Postoperative chemotherapy for non-small cell lung cancer : a systematic review and meta-analysis

Background Postoperative chemotherapy is currently not recommended for resected non-small cell lung cancer in many countries and centers. Recently, results of several large randomized clinical trials were reported with conflicting evidence. Accordingly, we sought to determine whether postoperative chemotherapy is associated with improved survival compared with that after surgical intervention alone. Methods Randomized clinical trials with cisplatin- or uracil plus ftorafur-containing regimens were included and evaluated separately. A systematic review that included randomized clinical trials performed before 1995 was identified and found to be of adequate quality. Further randomized controlled trials were identified by searching MEDLINE, EMBASE, and the Cochrane Controlled Trials Register from 1995 through 2004. In addition, the reference lists of articles and conference abstracts were searched. The logarithm of the hazard ratio and its standard error were calculated, and a fixed-effect model was used to combine the estimates. Results There were 7200 patients enrolled in 19 trials included in the analyses. An overall estimate of 13% relative reduction in mortality (95% confidence interval, 7%-19%) was found. There was 11% relative reduction in mortality associated with postoperative cisplatin (95% confidence interval, 4%-18%; P = .004) and 17% associated with uracil plus ftorafur (95% confidence interval, 5%-27%; P = .006) compared with that after surgical intervention alone. This means that there would be an additional survivor at 5 years for 25 patients treated with cisplatin or for 30 patients treated with uracil plus ftorafur. Conclusions Postoperative chemotherapy is associated with improved survival compared with that after surgical intervention alone. Selected patients with completely resected non-small cell lung cancer should be offered chemotherapy. Copyright © 2004 by The American Association for Thoracic Surgery.

Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma : clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study

Background The effects of extra-pleural pneumonectomy (EPP) on survival and quality of life in patients with malignant pleural mesothelioma have, to our knowledge, not been assessed in a randomised trial. We aimed to assess the clinical outcomes of patients who were randomly assigned to EPP or no EPP in the context of trimodal therapy in the Mesothelioma and Radical Surgery (MARS) feasibility study. Methods MARS was a multicentre randomised controlled trial in 12 UK hospitals. Patients aged 18 years or older who had pathologically confirmed mesothelioma and were deemed fit enough to undergo trimodal therapy were included. In a prerandomisation registration phase, all patients underwent induction platinum-based chemotherapy followed by clinical review. After further consent, patients were randomly assigned (1:1) to EPP followed by postoperative hemithorax irradiation or to no EPP. Randomisation was done centrally with computer-generated permuted blocks stratified by surgical centre. The main endpoints were feasibility of randomly assigning 50 patients in 1 year (results detailed in another report), proportion randomised who received treatment, proportion eligible (registered) who proceeded to randomisation, perioperative mortality, and quality of life. Patients and investigators were not masked to treatment allocation. This is the principal report of the MARS study; all patients have been recruited. Analyses were by intention to treat. This trial is registered, number ISRCTN95583524. Findings Between Oct 1, 2005, and Nov 3, 2008, 112 patients were registered and 50 were subsequently randomly assigned: 24 to EPP and 26 to no EPP. The main reasons for not proceeding to randomisation were disease progression (33 patients), inoperability (five patients), and patient choice (19 patients). EPP was completed satisfactorily in 16 of 24 patients assigned to EPP; in five patients EPP was not started and in three patients it was abandoned. Two patients in the EPP group died within 30 days and a further patient died without leaving hospital. One patient in the no EPP group died perioperatively after receiving EPP off trial in a non-MARS centre. The hazard ratio [HR] for overall survival between the EPP and no EPP groups was 1·90 (95% CI 0·92-3·93; exact p=0·082), and after adjustment for sex, histological subtype, stage, and age at randomisation the HR was 2·75 (1·21-6·26; p=0·016). Median survival was 14·4 months (5·3-18·7) for the EPP group and 19·5 months (13·4 to time not yet reached) for the no EPP group. Of the 49 randomly assigned patients who consented to quality of life assessment (EPP n=23; no EPP n=26), 12 patients in the EPP group and 19 in the no EPP group completed the quality of life questionnaires. Although median quality of life scores were lower in the EPP group than the no EPP group, no significant differences between groups were reported in the quality of life analyses. There were ten serious adverse events reported in the EPP group and two in the no EPP group. Interpretation In view of the high morbidity associated with EPP in this trial and in other non-randomised studies a larger study is not feasible. These data, although limited, suggest that radical surgery in the form of EPP within trimodal therapy offers no benefit and possibly harms patients. Funding Cancer Research UK (CRUK/04/003), the June Hancock Mesothelioma Research Fund, and Guy's and St Thomas' NHS Foundation Trust. © 2011 Elsevier Ltd.

