Comprehensive Geriatric Assessment in Men Aged 70 Years or Older with Localised Prostate Cancer Undergoing Radical Radiotherapy.

AIMS: Treatment decisions for men aged 70 years or over with localised prostate cancer need to take into account the risk of death from competing causes and fitness for the proposed treatment. Objective assessments such as those included in a comprehensive geriatric assessment (CGA) might help to inform the decision-making process. The aim of this study was to describe the CGA scores of a cohort of older men with prostate cancer, evaluate potential screening tools in this population and assess whether any CGA component predicts significant acute radiotherapy toxicity. MATERIALS AND METHODS: This was a prospective cohort study undertaking pretreatment CGA, Vulnerable Elders Survey (VES-13) and G8 assessment in patients aged 70 years and over with localised prostate cancer planned to undergo radical external beam radiotherapy. RESULTS: In total, 178 participants were recruited over a 3 year period and underwent a CGA. Fifty-five (30.1%) participants were defined as having health needs identified by their CGA. Both VES-13 and G8 screening tools showed a statistically significant association with CGA needs (P < 0.001 and X2 = 15.02, P < 0.001, respectively), but their sensitivity was disappointing. There was no association between a CGA (or its components) and significant acute radiotherapy toxicity. CONCLUSIONS: Many older men with localised prostate cancer are vulnerable according to a CGA. The screening tools evaluated were not sufficiently sensitive to identify this group. CGA outcome does not predict for significant acute radiotherapy toxicity.

A retrospective review of cancer treatments and outcomes among Inuit referred from Nunavut, Canada.

BACKGROUND: Cancer is a health concern in Inuit populations. Unique cultural, dietary, and genetic factors and geographic isolation influence cancer epidemiology in this group. Inuit-specific data about oncology treatments and survival outcomes in Canadian Inuit referred to urban treatment centres are lacking. METHODS: A retrospective chart review of Inuit patients referred to The Ottawa Hospital Cancer Centre (tohcc) from the Baffin region of Nunavut between 2000 and 2010 was conducted. Nunavut cancer registry data were used to establish the percentage of cancer cases referred and their survival outcomes. RESULTS: Of 307 cancer patients registered among Baffin-region Inuit, 216 [70% (63 men, 153 women)] were referred to tohcc for chemotherapy (ct) and radiation therapy (rt). Mean age in the referred group was 59.3 years (range: 25-89 years), and current smokers constituted half the group (52%). The cancers most commonly leading to referral in men were lung (55%), colorectal (19%), and nasopharyngeal (11%) cancers; in women, they were lung (46%), colorectal (24%), breast (10%), nasopharyngeal (6%), and cervical (5%) cancers. Of the 216 referred patients, 82 (38%) had already undergone surgery, and 18 (8%) received chemoradiation or rt only, all given with curative intent. Among the surgical patients referred, 33 (40%) and 23 (28%) went on to receive adjuvant ct and adjuvant rt respectively. Among 116 patients referred for palliative care, 64 (55%) received ct, 76 (66%) received rt, 43 (37%) received both ct and rt, and 19 (16%) received neither treatment. Median all-stage overall survival was 10 months for patients with lung cancer [95% confidence interval: 6.1 to 13.9 months] and 37 months for patients with colorectal cancer [95% confidence interval: 14.8 to 59.2 months]. CONCLUSIONS: High uptake of palliative and adjuvant ct and rt was observed in the Inuit patients referred to tohcc. Lung cancer was the most common cancer in referred Inuit men and women. The survival rates for Inuit lung cancer patients referred to tohcc were comparable to those in the rest of Canada. Further research is required to understand reasons for non-referral of Canadian Inuit to tohcc.

Compact hohlraum configuration with parallel planar-wire-array x-ray sources at the 1.7-MA Zebra generator.

