Chemotherapy in patients with advanced pancreatic cancer: too close to death?

PURPOSE: We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death. METHODS: Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9. RESULTS: We analyzed 231 patients: males/females, 53/47 %; metastatic/locally advanced disease, 80/20 %; and median age, 66 years (range 32-85). All patients died due to disease progression. Median overall survival was 6.1 months (95 % CI 5.1-7.2). At the last chemotherapy delivery, performance status was 0-1 in 37 % and 2 in 63 %. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1 % had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4 weeks in 24 %, ≥4-12 in 47 %, and >12 in 29 %. Median survival from last chemotherapy to death was 7.5 weeks (95 % CI 6.7-8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis. CONCLUSIONS: A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival.

Natural regeneration of Scots pine and Norway spruce close to the timberline in northern Finland

Abstract

Long-term close follow-up of chorioretinal lesions in presumed ocular tuberculosis.

PURPOSE: To evaluate the long-term outcome (up to 7 years) of presumed ocular tuberculosis (TB) when the therapeutic decision was based on WHO guidelines. METHODS: Twelve out of 654 new uveitic patients (1998-2004) presented with choroiditis and positive tuberculosis skin test (TST) (skin lesion diameter >15 mm). Therapy was administered according to WHO recommendations after ophthalmic and systemic investigation. The area size of ocular lesions at presentation and after therapy, measured on fluorescein and indocyanine green angiographies, was considered the primary outcome. Relapse of choroiditis was considered a secondary outcome. The T-SPOT TB test was performed when it became available. RESULTS: Visual acuity significantly improved after therapy (p=0.0357). The mean total surface of fluorescein lesions at entry was 44.8 ± 20.9 (arbitrary units) and decreased to 32.5 ± 16.9 after therapy (p=0.0165). The mean total surface of indocyanine green lesions at entry was 24.5 ± 13.3 and decreased to 10.8 ± 5.4 after therapy (p=0.0631). The T-SPOT TB revealed 2 false TST-positive results. The mean follow-up was 4.5 ± 1.5 years. Two relapses out of 10 confirmed ocular TB was observed after complete lesion healing, 2.5 years and 4.5 years after therapy, respectively. CONCLUSIONS: A decrease of ocular lesion mean size and a mean improvement of VA were observed after antituberculous therapy. Our long-term follow-up of chorioretinal lesions demonstrated relapse of ocular tuberculosis in 10% of patients with confirmed ocular TB, despite complete initial retinal scarring.

Patent foramen ovale in patients with ischaemic stroke of unknown cause: to close? "pro closure" position

There is ample epidemiological and anecdotal evidence that a PFO increases the risk of stroke both in young and elderly patients, although only in a modest way: PFOs are more prevalent in patients with cryptogenic (unexplained) stroke than in healthy subjects, and are more prevalent in cryptogenic stroke than in strokes of other causes. Furthermore, multiple case series confirm an association of paradoxical embolism across a PFO in patients with deep vein thrombosis and/or pulmonary emboli.2. Is stroke recurrence risk in PFO-patients really not elevated when compared to PFO-free patients, as suggested by traditional observational studies? This finding is an epidemiological artifact called "the paradox of recurrence risk research" (Dahabreh & Kent, JAMA 2011) and is due to one (minor) risk factor, such as PFO, being wiped out by other, stronger risk factors in the control population.3. Having identified PFO as a risk factor for a first stroke and probably also for recurrences, we have to treat it, because treating risk factors always has paid off. No one would nowadays question the aggressive treatment of other risk factors of stroke such as hypertension, atrial fibrillation, smoking, or hyperlipidemia.4. In order to be effective, the preventive treatment has to control the risk factor (i.e. close effectively the PFO), and has to have little or no side effects. Both these conditions are now fulfilled thanks to increasing expertise of cardiologists with technically advanced closure devices and solid back up by multidisciplinary stroke teams.5. Closing a PFO does not dispense us from treating other stroke risk factors aggressively, given that these are cumulative with PFO.6. The most frequent reason why patients have a stroke recurrence after PFO closure is not that closure is ineffective, but that the initial stroke etiology is insufficiently investigated and not PFO related, and that the recurrence is due to another mechanism because of poor risk factor control.7. Similarly, the randomized CLOSURE study was negative because a) patients were included who had a low chance that their initial event was due to the PFO, b) patients were selected with a low chance that a PFO-related recurrence would occur, c) there was an unacceptable high rate of closure-related side effects, and d) the number of randomized patients was too small for a prevention trial.8. It is only a question of time until a sufficiently large randomized clinical trial with true PFO-related stroke patients and a high PFO-related recurrence risk will be performed and show the effectiveness of this closure9. PFO being a rather modest risk factor for stroke does not mean we should prevent our patients from getting the best available prevention by the best physicians in the best stroke centers Therefore, a PFO-closure performed by an excellent cardiologist following the recommendation of an expert neurovascular specialist after a thorough workup in a leading stroke center is one of the most effective stroke prevention treatments available in 2011.