Prediction of activity type in preschool children using machine learning techniques

Objectives Recent research has shown that machine learning techniques can accurately predict activity classes from accelerometer data in adolescents and adults. The purpose of this study is to develop and test machine learning models for predicting activity type in preschool-aged children. Design Participants completed 12 standardised activity trials (TV, reading, tablet game, quiet play, art, treasure hunt, cleaning up, active game, obstacle course, bicycle riding) over two laboratory visits. Methods Eleven children aged 3–6 years (mean age = 4.8 ± 0.87; 55% girls) completed the activity trials while wearing an ActiGraph GT3X+ accelerometer on the right hip. Activities were categorised into five activity classes: sedentary activities, light activities, moderate to vigorous activities, walking, and running. A standard feed-forward Artificial Neural Network and a Deep Learning Ensemble Network were trained on features in the accelerometer data used in previous investigations (10th, 25th, 50th, 75th and 90th percentiles and the lag-one autocorrelation). Results Overall recognition accuracy for the standard feed forward Artificial Neural Network was 69.7%. Recognition accuracy for sedentary activities, light activities and games, moderate-to-vigorous activities, walking, and running was 82%, 79%, 64%, 36% and 46%, respectively. In comparison, overall recognition accuracy for the Deep Learning Ensemble Network was 82.6%. For sedentary activities, light activities and games, moderate-to-vigorous activities, walking, and running recognition accuracy was 84%, 91%, 79%, 73% and 73%, respectively. Conclusions Ensemble machine learning approaches such as Deep Learning Ensemble Network can accurately predict activity type from accelerometer data in preschool children.

Naomi Block Manners Stern collection of Eleanor Roosevelt correspondence undated, 1941-1962, 1972, 1974, 1976, 1984, 2003

This collection is mainly composed of correspondence between Ms. Stern and Mrs. Roosevelt, spanning the years from their first acquaintance in 1941 to Mrs. Roosevelt's decease in 1962. Letters that hold particular interest concern Ms. Stern's experience at the Summer Student Leadership Institute, and the White House. Additional material in the collection encompasses articles, newsclippings, programs, press releases, and photographs. The articles and newsclippings folder contains information pertaining to Ms. Stern's college career, the first Summer Student Leadership Institute, Mrs. Roosevelt's talk at Community Day, National Youth Association, and a donation of an ambulance to the war effort by Hunter college students. Naomi Block Manners Stern personal folder contains an article Naomi Block wrote in her college magazine, "Echo," describing her perceptions of President Roosevelt and Prime Minister Winston Churchill during her first visit at the White House. Also included is her graduation program, listing Mrs. Roosevelt as the main speaker, a commemoration of President Roosevelt in 1972 in which Ms. Stern took part, an article and press release describing Ms. Stern's career at Revlon, and a 2003 written summary of Ms. Stern's relationship with Mrs. Roosevelt. Photographs were taken by Naomi Block and others at the Summer Leadership Institute in 1941 portray identified fellow students, Mrs. Roosevelt, James Roosevelt, the Roosevelt home in Campobello, and Felix Frankfurter.

La literatura jurídica como praxis moral

Resumen: La dimensión literaria del acto comunicacional científico-jurídico es un elemento implícito en la interacción de la retórica y dialéctica jurídicas. La matriz artística surge ya del parangón ofrecido por Aristóteles en la Retórica: la evocación de la antistrofa (figura que nos reenvía a pulso cierto al arte poético) lo dice todo, apenas sugiriendo. La comunicación que defenderemos consiste en afirmar que la belleza del acto comunicacional científico jurídico y la perfección de su arte son imputables a su autor y supone una responsabilidad de tipo moral que trasunta en el arte comunicativo el vaso de lo comunicado. Existe una lealtad del recipiente al contenido implícita en la metáfora aristotélica, que requiere una fidelidad del científico para dar cuenta del tesoro que lleva en sus vasijas endebles.

