Adjuvant chemotherapy in elderly women with breast cancer (AChEW): an observational study identifying MDT perceptions and barriers to decision making.

BACKGROUND: As few older women with breast cancer receive adjuvant chemotherapy, we examined the barriers and perceptions of 24 UK NHS multidisciplinary breast cancer teams to offering this treatment to women ≥70 years. PATIENTS AND METHODS: Questionnaires regarding 803 patients with newly diagnosed breast cancer were completed by specialist teams following discussion or outpatient consultation. RESULTS: Of 803 patients, 116 (14%), all <85 years, were offered chemotherapy and 66 (8%) received it. Only 94 of 309 (30%) of women with high-risk disease were offered chemotherapy, and 53 (17%) received it. The most common reasons for not offering chemotherapy were 'other treatments more appropriate' (usually patients with ER-positive tumours) or 'benefits too small' (63% and 54% of patients, respectively). Co-morbidities and frailty were less common reasons but became more frequent with increasing age. Recommendations regarding chemotherapy were made in the absence of documented HER2 and performance status in 29% and 33%, respectively. Treatment offered varied considerably between cancer centres. CONCLUSIONS: National guidelines need development describing the minimally acceptable data for decision making, incorporating objective fitness measures and specific treatment recommendations. Such guidelines will require educational support for implementation but should standardise care and improve chemotherapy uptake in this increasing population of older patients.

Adjuvant chemotherapy in older women (ACTION) study - what did we learn from the pilot phase?

BACKGROUND: The ACTION trial was initiated to provide evidence from a randomised trial on the effects of chemotherapy in women aged over 70 years where evidence for risk and benefit are lacking. METHODS: This was a randomised, phase III clinical trial for high risk, oestrogen receptor (ER) negative/ER weakly positive early breast cancer. The trial planned to recruit 1000 women aged 70 years and older, randomised to receive 4 cycles of anthracycline chemotherapy or observation. The primary endpoint was relapse-free interval. The trial included a pilot phase to assess the acceptability and feasibility of recruitment. RESULTS: The trial opened at 43 UK centres. Information on number of patients approached was available from 38 centres. Of the 43 eligible patients that were approached, 39 were not randomised due to patients declining entry. After 10 months only 4 patients had been randomised and after discussion with the research funder, the trial was closed and funding terminated. CONCLUSION: Despite widespread support at several public meetings, input from patient groups including representation on the Trial Management Group, the trial failed to recruit due to the inability to convince patients to accept randomisation. It would therefore seem that randomising the patients to receive chemotherapy vs observation is not a viable design in the current era for this patient population.

Quality of life and patient-reported outcomes in the older breast cancer patient.

As the world population ages, the incidence of cancer will probably also increase as it is a disease predominantly affecting older people. However, those aged 70 years or more have largely been excluded from clinical trials. This review focuses on breast cancer. Increasingly there is recognition that many older breast cancer patients are being undertreated and could and should be offered the same treatments as younger patients. Comprehensive assessment of the quality of any survival benefit from treatments is also needed to ensure that in the future older patients can make fully informed decisions about their treatment options. The aim of this overview is two-fold: first to describe methods by which to assess quality of life; and second to review the recent surgical, radiotherapy, chemotherapy and other studies that include such assessment with older breast cancer patients. Current studies are also outlined, including quality of life assessments, and recommendations are made for future research in this area.

Corrosion behavior of 904L austenitic stainless steel in hydrofluoric acid.

Corrosion behaviors of 904L austenitic stainless steel in HF and HCl were studied and compared using electrochemical method, microscopic analysis, and phase analysis. An insoluble layer is deposited on 904L in HF due to a preferential reaction between [F-] and the [Ni] from the alloy. This insoluble deposited layer not only helps isolate the aggressive ions from the base metal, but also inhibits the passivation of 904L in HF, the mechanism for which was entirely different from that in HCl.

Drug Information Association (DIA) - 52nd Annual Meeting (June 26-30, 2016 - Philadelphia, Pennsylvania, USA).