A compact Z-pinch x-ray hohlraum design with parallel-driven x-ray sources is experimentally demonstrated in a configuration with a central target and tailored shine shields at a 1.7-MA Zebra generator. Driving in parallel two magnetically decoupled compact double-planar-wire Z pinches has demonstrated the generation of synchronized x-ray bursts that correlated well in time with x-ray emission from a central reemission target. Good agreement between simulated and measured hohlraum radiation temperature of the central target is shown. The advantages of compact hohlraum design applications for multi-MA facilities are discussed.

Wire ablation dynamics model and its application to imploding wire arrays of different geometries.

The paper presents an extended description of the amplified wire ablation dynamics model (WADM), which accounts in a single simulation for the processes of wire ablation and implosion of a wire array load of arbitrary geometry and wire material composition. To investigate the role of wire ablation effects, the implosions of cylindrical and planar wire array loads at the university based generators Cobra (Cornell University) and Zebra (University of Nevada, Reno) have been analyzed. The analysis of the experimental data shows that the wire mass ablation rate can be described as a function of the current through the wire and some coefficient defined by the wire material properties. The aluminum wires were found to ablate with the highest rate, while the copper ablation is the slowest one. The lower wire ablation rate results in a higher inward velocity of the ablated plasma, a higher rate of the energy coupling with the ablated plasma, and a more significant delay of implosion for a heavy load due to the ablation effects, which manifest the most in a cylindrical array configuration and almost vanish in a single-planar array configuration. The WADM is an efficient tool suited for wire array load design and optimization in wide parameter ranges, including the loads with specific properties needed for the inertial confinement fusion research and laboratory astrophysics experiments. The data output from the WADM simulation can be used to simplify the radiation magnetohydrodynamics modeling of the wire array plasma.

Extreme ultraviolet spectroscopy and modeling of Cu on the SSPX Spheromak and laser plasma "Sparky".

Impurities play a critical role in magnetic fusion research. In large quantities, impurities can cool and dilute plasma creating problems for achieving ignition and burn; however in smaller amounts the impurities could provide valuable information about several plasma parameters through the use of spectroscopy. Many impurity ions radiate within the extreme ultraviolet (EUV) range. Here, we report on spectra from the silver flat field spectrometer, which was implemented at the Sustained Spheromak Physics experiment (SSPX) to monitor ion impurity emissions. The chamber within the SSPX was made of Cu, which makes M-shell Cu a prominent impurity signature. The Spect3D spectral analysis code was utilized to identify spectral features in the range of 115-315 Å and to more fully understand the plasma conditions. A second set of experiments was carried out on the compact laser-plasma x-ray∕EUV facility "Sparky" at UNR, with Cu flat targets used. The EUV spectra were recorded between 40-300 Å and compared with results from SSPX.

X-ray absorption spectroscopy of aluminum z-pinch plasma with tungsten backlighter planar wire array source.

Absorption features from K-shell aluminum z-pinch plasmas have recently been studied on Zebra, the 1.7 MA pulse power generator at the Nevada Terawatt Facility. In particular, tungsten plasma has been used as a semi-backlighter source in the generation of aluminum K-shell absorption spectra by placing a single Al wire at or near the end of a single planar W array. All spectroscopic experimental results were recorded using a time-integrated, spatially resolved convex potassium hydrogen phthalate (KAP) crystal spectrometer. Other diagnostics used to study these plasmas included x-ray detectors, optical imaging, laser shadowgraphy, and time-gated and time-integrated x-ray pinhole imagers. Through comparisons with previous publications, Al K-shell absorption lines are shown to be from much lower electron temperature (∼10-40 eV) plasmas than emission spectra (∼350-500 eV).

Influence of induced axial magnetic field on plasma dynamics and radiative characteristics of Z pinches.

The influence of an induced axial magnetic field on plasma dynamics and radiative characteristics of Z pinches is investigated. An axial magnetic field was induced in a novel Z-pinch load: a double planar wire array with skewed wires (DPWAsk), which represents a planar wire array in an open magnetic configuration. The induced axial magnetic field suppressed magneto-Rayleigh-Taylor (MRT) instabilities (with m = 0 and m = 1 instability modes) in the Z-pinch plasma. The influence of the initial axial magnetic field on the structure of the plasma column at stagnation was manifested through the formation of a more uniform plasma column compared to a standard double planar wire array (DPWA) load [V. L. Kantsyrev et al., Phys. Plasmas 15, 030704 (2008)]. The DPWAsk load is characterized by suppression of MRT instabilities and by the formation of the sub-keV radiation pulse that occurs before the main x-ray peak. Gradients in plasma parameters along the cathode-anode gap were observed and analyzed for DPWAsk loads made from low atomic number Z (Al) and mid-Z (brass) wires.

