between this form used with the definite and indefinite determiner (<i>la foule i>vs. <i>une foulei>). Some theoretical issues concerning the definition of collective nouns are also addressed.

‘At First I Saw It as a Toy’: Life Stories, Social Consciousness and Music Ethnography

This article examines the role of life narratives as discursive spaces for the performance of individual resistance. Through the inspection of three interviews with professional musicians in Athens, the essay will illustrate how the recounting of nodal events in their lives and careers facilitates an assertion of their current social ideology and their disillusionment with the popular music industry in which they operate. Ultimately, what follows will suggest a mode of listening to individual utterances and narratives as discursive forms of resistance that need to be appreciated as social acts as opposed to mere ethnographic data.

"Things I did not know”: Retrospectives on a Canadian rural male youth suicide using an instrumental photo voice case study

In Canada, it is young rural based men who are at the greatest risk for suicide. While there is no consensus on the reasons for this, evidence points to contextual social factors including isolation, lack of confidential services and pressure to uphold restrictive norms of rural masculinity. In this article we share findings drawn from an instrumental photo voice case study to distil factors contributing to the suicide of a young Canadian rural based man. Integrating photo voice methods and in-depth qualitative we conducted interviews with 7 family members and close friends of the deceased. The interviews and image data were analyzed using constant comparative methods to discern themes related to participants’ reflections on and perceptions about rural male suicide. Three inductively derived themes, “Missing the signs”, “Living up to his public image” and “Down in Rural Canada ” reflect the challenges that survivors and young rural men can experience in attempting to be comply with restrictive dominant ideals of masculinity. We conclude that community based suicide prevention efforts would benefit from gender-sensitive and place specific approaches to advancing men’s mental health by making tangibly available and affirming an array of masculinities to foster the well-being of young rural based men.

‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals

Background

DES14X3taz: A Type I Superluminous Supernova Showing a Luminous, Rapidly Cooling Initial Pre-peak Bump

We present DES14X3taz, a new hydrogen-poor superluminous supernova (SLSN-I) discovered by the Dark Energy Survey (DES) supernova program, with additional photometric data provided by the Survey Using DECam for Superluminous Supernovae. Spectra obtained using Optical System for Imaging and low-Intermediate-Resolution Integrated Spectroscopy on the Gran Telescopio CANARIAS show DES14X3taz is an SLSN-I at <i style="margin: 0px; padding: 0px; border: 0px; font-variant-numeric: inherit; font-stretch: inherit; font-size: 18px; line-height: 27px; font-family: minion-pro, Georgia, "Times New Roman", STIXGeneral, serif; vertical-align: baseline; color: rgb(51, 51, 51);">zi> = 0.608. Multi-color photometry reveals a double-peaked light curve: a blue and relatively bright initial peak that fades rapidly prior to the slower rise of the main light curve. Our multi-color photometry allows us, for the first time, to show that the initial peak cools from 22,000 to 8000 K over 15 rest-frame days, and is faster and brighter than any published core-collapse supernova, reaching 30% of the bolometric luminosity of the main peak. No physical 56Ni-powered model can fit this initial peak. We show that a shock-cooling model followed by a magnetar driving the second phase of the light curve can adequately explain the entire light curve of DES14X3taz. Models involving the shock-cooling of extended circumstellar material at a distance of 400  are preferred over the cooling of shock-heated surface layers of a stellar envelope. We compare DES14X3taz to the few double-peaked SLSN-I events in the literature. Although the rise times and characteristics of these initial peaks differ, there exists the tantalizing possibility that they can be explained by one physical interpretation.

“I am in a constant state of insecurity trying to make ends meet, like our service users”: Shared austerity reality between social workers and service users: Towards a preliminary conceptualization

This article introduces the concept of an emerging shared austerity reality, which refers to the socio-economic context of austerity that is shared both by social workers and service users, albeit to different degrees. Traditionally, the concept of the shared reality has been utilized to encompass the experiences of welfare professionals working in situations where both they and service users are exposed to the adverse effects of a natural disaster, war or terrorist attack. Here, the concept of shared reality is expanded through the introduction of the context of austerity. Drawing on 21 in-depth interviews with public sector social work practitioners in Greece it discusses, among other things, social anxieties about their children’s future, and their inability to take care of their elderly relatives that suggest an emerging shared austerity reality, reflecting the deterioration of socio-economic conditions. The paper ends with a discussion about the possibilities of alliance and division that emerge from the concept and future research directions. Moreover, it concludes with a reflection on the role of the social work profession and recent political developments in Greece in anti-austerity struggles.