The Drug Information Association's Annual Meeting is the largest global event which crosses all disciplines involved in the discovery development and life cycle management of healthcare products. The 2016 meeting, its 52nd occurrence, brought experts from regulatory and government agencies, industry, academia and health and patient organizations together to discuss novel therapies in development and how to use these to enhance health and well-being in patient groups, with the hope of increasing knowledge across all areas involved.

CT abnormalities in schizophrenia. A preliminary study of their correlations with P300/P200 electrophysiological features and positive/negative symptoms.

Computed tomographic scans were scored blindly for the size of cerebrospinal fluid spaces in a group of nine medicated schizophrenics and a group of nine age-matched normal volunteers without psychiatric or medical problems. Overall, ten of the 18 computed tomography (CT) features measured were significantly enlarged in the schizophrenic group. These abnormal CT features were then correlated with electrophysiological and clinical measurements performed on the schizophrenic patients. Left sylvian fissure enlargement, thought to reflect temporal lobe tissue loss, was highly correlated with a left temporal scalp region feature of the auditory P300 measure (T3 electrode) that differentiated schizophrenics and normals, and both the left sylvian fissure enlargement and the P300 measure were highly correlated with positive symptoms (total score on the Scale for the Assessment of Positive Symptoms). Frontal superficial (cortical) sulcal enlargement was prominent in the schizophrenic group and was highly correlated with another electrophysiological measure, auditory P200, at left central scalp locations. There was no significant correlation between left sylvian fissure and frontal sulcal enlargement within the schizophrenic group, and intercorrelations between CT variables in the schizophrenic group were, in general, less significant than in the control group. Although we should be cautious about generalizability because of the small number of patients, these data are compatible with the hypothesis that different subgroups of schizophrenic pathological features are characterized by different CT, electrophysiological, and clinical presentations.

Correlations between abnormal auditory P300 topography and positive symptoms in schizophrenia: a preliminary report.

P300 component amplitude in the left temporal scalp region, shown in three previous studies to differentiate normals from schizophrenics, was found to be significantly correlated with the Thought Disorder Index (TDI) and the Scale for the Assessment of Positive Symptoms (SAPS). These correlations occurred primarily in the P300 waveform derived from the Goodin paradigm. These findings suggest a brain processing disturbance in positive symptom schizophrenia that may be reflected by electrophysiological abnormalities detectable in the temporal scalp region.

Clinical correlations of auditory P200 topography and left temporo-central deficits in schizophrenia: a preliminary study.

A number of studies using nontopographic analyses have reported an amplitude decrement of the auditory P200 component in schizophrenics compared to normal controls. Here we report a topographic analysis of the auditory P200 (204-272 ms; peak to baseline) in chronic medicated schizophrenics (N = 11) and normal controls (N = 18) and the correlation between this measure and clinical symptoms in schizophrenia. Exploratory T-statistic mapping (SPM) and "protected" Hotelling's T-squared contrasts of integrated voltages over the entire scalp showed that schizophrenics' P200 component had diminished amplitude in the left temporo-central region. Furthermore, P200 amplitude in the same scalp region during the experimental condition of counting infrequent tones was highly correlated with negative symptoms in the schizophrenic group.

Effects of various treatments of bovine complement on its lytic efficacy measured by two different tests.

Bovine complement was treated with various agents known to activate or inactivate one or more of the cascade components. The treated complement was then assessed for remaining hemolytic activity by a tube titration test and a radial hemolysis method. Divalent cation chelators (EDTA and EGTA); immune complexes prepared with serum and IgM, IgG1, IgG2, and IgA isotypes; smooth and rough lipopolysaccharides and lipid A; hydrazine; zymosan; cobra venom factor and brown recluse spider venom caused depletion of complement as determined in the tube titration test. Immune complexes (prepared with serum); hydrazine; cobra venom factor; EDTA and smooth lipopolysaccharide caused loss of hemolytic activity in the radial hemolysis test. This evidence suggests that the radial hemolysis test assessed complement consumed by the alternate pathway, while the tube titration method measured classical pathway consumption.