Observation of >400-eV precursor plasmas from low-wire-number copper arrays at the 1-MA zebra facility.

Experiments with cylindrical copper wire arrays at the 1-MA Zebra facility show that high temperatures exist in the precursor plasmas formed when ablated wire array material accretes on the axis prior to the stagnation of a z pinch. In these experiments, the precursor radiated approximately 20% of the >1000 eV x-ray output, and time-resolved spectra show substantial emission from Cu L-shell lines. Modeling of the spectra shows an increase in temperature as the precursor forms, up to approximately 450 eV, after which the temperature decreases to approximately 220-320 eV until the main implosion.

Diagnostic of charge balance in high-temperature tungsten plasmas using LLNL EBIT.

Diagnostic of high-temperature M-shell W plasmas is challenging because of contribution of numerous ionization stages in a relatively narrow x-ray spectral region. A method using LLNL EBIT data generated at different electron beam energies has been established for the identification of prominent spectral features and for the determination of charge balance in x-ray M-shell W spectra between 3.5 and 8.5 A. It extends previous work [A. S. Safronova et al., Can. J. Phys. 86, 267 (2008)] which used only Ni-like lines to include the neighboring ionization stages. This diagnostic procedure was tested with results from Z-pinch plasmas produced on the 1 MA pulse power generator Zebra at UNR. These results are of particular importance for fusion research.

X-ray diagnostics of imploding plasmas from planar wire arrays composed of Cu and few tracer Al wires on the 1MA pulsed power generator at UNR.

Tracer aluminum alloyed wires (Al5056) are used to provide additional information for x-ray diagnostics of implosions of Cu planar wire arrays (PWAs). Specifically, the analysis of combined PWA experiments using the extensive set of x-ray diagnostics is presented. In these experiments, which were conducted at the 1MA pulsed power generator at University of Nevada, Reno, the Z-pinch load consisted of several (eight) Cu alloyed (main material) and one to two Al alloyed (tracer) wires mounted in a single plane row or double parallel plane rows, single planar wire array (SPWA) or double planar wire array (DPWA), respectively. The analysis of x-ray spatially resolved spectra from the main material indicates the increase in the electron temperature T(e) near the cathode. In general, the axial gradients in T(e) are more pronounced for SPWA than for DPWA due to the more "columnlike" plasma formation for SPWA compared to "hot-spot-like" plasma formation for DPWA. In addition, x-ray spectra from tracer wires are studied, and estimated plasma parameters are compared with those from the main material. It is observed that the x-ray K-shell Al spectra manifest more opacity features for the case of SPWA with about 18% of Al mass (to the total load mass) compared to the case of DPWA with about 11% of Al mass. The analysis of time-gated spectra shows that the relative intensity of the most intense K-shell Al line, small before the x-ray burst, increases with time and peaks close to the maximum of the sub-keV signal.

Measurement of temperature, density, and particle transport with localized dopants in wire-array Z pinches.

Axially localized NaF dopants are coated onto Al cylindrical wire arrays in order to act as spectroscopic tracers in the stagnated z-pinch plasma. Non-local-thermodynamic-equilibrium kinetic models fit to Na K-shell lines provide an independent measurement of the density and temperature that is consistent with spectroscopic analysis of K-shell emissions from Al and an alloyed Mg dopant. Axial transport of the Na dopant is observed, enabling quantitative study of instabilities in dense z-pinch plasmas.

Congenital heart defects in Canadian Inuit: is more folic acid making a difference?

