Cilengitide combined with cetuximab and platinum-based chemotherapy as first-line treatment in advanced non-small-cell lung cancer (NSCLC) patients: Results of an open-label, randomized, controlled phase II study (CERTO)

Background: This multicentre, open-label, randomized, controlled phase II study evaluated cilengitide in combination with cetuximab and platinum-based chemotherapy, compared with cetuximab and chemotherapy alone, as first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC). Patients and methods: Patients were randomized 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (control), or combined with cilengitide 2000 mg 1×/week i.v. (CIL-once) or 2×/week i.v. (CIL-twice). A protocol amendment limited enrolment to patients with epidermal growth factor receptor (EGFR) histoscore ≥200 and closed the CIL-twice arm for practical feasibility issues. Primary end point was progression-free survival (PFS; independent read); secondary end points included overall survival (OS), safety, and biomarker analyses. A comparison between the CIL-once and control arms is reported, both for the total cohorts, as well as for patients with EGFR histoscore ≥200. Results: There were 85 patients in the CIL-once group and 84 in the control group. The PFS (independent read) was 6.2 versus 5.0 months for CIL-once versus control [hazard ratio (HR) 0.72; P = 0.085]; for patients with EGFR histoscore ≥200, PFS was 6.8 versus 5.6 months, respectively (HR 0.57; P = 0.0446). Median OS was 13.6 for CIL-once versus 9.7 months for control (HR 0.81; P = 0.265). In patients with EGFR ≥200, OS was 13.2 versus 11.8 months, respectively (HR 0.95; P = 0.855). No major differences in adverse events between CIL-once and control were reported; nausea (59% versus 56%, respectively) and neutropenia (54% versus 46%, respectively) were the most frequent. There was no increased incidence of thromboembolic events or haemorrhage in cilengitide-treated patients. αvβ3 and αvβ5 expression was neither a predictive nor a prognostic indicator. Conclusions: The addition of cilengitide to cetuximab/chemotherapy indicated potential clinical activity, with a trend for PFS difference in the independent-read analysis. However, the observed inconsistencies across end points suggest additional investigations are required to substantiate a potential role of other integrin inhibitors in NSCLC treatment.

Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-Lung 3 and LUX-Lung 6): analysis of overall survival data from two randomised, phase 3 trials

Background We aimed to assess the effect of afatinib on overall survival of patients with EGFR mutation-positive lung adenocarcinoma through an analysis of data from two open-label, randomised, phase 3 trials. Methods Previously untreated patients with EGFR mutation-positive stage IIIB or IV lung adenocarcinoma were enrolled in LUX-Lung 3 (n=345) and LUX-Lung 6 (n=364). These patients were randomly assigned in a 2:1 ratio to receive afatinib or chemotherapy (pemetrexed-cisplatin [LUX-Lung 3] or gemcitabine-cisplatin [LUX-Lung 6]), stratified by EGFR mutation (exon 19 deletion [del19], Leu858Arg, or other) and ethnic origin (LUX-Lung 3 only). We planned analyses of mature overall survival data in the intention-to-treat population after 209 (LUX-Lung 3) and 237 (LUX-Lung 6) deaths. These ongoing studies are registered with ClinicalTrials.gov, numbers NCT00949650 and NCT01121393. Findings Median follow-up in LUX-Lung 3 was 41 months (IQR 35–44); 213 (62%) of 345 patients had died. Median follow-up in LUX-Lung 6 was 33 months (IQR 31–37); 246 (68%) of 364 patients had died. In LUX-Lung 3, median overall survival was 28·2 months (95% CI 24·6–33·6) in the afatinib group and 28·2 months (20·7–33·2) in the pemetrexed-cisplatin group (HR 0·88, 95% CI 0·66–1·17, p=0·39). In LUX-Lung 6, median overall survival was 23·1 months (95% CI 20·4–27·3) in the afatinib group and 23·5 months (18·0–25·6) in the gemcitabine-cisplatin group (HR 0·93, 95% CI 0·72–1·22, p=0·61). However, in preplanned analyses, overall survival was significantly longer for patients with del19-positive tumours in the afatinib group than in the chemotherapy group in both trials: in LUX-Lung 3, median overall survival was 33·3 months (95% CI 26·8–41·5) in the afatinib group versus 21·1 months (16·3–30·7) in the chemotherapy group (HR 0·54, 95% CI 0·36–0·79, p=0·0015); in LUX-Lung 6, it was 31·4 months (95% CI 24·2–35·3) versus 18·4 months (14·6–25·6), respectively (HR 0·64, 95% CI 0·44–0·94, p=0·023). By contrast, there were no significant differences by treatment group for patients with EGFR Leu858Arg-positive tumours in either trial: in LUX-Lung 3, median overall survival was 27·6 months (19·8–41·7) in the afatinib group versus 40·3 months (24·3–not estimable) in the chemotherapy group (HR 1·30, 95% CI 0·80–2·11, p=0·29); in LUX-Lung 6, it was 19·6 months (95% CI 17·0–22·1) versus 24·3 months (19·0–27·0), respectively (HR 1·22, 95% CI 0·81–1·83, p=0·34). In both trials, the most common afatinib-related grade 3–4 adverse events were rash or acne (37 [16%] of 229 patients in LUX-Lung 3 and 35 [15%] of 239 patients in LUX-Lung 6), diarrhoea (33 [14%] and 13 [5%]), paronychia (26 [11%] in LUX-Lung 3 only), and stomatitis or mucositis (13 [5%] in LUX-Lung 6 only). In LUX-Lung 3, neutropenia (20 [18%] of 111 patients), fatigue (14 [13%]) and leucopenia (nine [8%]) were the most common chemotherapy-related grade 3–4 adverse events, while in LUX-Lung 6, the most common chemotherapy-related grade 3–4 adverse events were neutropenia (30 [27%] of 113 patients), vomiting (22 [19%]), and leucopenia (17 [15%]). Interpretation Although afatinib did not improve overall survival in the whole population of either trial, overall survival was improved with the drug for patients with del19 EGFR mutations. The absence of an effect in patients with Leu858Arg EGFR mutations suggests that EGFR del19-positive disease might be distinct from Leu858Arg-positive disease and that these subgroups should be analysed separately in future trials.