Frescos caballerescos y artúricos en el norte de Italia : tres castillos en los alrededores de Trento

Integran este número de la revista ponencias presentadas en Studia Hispanica Medievalia VIII: Actas de las IX Jornadas Internacionales de Literatura Española Medieval, 2008, y de Homenaje al Quinto Centenario de Amadis de Gaula

Water quality strategy for the Lockwoods Folly River: A partnership for an ailing river

As with a majority of the remaining undeveloped coastal areas in North Carolina, Brunswick County is not a hidden treasure any more. Since 1980 the county’s population has more than tripled to over 95,000 and another 30,000 or so residents are expected to make this last bastion of undeveloped southeastern NC their home by 2020, even with the current economic downturn. As the 29th fastest growing county in the nation this population explosion is resulting in rapid landscape scale land use changes within the watershed of the Lockwoods Folly River. Subdivisions, shopping centers, new highways and bridges, golf courses, and marinas are becoming significant land use activities. The surging development within this 150-square mile 88 thousand-acre watershed has had a severe effect on the health of the river. The portion of the river closed to shell fishing has more that tripled from 18 percent in 1980 to more than 55 percent today and 60% of the beds are considered impaired. For generations, locals have enjoyed the bounty of the Lockwoods Folly River and estuarine system famed for its rich and abundant shell fish beds and excellent coastal inshore fishing. This river system stretches from the Lockwoods Folly Inlet at the Atlantic Ocean inland where it makes the transformation from saltwater marshes to a winding blackwater river that snakes into hundreds of smaller tributaries and blackwater swamps. (PDF contains 4 pages)

Era uma vez... contos, romances, poemas: um tesouro linguístico

Esta dissertação tem por objetivo promover a exploração do texto literário como meio de aquisição/desenvolvimento do domínio linguístico e apresentar uma perspectiva de aprendizagem de língua e literatura como processo indissociável, que se realiza na interação dos sujeitos com diferentes textos. Trabalha-se no limite entre gramática, linguística e literatura cujo objeto é a palavra, tendo como propósito o ensino da Língua Portuguesa. Objetiva-se, ainda, promover uma reflexão que possa melhorar as práticas quotidianas do ensino da língua e fornecer subsídios teóricos e práticos aos professores de Língua Portuguesa e Literatura visando a ampliar opções para o preparo e realização de aulas de leitura e escrita. O aluno, por sua vez, é convidado a interagir com o material apresentado de forma criativa, desenvolvendo sua habilidade de pesquisa em diferentes fontes e sua capacidade de relacionar saberes oriundos de diferentes áreas do conhecimento, respondendo positivamente a propostas desafiadoras de interpretação da realidade que o circunda e da história da sua sociedade, a partir de uma abordagem significativa. Faz-se um conjunto de reflexões acerca da língua, da leitura e da literatura enfatizando que o ensino da língua deve ser pautado no texto, na sua interpretação, estrutura e significação, desenvolvendo a percepção dos elementos que constituem a linguagem, para habituar o aluno a ver as palavras em sua pluralidade de sons, imagens e sentidos. No centro deste trabalho, apresentam-se elementos que têm origem no exercício de práticas de orientação de ensino de língua e de literatura, buscando estratégias para minimizar as deficiências na competência de leitura e interpretação comprovadas pelas avaliações por que têm passado as escolas brasileiras. Finalizando tenta-se deixar claro que a meta desta dissertação é contribuir para que o ensino da língua e literatura promova de fato o desenvolvimento da linguagem em suas funções de compreensão, expressão e comunicação e em seus valores estéticos, formadores e informadores