INTRODUCTION: Grain fortification of flour with folic acid has successfully reduced neural tube defects (NTDs) by approximately one half of the pre-fortification rate. The knowledge that the use of multivitamins with folic acid has also been shown to reduce some birth defects has prompted interest in determining whether folic acid may also play a role in the prevention of non-neural tube defects. Although NTDs are not more frequent in the Inuit of the Eastern Arctic, septal heart defects, were documented pre-fortification (1989-1994) to be increased 4 fold. OBJECTIVES: To determine if current efforts of fortification are sufficient and to explore other genetic/ environmental determinants of the increased rate of septal heart defects in the Eastern Arctic. METHODS: Inuit mothers of children from communities on Baffin Island with and without heart defects were invited to participate in a case control study evaluating nutrient intake, pregnancy exposures, RBC folate, serum cobalamin, homocysteine, and functional polymorphisms for genes important in folate metabolism and uptake. RESULTS: 41 children with isolated heart defects and their mothers with 36 community matched Inuit controls have entered the study to date. RESULTS: There were no differences in RBC folate (953 Vs 922 nmol/L p = .49), serum cobalamin, and homocysteine, between mothers of cases and controls. The combined average RBC folate for the women ages 18-45 was 947 +/- 32 nmol/L. There was no difference between any documented alcohol (H"30%) and cigarette (H"82%) use in pregnancy. No Inuit women were taking vitamins at conception or at the time of this study. The results of the genetic studies will be reported elsewhere. CONCLUSIONS: RBC folate (post-fortification) in our sample of women of childbearing years is reassuring. However, it is possible that pre-fortification levels combined with genetic predisposition may have previously influenced the high rate of heart defects. Follow-up study is underway to determine if rates of heart defects have decreased since fortification was commenced. Since folate alone may not be sufficient to reduce non-neural tube defects, culturally appropriate public health efforts need to be initiated to encourage multivitamin use periconceptionally.

Role of the prelimbic cortex in the acquisition, re-acquisition or persistence of responding for a drug-paired conditioned reinforcer.

The medial prefrontal cortex has been suggested to play a role in drug addiction due to its involvement in the reinstatement of drug seeking. In the present study, the role of the prelimbic cortex in persistent responding maintained by the earned presentations of a drug-paired conditioned reinforcer was studied. Temporary inactivation of the prelimbic, prefrontal cortex of rats had no effect on this persistent response, but did impair its initial acquisition, maintained by the drug-paired conditioned reinforcer. The lesion also impaired re-acquisition of this response after extinction by omission of the contingent conditioned reinforcer. These results suggest that the prelimbic cortex has a selective role in the acquisition, or re-acquisition, of instrumental responses for drug-paired conditioned reinforcers, that may be important in relapse to drug seeking. Anatomical controls with placements in the infralimbic cortex showed longer-lasting impairments in the acquisition of this response, consistent with the suggestion that the prelimbic and infralimbic cortices mediate different aspects of behavior, with the infralimbic being more specialized for habits. The implications of the present findings toward the understanding of drug seeking and relapse behaviors and the separate brain systems that may underlie them are discussed.

Novel treatment of Sézary-like syndrome due to adult T-cell leukaemia/lymphoma with daclizumab (humanized anti-interleukin-2 receptor alpha antibody).

We describe a patient with erythrodermic adult T-cell leukaemia/lymphoma resistant to multiple systemic therapies who, on the commencement of daclizumab, a humanized anti-interleukin-2 receptor antibody, developed a rapid and sustained complete response with resolution of previously debilitating erythroderma, suggesting significant activity of this agent in this disease process.

Crisis management during anaesthesia: awareness and anaesthesia.