A model of factors that influence meeting the needs of family with a relative in ICU

This thesis developed a model of factors that influence meeting the needs of family with a relative admitted to an adult intensive care unit. The results from the model indicate that several variables are significant in meeting the needs of families in ICU. The factors identified in this study should be considered when planning future intervention studies or implementing interventions into ICU clinical practice. Meeting the needs of families is an integral part of caring for a critically ill patient. ICU staff can minimise this stressful time for relatives by anticipating and addressing family needs.

Metal-spinel-corundum three phase equilibria in the system Ni-Cr-Al-O at 1373 K

The tie-lines representing the inter-crystalline ion exchange equilibria between the NiCr2O4-NiAl2O4 spinet solid solution and Cr2O3-Al2O3 corundum solid solution are determined by electron microprobe andEDAX pointcountanalysis of the oxide phases equilibrated with metallic Ni at 1373 K. The component activities in the spinet solid solution are derived from the tie-lines and thermodynamic data for Cr2O3-Al2O3 solid solution available in the literature. The Gibbs energy of mixing of the spinet solid solution calculated from the experimental data is discussed in relation to the values derived from the cation distribution models which assume random mixing of cations on both tetrahedral and octahedral sites. Positive deviation from the models is observed indicating significant positive enthalpy contribution arising form the size mismatch between Al+3 and Ni+2 ions on the tetrahedral site and Al+3, Ni+2 and Cr+3 on the octahedral site. Variation of the oxygen potential for threephase equilibrium involving metallic nickel, spinet solid solution and corundum solid solution is computed as a function of composition of the solid solutions at 1373 K. The oxygen potential exhibits a minimum at aluminum cationic fraction eta(Al)/(eta(Al) + eta(Cr)) = 0.524 in the oxide solid solutions.

Single and multi-step phase transformation in CuZr nanowire under compressive/tensile loading