Metastatic carcinoma of unknown primary: complete response to second-line treatment with plicamycin.

In selected groups of patients, metastatic carcinoma of unknown primary (MCUP) is highly responsive to cisplatin-based combination chemotherapy. These therapeutic responses usually are partial and shortlived. The authors report the case of a 41-year-old man whose MCUP relapsed after responding to cisplatin, bleomycin, and etoposide. Alternate-day treatment with plicamycin induced a second complete remission (CR) in this patient with minimal hematologic and metabolic toxicity. Plicamycin may prove effective in enhancing CR rate, prolonging CR duration, and salvaging cisplatin failures in MCUP.

Lipid provisioning of turtle eggs and hatchlings: total lipid, phospholipid, triacylglycerol and triacylglycerol fatty acids.

Lipid composition of eggs and hatchlings was studied in painted, snapping and Blanding's turtles from western Nebraska. The average total lipid proportions of the egg yolk, post-embryonic yolk and hatchling soma dry masses were high in painted turtles (29.80%, 42.16% and 14.18%, respectively) relative to snapping and Blanding's turtles (egg yolk < 14%, postembryonic yolk < 17%, hatchling soma < 2%). The proportion of total egg yolk lipid used during development varied among species (painted turtles, x = 45.4%; snapping turtles, x = 68.9%; Blanding's turtles, x = 86.6%). Total lipid data are consistent with patterns reported for turtle species whose hatchlings overwinter in the nest (e.g., painted turtles) vs those whose hatchlings emerge in the fall (e.g., snapping and Blanding's turtles). In all species, the total lipid quantity of egg and hatchling components was primarily triacylglycerol (> 63%), an energy storage form. Predominant triacylglycerol fatty acids in eggs and hatchlings were 16:0, 16:1 and 18:1, and concentration changes of some yolk fatty acids occurred during development. The average phospholipid (a membrane form) quantity of the egg and hatchling components was relatively low in painted turtles (< 2% of the total lipid). In snapping and Blanding's turtles, the relatively large phospholipid proportion of the post-embryonic yolks (approximately 7%) could potentially contribute more to post-embryonic growth in these species than the phospholipids of painted turtle post-embryonic yolks.

Occurrence and seasonal incidence of mosquitoes on Indian reservations in Iowa, Nebraska and South Dakota during 1983.

A mosquito surveillance program designed to prevent future human cases of Western equine encephalitis or Saint Louis encephalitis was established in 1983 on Indian reservations under the jurisdiction of the Aberdeen Area Indian Health Service in Iowa, Nebraska and South Dakota. Standard New Jersey light traps were operated on all reservations throughout the summer season while CDC miniature and encephalitis virus surveillance traps were employed for shorter periods of time on 4 reservations. Aedes vexans was the most abundant species except on the Pine Ridge, Rosebud, Winnebago and Yankton Sioux reservations in which Culex tarsalis predominated and for the Sac-n-Fox where Aedes trivittatus occurred with the greatest frequency.

Veterans Affairs Multicenter Low Vision Enhancement System (LVES) study: clinical results. Report 1: effects of manual-focus LVES on visual acuity and contrast sensitivity.

PURPOSE: The Department of Veterans Affairs LVES Study is a multicenter study to determine the effectiveness of the Low Vision Enhancement System (LVES) as a visual rehabilitation device. The purpose of this study was to explore the efficacy of the Beta 1 manual-focus LVES for improving visual acuity and contrast sensitivity. METHODS: Patients whose visual acuity was 20/80 or worse in the better eye from any disease, who did not have significant visual field loss, who had previous low vision experience and were capable of working with the LVES were enrolled in a comprehensive prospective multicenter clinical evaluation. Initially, corrected spectacle visual acuities were measured using a standardized ETDRS chart. Contrast sensitivities were also measured with spectacle correction using a standardized Peli-Robson chart. These results were then compared to the acuities and contrast sensitivity obtained with the LVES at optimal magnification. Also, visual acuities were measured using an Eschenbach 3x spectacle-mounted binocular telescope, then compared to the acuities obtained using the LVES set at the lowest magnification (3x). RESULTS: All patients who completed the study demonstrated an improvement in visual acuity, with a median improvement of six lines of Snellen equivalent acuity using the LVES. Improvement in visual acuity was the same in both ARMD and non-ARMD causes of vision loss. Mean contrast sensitivity improved in 52 of 58 patients tested, with a mean improvement of 0.49 log units. CONCLUSION: The LVES significantly improves both visual acuity and contrast sensitivity in visually impaired patients who fall within the study criteria. Up to 10-fold improvement in visual acuity and up to 1.80 log units improvement in contrast sensitivity were noted in the study group when the LVES was used.