Tan cerca, tan lejos: Aldo Rossi y el Grupo 2C. Arquitectura, ideología y disidencias en la Barcelona de los 70 = So close, so far : Aldo Rossi and the 2C Group. Architecture, ideology and dissents in the Barcelona of the 70s

The Catalan reception of the 1966 manifestos by Robert Venturi and Aldo Rossi marks the scenario of a breakup: while North America debates about the architectural shape as a linguistic structure, Italy dips its roots in the Modern Movement tradition as an origin for a new temporal and ideological architectural dimension. The first contacts between Rossi and Spain verify this search and allow the Italian to construct common itineraries with some architects from Barcelona. From these exchanges the 2C group will be born, taking part on typical vanguardist mechanisms: they will publish the magazine, 2C. The construction of the city (1972-1985), they will attend the XV Triennale di Milano in 1973 with the Torres Clavé Plan (1971) and the Aldo Rossi + 21 Spanish architects exhibition (1975) while he will organize the three issues of the Seminarios Internacionales de Arquitectura Contemporánea (S.I.AC.) which took place in Santiago, Sevilla and Barcelona between 1976 and 1980. In front of the unfolding of the firsts, the American contacts of Federico Correa, Oriol Bohigas, Lluís Domènech and the PER studio or the teaching work of Rafael Moneo from Barcelona since 1971, allow to draw replica itineraries with the foundation of the magazine Arquitecturas Bis (1974-1985), the organization of the meetings between international publications such as Lotus and Oppositions in Cadaqués (1975) and New York (1977), while stablishing exchanges with members of the Five Architects. Replicas that in 1976 conduct the initial ideological affirmations between Rossi and the 2C group towards irreconcilable distancing. Verifying the itinerary of the journey that the Italian leads from the Italian resistance towards the American backing down is part of the aim of this article

Fluvio-morphological processes of meander bends - Combining conventional field measurements, close-range remote sensing and computational modelling

Meandering rivers have been perceived to evolve rather similarly around the world independently of the location or size of the river. Despite the many consistent processes and characteristics they have also been noted to show complex and unique sets of fluviomorphological processes in which local factors play important role. These complex interactions of flow and morphology affect notably the development of the river. Comprehensive and fundamental field, flume and theoretically based studies of fluviomorphological processes in meandering rivers have been carried out especially during the latter part of the 20th century. However, as these studies have been carried out with traditional field measurements techniques their spatial and temporal resolution is not competitive to the level achievable today. The hypothesis of this study is that, by exploiting e increased spatial and temporal resolution of the data, achieved by combining conventional field measurements with a range of modern technologies, will provide new insights to the spatial patterns of the flow-sediment interaction in meandering streams, which have perceived to show notable variation in space and time. This thesis shows how the modern technologies can be combined to derive very high spatial and temporal resolution data on fluvio-morphological processes over meander bends. The flow structure over the bends is recorded in situ using acoustic Doppler current profiler (ADCP) and the spatial and temporal resolution of the flow data is enhanced using 2D and 3D CFD over various meander bends. The CFD are also exploited to simulate sediment transport. Multi-temporal terrestrial laser scanning (TLS), mobile laser scanning (MLS) and echo sounding data are used to measure the flow-based changes and formations over meander bends and to build the computational models. The spatial patterns of erosion and deposition over meander bends are analysed relative to the measured and modelled flow field and sediment transport. The results are compared with the classic theories of the processes in meander bends. Mainly, the results of this study follow well the existing theories and results of previous studies. However, some new insights regarding to the spatial and temporal patterns of the flow-sediment interaction in a natural sand-bed meander bend are provided. The results of this study show the advantages of the rapid and detailed measurements techniques and the achieved spatial and temporal resolution provided by CFD, unachievable with field measurements. The thesis also discusses the limitations which remain in the measurement and modelling methods and in understanding of fluvial geomorphology of meander bends. Further, the hydro- and morphodynamic models’ sensitivity to user-defined parameters is tested, and the modelling results are assessed against detailed field measurement. The study is implemented in the meandering sub-Arctic Pulmanki River in Finland. The river is unregulated and sand-bed and major morphological changes occur annually on the meander point bars, which are inundated only during the snow-melt-induced spring floods. The outcome of this study applies to sandbed meandering rivers in regions where normally one significant flood event occurs annually, such as Arctic areas with snow-melt induced spring floods, and where the point bars of the meander bends are inundated only during the flood events.