A novel stress induced martenistic phase transformation is reported in an initial B2-CuZr nanowire of cross-sectional dimensions in the range of 19.44 x 19.44-38.88 x 38.88 angstrom(2) and temperature in the range of 10-400 K under both tensile and compressive loading. Extensive Molecular Dynamic simulations are performed using an inter-atomic potential of type Finnis and Sinclair. The nanowire shows a phase transformation from an initial B2 phase to BCT (body-centered-tetragonal) phase with failure strain of similar to 40% in tension, whereas in compression, comparatively a small B2 -> BCT phase transformation is observed with failure strain of similar to 25%. Size and temperature dependent deformation mechanisms which control ultimately the B2 -> BCT phase transformation are found to be completely different for tensile and compressive loadings. Under tensile loading, small cross-sectional nanowire shows a single step phase transformation, i.e. B2 -> BCT via twinning along {100} plane, whereas nanowires with larger cross-sectional area show a two step phase transformation, i.e. B2 -> R phase -> BCT along with intermediate hardening. In the first step, nanowire shows phase transformation from B2 -> R phase via twinning along {100} plane, afterwards the nanowire deforms via twinning along {110} plane which cause further transformation from R phase -> BCT phase. Under compressive loading, the nanowire shows crushing along {100} plane after a single step phase transformation from B2 -> BCT. Proper tailoring of such size and temperature dependent phase transformation can be useful in designing nanowire for high strength applications with corrosion and fatigue resistance. (C) 2009 Elsevier Ltd. All rights reserved.

Lightcurve inversion for asteroid spins and shapes

Knowledge of the physical properties of asteroids is crucial in many branches of solar-system research. Knowledge of the spin states and shapes is needed, e.g., for accurate orbit determination and to study the history and evolution of the asteroids. In my thesis, I present new methods for using photometric lightcurves of asteroids in the determination of their spin states and shapes. The convex inversion method makes use of a general polyhedron shape model and provides us at best with an unambiguous spin solution and a convex shape solution that reproduces the main features of the original shape. Deriving information about the non-convex shape features is, in principle, also possible, but usually requires a priori information about the object. Alternatively, a distribution of non-convex solutions, describing the scale of the non-convexities, is also possible to be obtained. Due to insufficient number of absolute observations and inaccurately defined asteroid phase curves, the $c/b$-ratio, i.e., the flatness of the shape model is often somewhat ill-defined. However, especially in the case of elongated objects, the flatness seems to be quite well constrained, even in the case when only relative lightcurves are available. The results prove that it is, contrary to the earlier misbelief, possible to derive shape information from the lightcurve data if a sufficiently wide range of observing geometries is covered by the observations. Along with the more accurate shape models, also the rotational states, i.e., spin vectors and rotation periods, are defined with improved accuracy. The shape solutions obtained so far reveal a population of irregular objects whose most descriptive shape characteristics, however, can be expressed with only a few parameters. Preliminary statistical analyses for the shapes suggests that there are correlations between shape and other physical properties, such as the size, rotation period and taxonomic type of the asteroids. More shape data of, especially, the smallest and largest asteroids, as well as the fast and slow rotators is called for in order to be able to study the statistics more thoroughly.

Dancing into the second phase of creative industries

As we enter the second phase of creative industries there is a shift away from the early 1990s ideology of the arts as a creative content provider for the wealth generating ‘knowledge’ economy to an expanded rhetoric encompassing ‘cultural capital’ and its symbolic value. A renewed focus on culture is examined through a regional scan of creative industries in which social engineering of the arts occurs through policy imperatives driven by ‘profit oriented conceptualisations of culture’ (Hornidge 2011, p. 263) In the push for artists to become ‘culturpreneurs’ a trend has emerged where demand for ‘embedded creatives’ (Cunningham 2013) sees an exodus from arts-based employment through use of transferable skills into areas outside the arts. For those that stay, within the performing arts in particular, employment remains project-based, sporadic, underpaid, self-initiated and often self-financed, requiring adaptive career paths. Artist entrepreneurs must balance creation and performance of their art with increasing amounts of time spent on branding, compliance, fundraising and the logistical and commercial requirements of operating in a CI paradigm. The artists’ key challenge thus becomes one of aligning core creative and aesthetic values with market and business considerations. There is also the perceived threat posed by the ‘prosumer’ phenomenon (Bruns 2008), in which digital on-line products are created and produced by those formerly seen as consumers of art or audiences for art. Despite negative aspects to this scenario, a recent study (Steiner & Schneider 2013) reveals that artists are happier and more satisfied than other workers within and outside the creative industries. A lively hybridisation of creative practice is occurring through mobile and interactive technologies with dynamic connections to social media. Continued growth in arts festivals attracts participation in international and transdisciplinary collaborations, whilst cross-sectoral partnerships provide artists with opportunities beyond a socio-cultural setting into business, health, science and education. This is occurring alongside a renewed engagement with place through the rise of cultural precincts in ‘creative cities’ (Florida 2008, Landry 2000), providing revitalised spaces for artists to gather and work. Finally, a reconsideration of the specialist attributes and transferable skills that artists bring to the creative industries suggests ways to dance through both the challenges and opportunities occasioned by the current complexities of arts’ practices.