O efeito do estranho na obra de Salvador Dali

Através do estudo da obra de Salvador Dali, pontuamos algumas questões importantes que envolvem a conexão da arte com a psicanálise. Os pontos assinalados da teoria freudiana sobre a temática da angústia e sua relação com a arte praticada por Dali se baseiam no ensaio O estranho (1919) e no Seminário lacaniano, livro 10. Dali escreveu vários artigos e um ensaio teórico sobre o que ele entendeu por método paranóico-crítico de conhecimento da realidade. Por conta disso, revisamos alguns dos textos freudianos que tocam no tema da paranóia e da realidade psíquica. Esse método aplicado à sua própria arte nos ensinou que uma obra de arte pode funcionar como objeto pequeno a para o observador cuja realidade psíquica tenha sido tocada por uma dada tela. Outro tema importante refere-se ao que resolvemos chamar de o Outro Geográfico de Dali. Baseamos essa pesquisa na noção lacaniana do grande Outro como tesouro dos significantes e a relação disso com a região nordeste da Catalunha, na Espanha. Notamos que os lugares onde Dali viveu e onde construiu suas casas-museu foram extremamente importantes para ele, o que fica claro pelo fato dele repetir insistentemente partes da natureza dessa região ao longo de toda sua obra, como significantes que insistem em ser reescritos. Conhecido como o triângulo daliniano por seus biógrafos, os lugares que compõem essa estrutura são: Figueres, sua cidade natal; Cadaqués, no litoral nordeste da Catalunha onde o menino Dali passava as férias de verão e onde construiu sua morada conjugal com sua adorada Gala; e Púbol, no interior da Catalunha, onde restaurou um Castelo para sua mulher morar. Supomos que esses três lugares, tal qual o tempo para o psiquismo, funcionaram, para Dali, dentro da lógica própria do inconsciente. Além disso, falaremos sobre a influência dos pintores favoritos de Dali, em especial daqueles que funcionaram para ele como grandes mestres.

National Centers for Coastal Ocean Science (NCCOS) research highlights in the Chesapeake Bay

The Chesapeake Bay is the largest estuary in the United States. It is a unique and valuable national treasure because of its ecological, recreational, economic and cultural benefits. The problems facing the Bay are well known and extensively documented, and are largely related to human uses of the watershed and resources within the Bay. Over the past several decades as the origins of the Chesapeake’s problems became clear, citizens groups and Federal, State, and local governments have entered into agreements and worked together to restore the Bay’s productivity and ecological health. In May 2010, President Barack Obama signed Executive Order number 13508 that tasked a team of Federal agencies to develop a way forward in the protection and restoration of the Chesapeake watershed. Success of both State and Federal efforts will depend on having relevant, sound information regarding the ecology and function of the system as the basis of management and decision making. In response to the executive order, the National Oceanic and Atmospheric Administration’s National Centers for Coastal Ocean Science (NCCOS) has compiled an overview of its research in Chesapeake Bay watershed. NCCOS has a long history of Chesapeake Bay research, investigating the causes and consequences of changes throughout the watershed’s ecosystems. This document presents a cross section of research results that have advanced the understanding of the structure and function of the Chesapeake and enabled the accurate and timely prediction of events with the potential to impact both human communities and ecosystems. There are three main focus areas: changes in land use patterns in the watershed and the related impacts on contaminant and pathogen distribution and concentrations; nutrient inputs and algal bloom events; and habitat use and life history patterns of species in the watershed. Land use changes in the Chesapeake Bay watershed have dramatically changed how the system functions. A comparison of several subsystems within the Bay drainages has shown that water quality is directly related to land use and how the land use affects ecosystem health of the rivers and streams that enter the Chesapeake Bay. Across the Chesapeake as a whole, the rivers that drain developed areas, such as the Potomac and James rivers, tend to have much more highly contaminated sediments than does the mainstem of the Bay itself. In addition to what might be considered traditional contaminants, such as hydrocarbons, new contaminants are appearing in measurable amounts. At fourteen sites studied in the Bay, thirteen different pharmaceuticals were detected. The impact of pharmaceuticals on organisms and the people who eat them is still unknown. The effects of water borne infections on people and marine life are known, however, and the exposure to certain bacteria is a significant health risk. A model is now available that predicts the likelihood of occurrence of a strain of bacteria known as Vibrio vulnificus throughout Bay waters.