BACKGROUND: Patient awareness during general anaesthesia has considerable potential for severe emotional distress in the patient as well as professional, personal, and financial consequences for the anaesthetist. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for awareness, in the detection and management of potential awareness in association with general anaesthesia. METHOD: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: Of the first 4000 reports received by AIMS, there were 21 incidents of patient awareness under general anaesthesia, and 20 of patients being paralysed while awake from "syringe swaps" before induction of anaesthesia. In 12 of the 21 reports there was an obvious cause, most commonly a low concentration of volatile agent (8 of 12 reports). The AIMS "core" crisis management algorithm would have detected the cause of awareness in all of these cases. In nine reports the course of anaesthesia appeared unremarkable, and in these the algorithm would not have been expected to detect or prevent awareness. Volatile agent monitoring would have prevented some cases of awareness, as would bispectral index electroencephalographic (BIS) monitoring. The role of BIS monitoring is still contentious, but it should be considered for high risk patients. CONCLUSION: Awareness should be minimised by thorough checking of equipment, particularly vaporisers, and frequent application of a structured scanning routine. Awareness may occur during crisis management and aftermath protocols should include patient follow up to detect and manage awareness when it occurs.

Trauma: development of a sub-algorithm.

BACKGROUND: Anaesthetists are regularly involved in the management of patients who have suffered trauma. Acute physiological derangements can occur at any time after the original injury, with life threatening sequelae. These problems may be complex in nature and evolve rapidly, often with an obscure aetiology, so a systematic approach to them is essential. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for trauma, in the management of anaesthesia involving trauma cases. METHODS: The potential performance of a structured approach for each of the trauma incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved. RESULTS: There were 38 relevant reports relating to trauma in the first 4000 reports to AIMS. In 39% of these there was "emergency corner cutting", although in the majority the urgency was thought to have been more perceived than real. The previously described "core" crisis management algorithm for crises during general anaesthesia was an effective means of discovering (82%), diagnosing (68%), and correcting (66%) the majority of trauma incidents. However a sub-algorithm specific for the traumatised patient was required for unusual, obscure, or complex presentations. CONCLUSION: Although the small numbers preclude validation of the sub-algorithm, it would have successfully managed all the trauma cases reported to AIMS.

Crisis management during anaesthesia: sepsis.

BACKGROUND: Anaesthesia with concurrent sepsis is risky, and involves consideration of possible organ dysfunctions-respiratory, cardiovascular, renal, and haematological--as well as ensuring that appropriate antibiotics are given after taking the necessary microbiological specimens. Because prompt attention needs to be paid to so many body systems, the place for a structured approach during anaesthesia for a septic patient was assessed. OBJECTIVES: To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a specific sub-algorithm for sepsis, in the management of sepsis occurring in association with anaesthesia. METHODS: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. RESULTS: Sepsis was identified as the primary problem in 13 of the first 4000 reports (<1%) to AIMS. The incidents reported generally occurred in sick patients; 70% were ASA status III or worse. The COVER ABCD algorithm provided a diagnosis and corrective manoeuvre in only 15% (2/13) of reported incidents, and the sepsis sub-algorithm provided adequate therapeutic strategies in a further 38% (5/13) of the incidents. Eight cases required the use of additional sub-algorithms for desaturation (30%), cardiac arrest (15%), hypotension (8%), and aspiration (8%). CONCLUSION: Sepsis involves a serious physiological stress upon multiple organ systems. The use of a structured approach involving a core algorithm and additional sub-algorithms as required provides a series of checklists that can successfully deal with the complex multiple and interrelating problems that these patients present.

Factors associated with quality of life in Menière's disease.

The aim of this study was to identify the factors associated with better or worse quality of life in a sample of people with Menière's disease drawn from a UK self-help group (the Menière's Society) and to assess the forms of support on which the respondents could draw. A postal survey was sent to 1000 randomly selected group members, containing validated questionnaires assessing: (1) quality of life (the Short Form 36 (SF-36)); (2) factors that might predict quality of life; and (3) usage of resources provided to members by the Menière's Society. A total of 509 members completed the main survey, and 370 the second part of the survey. Factors associated with a less good quality of life included more severe vertigo, pressure in the ear, hearing loss and tinnitus, being younger, being female, living alone, having a lower occupational status and believing that the attitude of the consultant is unhelpful. Levels of vertigo severity in this sample were similar to those found in hospital samples, but it is possible that these respondents may differ in other respects from patients who do not join a self-help group.