A simple analog controller for single-phase half-bridge rectifier and its application to transformerless UPS

A simple, low-cost, constant frequency, analog controller is proposed for the front-end half-bridge rectifier of a single-phase transformerless UPS system to maintain near unity power factor at the input and zero dc-offset voltage at the output. The controller generates the required gating pulses by comparing the input current with a periodic, bipolar, linear carrier without sensing the input voltage. Two voltage controllers and a single integrator with reset are used to generate the required carrier. All the necessary control operations can be performed without using any PLL, multiplier and/or divider. The controller can be fabricated as a single integrated circuit. The control concept is validated through simulation and also experimentally on an 800W half-bridge rectifier. Experimental results are presented for ac-dc application, and also for ac-dc-ac UPS application with both sinusoidal and nonlinear loads. The simulation and experimental results agree well.

A Proportional plus Multiresonant Controller for Three-Phase Four-Wire High-Frequency Link Inverter

A new solution for unbalanced and nonlinear loads in terms of power circuit topology and controller structure is proposed in this paper. A three-phase four-wire high-frequency ac-link inverter is adopted to cater to such loads. Use of high-frequency transformer results in compact and light-weight systems. The fourth wire is taken out from the midpoint of the isolation transformer in order to avoid the necessity of an extra leg. This makes the converter suitable for unbalanced loads and eliminates the requirements of bulky capacitor in half-bridge inverter. The closed-loop control is carried out in stationary reference frame using proportional + multiresonant controller (three separate resonant controller for fundamental, fifth and seventh harmonic components). The limitations on improving steady-state response of harmonic resonance controllers is investigated and mitigated using a lead-lag compensator. The proposed voltage controller is used along with an inner current loop to ensure excellent performance of the power converter. Simulation studies and experimental results with 1 kVA prototype under nonlinear and unbalanced loading conditions validate the proposed scheme.

The Relational Self, the Social Bond and the Dynamics of Personal Relationships : A Sociological Analysis

This study analyses personal relationships linking research to sociological theory on the questions of the social bond and on the self as social. From the viewpoint of disruptive life events and experiences, such as loss, divorce and illness, it aims at understanding how selves are bound to their significant others as those specific people ‘close or otherwise important’ to them. Who form the configurations of significant others? How do different bonds respond in disruptions and how do relational processes unfold? How is the embeddedness of selves manifested in the processes of bonding, on the one hand, and in the relational formation of the self, on the other? The bonds are analyzed from an anti-categorical viewpoint based on personal citations of significance as opposed to given relationship categories, such as ‘family’ or ‘friendship’ – the two kinds of relationships that in fact are most frequently significant. The study draws from analysis of the personal narratives of 37 Finnish women and men (in all 80 interviews) and their entire configurations of those specific people who they cite as ‘close or otherwise important’. The analysis stresses the subjective experiences, while also investigating the actualized relational processes and configurations of all personal relationships with certain relationship histories embedded in micro-level structures. The research is based on four empirical sub-studies of personal relationships and a summary discussing the questions of the self and social bond. Discussion draws from G. H. Mead, C. Cooley, N. Elias, T. Scheff, G. Simmel and the contributors of ‘relational sociology’. Sub-studies analyse bonds to others from the viewpoint of biographical disruption and re-configuration of significant others, estranged family bonds, peer support and the formation of the most intimate relationships into exclusive and inclusive configurations. All analyses examine the dialectics of the social and the personal, asking how different structuring mechanisms and personal experiences and negotiations together contribute to the unfolding of the bonds. The summary elaborates personal relationships as social bonds embedded in wider webs of interdependent people and social settings that are laden with cultural expectations. Regarding the question of the relational self, the study proposes both bonding and individuality as significant. They are seen as interdependent phases of the relationality of the self. Bonding anchors the self to its significant relationships, in which individuality is manifested, for example, in contrasting and differentiating dynamics, but also in active attempts to connect with others. Individuality is not a fixed quality of the self, but a fluid and interdependent phase of the relational self. More specifically, it appears in three formats in the flux of relational processes: as a sense of unique self (via cultivation of subjective experiences), as agency and as (a search for) relative autonomy. The study includes an epilogue addressing the ambivalence between the social expectation of individuality in society and the bonded reality of selves.