大熊猫“盛林1号”放归监测

大熊猫(Ailuropoda melanoleuca)是我国特有的珍稀濒危物种，国家Ⅰ级重点保护野生动物，被称为“国宝”。目前，大熊猫被局限在我国中西部的岷山、邛崃、大相岭、小相岭、凉山和秦岭6大山系中。对大熊猫的保护和研究，我国政府、保护生物学科研人员、社会各界及国际保护组织都做了大量的工作。根据全国三次大熊猫调查结果显示，大熊猫栖息地片段化现象依然存在，形成多个隔离的大熊猫小种群。尤其在小相岭、大相岭、岷山B和岷山C种群，大熊猫数量较少，且栖息地破碎，面临较大威胁。有的山系大熊猫种群数量些已低于最小可存活大熊猫种群的数量，如果不采取人工措施，这些种群的大熊猫存在灭绝的危险。 将圈养大熊猫放归野外，以补充野外大熊猫种群数量，增加其遗传多样性，复壮和扩大野生大熊猫种群，是大熊猫人工繁育的最终目标。为降低放归的风险性，在放归人工繁育大熊猫前，将救护存活的野生大熊猫先有计划放归野外，并对其进行跟踪监测，对积累大熊猫放归经验，进一步研究大熊猫野外生物学习性，丰富放归地大熊猫种群遗传多样性，为人工繁育大熊猫放归野外夯实基础，具有十分重要的意义。2005年8月8日，国家林业局和四川省人民政府联合将救护野生大熊猫“盛林1号”放归于龙溪－虹口国家级自然保护区内岷山B大熊猫种群栖息地，并进行系统监测研究。成功的积累了一些放归经验和放归大熊猫的生物学资料，为人工繁育大熊猫的放归奠定了一定基础。 2005年8月至2007年6月期间，我们采用GPS无线电项圈、粪便DNA检测和红外线自动触发相机陷阱的方法，对大熊猫“盛林１号”进行了追踪监测，获得了以下成果： 1.通过分析“盛林1号”放归后了活动趋势和采用两种贝叶斯方法，利用目前五大山系的已有微卫星遗传数据，检测“盛林１号”与五大山系的遗传关系的远近，推测其来源于邛崃山系的可能性较大。 2.收集了大量“盛林1号”野外生境选择数据。我们认为“盛林1号”放归后经历了应急期、初步稳定期、长途迁徙期三个阶段（这可能是今后放归大熊猫都必经的三个时期），并与当地大熊猫种群已发生交流。目前“盛林１号”仍在寻找适合的巢域。 3.结合过去监测数据分析，在放归区域大熊猫和羚牛尽管同域分布，但由于食性不同，对微生境选择还是有着很大差异，因此保护管理对策要有针对性。 4.“盛林1号”的放归是成功的。救护大熊猫异地放归工作应继续开展，但要改进放归后的监测技术。要改进现有对人工饲养大熊猫野化培训方法和放归方式，才能真正将人工繁殖个体放归野外。 Giant Panda (Ailuropoda melanoleuca) is an endangered species endemic to China. It was listed as National Protected I Class Species and is crowned as “National treasure” of China. The populations of Giant Panda are limited in 6 mountain system in Center-West of China, i.e. Mingshan, Mt. Qionglai, Mt. Daxiangling，Mt. Xiaoxiangling, Mt. Liangshan and Mt. Qinling. The results of the Third National Survey on Giant Panda showed that the habitats of Giant Panda is still fracted and Giant Panda population is divided into several isolated small populations. Population B from Mt. Daxiangling, Mt. Xiaoxiangling and Mt. Mingshan and Population C from Mt. Mingshan are very small with very fracted habitat and are more endangered. Several populations in those mountain systems are smaller than Minimum Viable Population of Giant Panda. It is very possible that those populations will be extinct without artificial help. The ultimate Goal of Reintroduction caged Giant Panda to wild is to increase wild population size and genetics diversity and rebuild and expand wild Giant Panda population. It is of significant to return rescued wild Giant Panda to wild and monitor their behavior before reintroduction artificial reproduced Giant Panda. It will increase our knowledge on reintroduction of Giant Panda. Aug 8th, 2005, “Shenglin 1”, a rescued wild Giant Panda was returned to Longxi-Hongkou National Nature Reservoir, which is habitat of Giant Panda Population B of Mt. Mingshan. A systematic monitor was carried out on “Shenglin 1”, and the successful return enriched our biological knowledge on Giant Panda reintroduction. It will be very help for future conservation work on reintroduce artificial reproduced Giant Panda. “Shenglin 1” was tracked with GPS collar, DNA in feces and infrared-trigged camera from Aug 2005 to Jun 2007. 1. Locomotion behavior and microsatellites comparison with Giant Panda from the 5 mountain systems indicated that “Shenglin 1” is possibly from Mt. Qionglai. 2. Habitat usage of “Shenglin 1” was studied. It was suggested that there were 3 phases after return, i.e. emergency response, preliminary stable phase and long distance locomotion, which could be a general process for other returned Giant Panda. It was indicated that there was some interaction between “Shenglin 1” and local population. “Shenglin 1” is seeking for suitable home range now. 3. Monitor data also indicated that microhabitat preference of Giant Panda and takin (Budorcas taxicolor) are different because of different diet, though they are sympatric. It was suggested that conservation management for the two species should be plan in particular. 4. The reintroduction of “Shenglin 1” is a successful case. The program of return rescued Giant Panda to other habitats is of value and should be continued. However, more improvement is needed for the monitor technique. More improvement is need for feralization and returning before we return artificial reproduced Giant Panda to wild.

