Treatment patterns and long-term survival outcomes for patients with stage III non-small cell lung cancer: A retrospective study.

AIM: Lung cancer is the leading cause of cancer-related deaths in Australia with poor long-term survival outcomes. Stage III non-small cell lung cancer (NSCLC) is a highly heterogenous group with diverse tumor characteristics and multiple, possible treatment options. We present retrospective data on patient characteristics, treatment patterns, and long-term outcomes in stage III NSCLC patients treated at a single cancer center in New South Wales, Australia. METHODS: Stage III NSCLC patients were identified from the 'Nepean Cancer Research Biobank'. Patient demographics, cancer-related information, and long-term follow-up data were collected and analyzed. RESULTS: A total of 88 patients were eligible for analysis with 61% of them diagnosed as stage IIIA, 35% IIIB, and 4% IIIC. Induction chemotherapy was administered in 20% of the patients. Overall, 48% of the study population underwent surgery, and 38% underwent concurrent chemoradiotherapy (CCRT). Both median progression-free survival and overall survival (OS) were superior in stage IIIA patients in comparison to stage IIIB (and IIIC) patients (22 vs. 11 months, p = .018; and 58 vs. 19 months, p = .048, respectively). Patients who were younger (<65 years old), good Eastern Cooperative Oncology Group performance status (ECOG PS <2), and females had better prognosis on univariate analysis. There was a nonstatistically significant trend toward better median OS with CCRT in comparison to surgery (58 vs. 37 months, p = .87). CONCLUSIONS: Long-term outcomes remain poor, and hence better treatment strategies are urgently needed in stage III NSCLC. Equally, more robust, prospective studies would help delineate the optimal treatment modality in these patients.

Analysis of Ignition Sites for the Explosives 3,3'-Diamino-4,4'-azoxyfurazan (DAAF) and 1,3,5,7-Tetranitro-1,3,5,7-tetrazoctane (HMX) Using Crush Gun Impact Testing.

The handling safety characteristics of energetic materials must be measured in order to ensure the safe transport and use of explosives. Drop-weight impact sensitivity measurements are one of the first standardized tests performed for energetics. They utilize a small amount of the explosive sample and a standard weight, which is dropped on the material from various heights to determine its sensitivity. While multiple laboratories have used the impact sensitivity test as an initial screening tool for explosive sensitivity for the past 60 years, variability exists due to the use of different instruments, different methods to determine the initiation, and the scatter commonly associated with less-sensitive explosives. For example, standard explosives such as 1,3,5,7-tetranitro-1,3,5,7-tetrazoctane (HMX) initiate reliably and consistently on the drop-weight impact test, whereas insensitive explosives such as 3,3'-diamino-4,4'-azoxyfurazan (DAAF) exhibit variability in sound levels and the expended material. Herein we investigate the impact sensitivity of DAAF and HMX along with a more detailed investigation of ignition sites using a novel "crush gun" apparatus: a pneumatically powered drop-weight tower with advanced diagnostics, including high-speed visual and infrared cameras. Using this crush gun assembly, the ignition sites in HMX and DAAF were analyzed with respect to the effects of particle size and the presence of a source of grit. The formation of ignition sites was observed in both explosives; however, only HMX showed ignition sites that propagated to a deflagration at lower firing speeds. Finally, the presence of grit particles was shown to increase the occurrence of ignition sites in DAAF at lower firing speeds, though propagation to a full reaction was not observed on the time scale of the test. These results enable a better understanding of how ignition and propagation occurs during the impact testing of DAAF.

Synthesis of Erythritol Tetranitrate Derivatives: Functional Group Tuning of Explosive Sensitivity.

Understanding the factors that affect explosive sensitivity is paramount to the safe handling and development of new explosives molecules. Erythritol tetranitrate (ETN) is an explosive that recently has attracted significant attention in the explosives community because of its ease of synthesis and physical properties. Herein, we report the synthesis of ETN derivatives using azide, nitramine, and nitrate ester functional groups. Impact, spark, and friction sensitivity measurements, computationally calculated explosive properties, and the crystal structure analysis of the ETN derivatives are reported. Mixing explosive functional groups led to changes in the explosive sensitivity, explosive performance as well as physical properties including melting point and physical state at room temperature. Overall, we have demonstrated that combining functional groups can enable the tuning of explosive and physical properties of a molecule. This tunability can potentially aid in the development of new explosives in which characteristics are varied to meet certain specifications.

Increased handling sensitivity of molten erythritol tetranitrate (ETN).

Erythritol tetranitrate (ETN) is a well-studied homemade explosive (HME), which is known for its ability to be melt-cast at a fairly low temperature. We have observed dramatically increased handling sensitivity of ETN in the molten state, using temperature controlled drop-weight impact sensitivity measurements. Impact testing was performed using ERL Type 12 drop hammer equipment using a 2.5 kg weight, a 0.8 kg striker, an anvil and sound detection equipment. Most experiments were performed in the absence of standard grit paper, due to the elevated temperature measurements with a liquid. At room temperature, ETN exhibited an impact sensitivity of 14.7 ± 3.4 cm, which changed to 1.0 ± 0.6 cm in the liquid state at 65 °C. The change in sensitivity in the liquid state was found to be reversible upon solidification, and did not appear to correlate with temperature. Control experiments were performed in the same setup using standard explosives pentaerythritol tetranitrate (PETN) and triacetone triperoxide (TATP). This is the most sensitive material that we have been able to measure using our instrumentation, and indicates that ETN be handled with extreme caution during the melt-casting process.

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary work group to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.

Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety.

Perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age. When left untreated, perinatal mood and anxiety disorders can have profound adverse effects on women and their children, ranging from increased risk of poor adherence to medical care, exacerbation of medical conditions, loss of interpersonal and financial resources, smoking and substance use, suicide, and infanticide. Perinatal mood and anxiety disorders are associated with increased risks of maternal and infant mortality and morbidity and are recognized as a significant patient safety issue. In 2015, the Council on Patient Safety in Women's Health Care convened an interdisciplinary workgroup to develop an evidence-based patient safety bundle to address maternal mental health. The focus of this bundle is perinatal mood and anxiety disorders. The bundle is modeled after other bundles released by the Council on Patient Safety in Women's Health Care and provides broad direction for incorporating perinatal mood and anxiety disorder screening, intervention, referral, and follow-up into maternity care practice across health care settings. This commentary provides information to assist with bundle implementation.