Observation of a chiral smectic phase in azobenzene-linked bolaamphiphiles containing free sugars

Amphiphilic sugars exhibit both lyotropic and thermotropic liquid-crystalline behavior. Interestingly, in spite of the abundance of chiral centers in amphiphilic sugars, their liquid-crystalline phases do not exhibit macroscopic chirality. Herein, we report on the first observation of macroscopic chirality in sugar-based bolaamphiphiles containing free hydroxyl groups. The manifestation of the chiral smectic C* phase in these bolaamphiphiles has been observed to be critically dependent on the presence of the azobenzene moiety and the suitable length of the methylene spacer. These results imply that by suitable selection of linker groups, mesogenic bolaamphiphiles possessing macroscopic chirality can be designed using a variety of naturally available sugar derivatives.

Characterization of the interactions of a polycationic, amphiphilic, terminally branched oligopeptide with lipid A and lipopolysaccharide from the deep rough mutant of Salmonella minnesota

The lipid A and lipopolysaccharide (LPS) binding and neutralizing activities of a synthetic, polycationic, amphiphilic peptide were studied. The branched peptide, designed as a functional analog of polymyxin B, has a six residue hydrophobic sequence, bearing at its N-terminus a penultimate lysine residue whose alpha- and epsilon-amino groups are coupled to two terminal lysine residues. In fluorescence spectroscopic studies designed to examine relative affinities of binding to the toxin, neutralization of surface charge and fluidization of the acyl domains, the peptide was active, closely resembling the effects of polymyxin B and its nonapeptide derivative; however, the synthetic peptide does not induce phase transitions in LPS aggregates as do polymyxin B and polymyxin B nonapeptide. The peptide was also comparable with polymyxin B in its ability to inhibit LPS-mediated IL-l and IL-6 release from human peripheral blood mononuclear cells. The synthetic compound is devoid of antibacterial activities and did not induce conductance fluxes in LPS-containing asymmetric planar membranes. These results strengthen the premise that basicity and amphiphilicity are necessary and sufficient physical properties that ascribe endotoxin binding and neutralizing activities, and further suggest that antibacterial/membrane perturbant and LPS neutralizing activities are dissociable, which may be of value in designing LPS-sequestering agents of low toxicity.

Phase behavior of concentrated aqueous solutions of cetyltrimethylammonium bromide (CTAB) and sodium hydroxy naphthoate (SHN)

We have characterized the phase behavior of mixtures of the cationic surfactant cetyltrimethylammonium bromide (CTAB) and the organic salt 3-sodium-2-hydroxy naphthoate (SHN) over a wide range of surfactant concentrations using polarizing optical microscopy and X-ray diffraction. A variety of liquid crystalline phases, such as hexagonal, lamellar with and without curvature defects, and nematic, are observed in these mixtures. At high temperatures the curvature defects in the lamellar phase are annealed gradually on decreasing the water content. However, at lower temperatures these two lamellar structures are separated by an intermediate phase, where the bilayer defects appear to order into a lattice. The ternary phase diagram shows a high degree of symmetry about the line corresponding to equimolar CTAB/SHN composition, as in the case of mixtures of cationic and anionic surfactants.

Direct torque control schemes for split-phase induction machine

In this paper, direct torque control (DTC) algorithms for a split-phase induction machine (SPIM) are established. An SPIM has two sets of three-phase stator windings, with a shift of thirty electrical degrees between them. The significant contributions of this paper are: 1) two new methods of DTC technique for an SPIM are developed, called Resultant Flux Control Method and Individual Flux Control Method and 2) advantages and disadvantages of both methods are discussed. High torque ripple is a disadvantage for three-phase DTC. It is found that torque ripple in an SPIM can be significantly reduced without increasing the switching frequency.

Quantum phase transition in capacitively coupled double quantum dots

We investigate two equivalent, capacitively coupled semiconducting quantum dots, each coupled to its own lead, in a regime where there are two electrons on the double dot. With increasing interdot coupling, a rich range of behavior is uncovered: first a crossover from spin- to charge-Kondo physics, via an intermediate SU(4) state with entangled spin and charge degrees of freedom, followed by a quantum phase transition of Kosterlitz-Thouless type to a non-Fermi-liquid "charge-ordered" phase with finite residual entropy and anomalous transport properties. Physical arguments and numerical renormalization group methods are employed to obtain a detailed understanding of the problem.