New method for analysis of Chinese herbal complex prescription and its application

Traditional Chinese medicine (TCM) is a great treasure of China, the analysis of which is an arduous task. The viewpoint that all chemical constituents of Chinese herbal complex prescription should be analyzed as a black box is elucidated for the first time. Intelligent multi-mode multi-column chromatographic system (IMMCC) with its hybrids is the basic method and HPLC Unified Method is the breakthrough for the black box analysis. Dang-Gui-Bu-Xue-Tang was selected as a typical TCM and a systematic separation method from non-aqueous mobile phase to pure water mobile phase was put forward in order to convert unknown sample to known sample. The a, c values and UV spectra of 66 components of Astragalus, 78 components of Angelica and 71 components of Dang-Gui-Bu-Xue-Tang were obtained. Intelligent optimization and peak identification method and software for complex samples were developed and the optimum multi-step multi-binary gradient curve of mobile phase for Astragalus was ascertained. The maximum error and minimum error of predicted retention time for all components of Astragalus are 8.62% and 0.05% respectively. All components of Astragalus were compared with those of Angelica and it is found that many components of Astragalus are the same as those of Angelica, while the contents of these components are different. Many components of Dang-Gui-Bu-Xue-Tang are also the same as those of Astragalus and Angelica with different contents.

Hidden land and changing landscape: Narratives about Mount Khangchendzonga among the Lepcha and the Lhopo

This article explores contemporary ‘hidden land’ narrative constructs of Máyel Lyáng and Beyul Dremojong in Sikkim, India, as conceived by the Lepcha and the Lhopo, two ‘scheduled tribes’. Lepcha and Lhopo narratives about these hidden lands in Mount Khangchendzonga inform us about their contemporary and historical, indigenous and Buddhist contexts and the interactions between these contexts. Lhopo perspectives on the hidden Beyul Dremojong echo classical Tibetan Buddhist ‘revealed treasure’ guidebooks and exist within the complex and reciprocal relationship between the Lhopo and the land they inhabit; development initiatives are understood to have caused illness and death in the Lhopo community of Tashiding, often referred to as the geographical ‘center’ of Beyul Dremojong. Contemporary Lepcha comprehensions of Máyel Lyáng, described in oral narratives within an ethnic community whose cosmology is intimately connected with Mount Khangchendzonga, today show some influence of Lhopo interpretations of Beyul Dremojong and the treasure texts; they also reflect Lepcha fears about cultural dispersion. Present-day narratives about both hidden lands reference notable political events in modern Sikkimese history (encounters with the British; the Chinese occupation of Tibet).

Collective action and individual choice: rethinking how we regulate narcotics and antibiotics.

Governments across the globe have squandered treasure and imprisoned millions of their own citizens by criminalising the use and sale of recreational drugs. But use of these drugs has remained relatively constant, and the primary victims are the users themselves. Meanwhile, antimicrobial drugs that once had the power to cure infections are losing their ability to do so, compromising the health of people around the world. The thesis of this essay is that policymakers should stop wasting resources trying to fight an unwinnable and morally dubious war against recreational drug users, and start shifting their attention to the serious threat posed by our collective misuse of antibiotics.