Policy development and the estuary environment: a Severn Estuary case study.

The paper reviews the development of key policy relating to estuary management, highlighting the trends and drivers in policy development which have shaped the management and protection of the estuary environment. Focusing on policy developments over the last three decades, the paper draws attention to the significant influence of European policy and new approaches to environmental governance in stimulating wider and more integrated approaches to the environmental management of the estuary, as well as highlighting considerable environmental improvements associated with increased environmental regulation. The paper discusses how 'fit for purpose' the policy framework is to address current challenges, including those identified by recent stakeholder consultations. Significant issues include limited understanding and information related to the cause-effect relationships between policy and environmental quality as well as ongoing institutional and policy fragmentation associated with devolutionary processes. Such fragmentation, alongside under-investment in integrated estuary planning, is likely to prove a particular challenge to balanced and informed decision-making. Whilst the paper focuses on the Severn experience, the approach adopted will be of interest to all assessing policy-environment linkages.

CMV retinitis.

BACKGROUND: Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection in patients with AIDS. CMV retinitis is often asymptomatic and usually appears when the patient's CD4 lymphocyte levels fall below 50/mm3. The infection may present a variety of clinical appearances and must be carefully differentiated from cotton-wool spots in early infection. PURPOSE: This paper reviews the natural history of CMV infection in both the normal population and in patients with AIDS. CMV retinitis presenting in AIDS patients is then described in detail with clinical presentations of fundus features. Finally, the management of patients who may be at risk or have developed CMV retinitis is reviewed. Recent data on suggested management protocols are also provided. CONCLUSIONS: Cases of CMV retinitis will continue to increase as the AIDS epidemic progresses. The primary care practitioner will play an increasingly important role in the diagnosis and management of patients with this infection.

Quantitative analytical electron microscopy of multiphase alloys.

In this paper, we present a technique for analysis of composition gradients, using an analytical electron microscope, within the primary phase of a two-phase alloy for the case where the second-phase particle size is similar to the size of the irradiated volume. If the composition difference between the two phases is large, the detected compositional fluctuations associated with varying phase fractions may mask any underlying composition gradient of the primary phase. The analysis technique was used to determine grain boundary chromium concentration gradients in a nickel-base superalloy, alloy X-750. The technique may also be of use in other alloy systems.

A "dipstick" enzyme immunoassay for detection of antibody to Brucella abortus in cattle sera.

An enzyme immunoassay that utilizes antigen bound to a matrix which can be removed from the substrate to stop development is described. The assay which is performed in glass or plastic disposable tubes uses Gel-Bond film strips for attachment of antigen. The only equipment requirements are a rotary shaker and a spectrophotometer (optional). The antigen coated strips are passed through a series of tubes containing test serum, wash solution, antibody-enzyme conjugate, wash solution and substrate-chromogen taking about 45 minutes to perform. In testing sera with or without antibody to Brucella abortus a very high correlation existed between same day tests and tests performed over several days as well as with data on the same sera obtained by an enzyme immunoassay in a microtiter format.

Sucrose polyester: a new oral contrast agent for MRI.

Sucrose polyester (a dietary fat substitute) opacifies the entire gastrointestinal tract of the rat with oral administration in magnetic resonance imaging (MRI). These results suggest the potential use of this material as an oral contrast agent for human abdominal MRI studies.