Acute exercise performed close to the anaerobic threshold improves cognitive performance in elderly females

The objective of the present study was to compare the effect of acute exercise performed at different intensities in relation to the anaerobic threshold (AT) on abilities requiring control of executive functions or alertness in physically active elderly females. Forty-eight physically active elderly females (63.8 ± 4.6 years old) were assigned to one of four groups by drawing lots: control group without exercise or trial groups with exercise performed at 60, 90, or 110% of AT (watts) and submitted to 5 cognitive tests before and after exercise. Following cognitive pretesting, an incremental cycle ergometer test was conducted to determine AT using a fixed blood lactate concentration of 3.5 mmol/L as cutoff. Acute exercise executed at 90% of AT resulted in significant (P < 0.05, ANOVA) improvement in the performance of executive functions when compared to control in 3 of 5 tests (verbal fluency, Tower of Hanoi test (number of movements), and Trail Making test B). Exercising at 60% of AT did not improve results of any tests for executive functions, whereas exercise executed at 110% of AT only improved the performance in one of these tests (verbal fluency) compared to control. Women from all trial groups exhibited a remarkable reduction in the Simple Response Time (alertness) test (P = 0.001). Thus, physical exercise performed close to AT is more effective to improve cognitive processing of older women even if conducted acutely, and using a customized exercise prescription based on the anaerobic threshold should optimize the beneficial effects.

"Attitude is a little thing that makes a big difference" : further exploration of attitude alignment in the context of close relationship dyads /

One hundred and five primarily Caucasian undergraduate couples were tested to study the phenomenon of attitude alignment, or the way in which individuals change their opinions to achieve greater attitudinal congruence with their romantic partners, and the hypotheses that relationship closeness, affect, attachment, social desirability, and centrality are each related to attitude alignment for individuals in close couples. The couples filled out an attitude questionnaire consisting of 50 issues in which they were asked to give their attitude on a scale from 1 to 9 as well as to rate the centrality, or importance, of that issue on a scale from 1 to 9. Before discussing four of these issues with each other - 2 were more central to the man and less central, or peripheral, to the woman, whereas the other 2 were central to the woman and peripheral to the man - the individuals completed established measures of relationship closeness, affect, attachment, and social desirability. The couples then filled out the identical attitudes questionnaire again, and their answers on the four discussion issues were compared to their prediscussion answers to determine whether attitude alignment had occurred. There were two experimental groups: a social desirability group, where the couples were told it was natural and normal to disagree with their partners, and a control group. Results indicated that attitude alignment did significantly occur across all couples, but most other variables - including centrality, relationship closeness, and affect - did not predict attitude alignment behaviour. As well, the social desirability experimental groups did not significantly differ on attitude alignment behaviours, but higher scores on the social desirability scale, specifically self-deception, significantly predicted higher attitude alignment scores across all couples. Large differences between individuals' frequency.

Hurry up and slow down : education to close the ingenuity gap /

To explore the idea of education to close the ingenuity gap I use Thomas Homer-Dixon's work to define ingenuity. The notion that the supply of ingenuity to solve our technical and social problems is not keeping pace with the ingenuity required to solve those problems is called the ingenuity gap. Man-made technological developments are increasing the density, intensity, and pace of globalisation. People must reorganise decision-making organisations and problem-solving methods to pragmatically combat the growing ingenuity gap. John Dewey's work illustrates the fundamental attitudes for the thinking and judgment associated with educating for ingenuity. Howard Gardner's idea that truth, beauty, and morality ought to form the core values and tenets of the philosophy of educating for ingenuity is integral to this thesis. The act of teaching facilitates the invitation to the communication necessary to foster ingenuity. John Novak-discusses the five relationships of educational leadership that enhance an environment of ingenuity. The International Baccalaureate (IB) is an existing model of global education, one that defines some of the school experiences and academic development of core values of educating for ingenuity. Expanding upon the structure of the IB and other research within this thesis, I speculate upon what my school, where educating for ingenuity so as to close the ingenuity gap is the goal, would be like.

We need to have a conversation about OpenURL, a close look at a corpus of error reports from the 2013 academic year. Or, How I learned to stop worrying and give up on clean metadata.

Presented at Access 2014, winner of poster contest.

Photograph - Percy Band Eating Watermelon Close-up

Black and white photo of Percy Band eating watermelon. This picture is 5 cm x 4 cm.

Vibrational behaviour of bcc Cu-based shape memory alloys close to the martensitic transition

Experimental data from ultrasonic and inelastic neutron scattering measurements are analyzed for different families of Cu-based shape-memory alloys. It is shown that the transition occurs at a value, independent of composition and alloy family, of the ratio between the elastic constants associated with the two shears necessary to accomplish the lattice distortion from the bcc to the close-packed structure. The zone boundary frequency of the TA2[110] branch evaluated at the transition point (TM), weakly depends, for each family, on composition. A linear relationship between this frequency and the inverse of the elastic constant C', both quantities evaluated at TM, has been found, in agreement with the prediction of a Landau model proposed for martensitic transformations.