bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non–Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care
Authors: Temel Jennifer S. , Greer Joseph A. , Admane Sonal , Gallagher Emily R. , Jackson Vicki A. , Lynch Thomas J. , Lennes Inga T. , Dahlin Connie M. , Pirl William F. 
Published: May 2011

Purpose Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. Patients and Methods Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). Conclusion Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.
Response, Survival, and Long-Term Toxicity After Therapy With the Radiolabeled Somatostatin Analogue [90Y-DOTA]-TOC in Metastasized Neuroendocrine Cancers
Authors: Imhof Anna , Brunner Philippe , Marincek Nicolas , Briel Matthias , Schindler Christian , Rasch Helmut , Mäcke Helmut R. , Rochlitz Christoph , Müller-Brand Jan , Walter Martin A. 
Published: May 2011

Purpose To investigate response, survival, and safety profile of the somatostatin-based radiopeptide 90yttrium-labeled tetraazacyclododecane-tetraacetic acid modified Tyr-octreotide ([90Y-DOTA]-TOC) in neuroendocrine cancers. Patients and Methods In a clinical phase II single-center open-label trial, patients with neuroendocrine cancers were treated with repeated cycles of [90Y-DOTA]-TOC. Each cycle consisted of a single intravenous injection of 3.7GBq/m2 body-surface [90Y-DOTA]-TOC. Additional cycles were withheld in case of tumor progression and/or permanent toxicity. Results Overall, 1,109 patients received 2,472 cycles of [90Y-DOTA]-TOC (median, two; range, one to 10 cycles per patient). Of the 1,109 patients, 378 (34.1%) experienced morphologic response; 172 (15.5%), biochemical response; and 329 (29.7%), clinical response. During a median follow-up of 23 months, 491 patients (44.3%) died. Longer survival was correlated with each: morphologic (hazard ratio [HR], 0.46; 95% CI, 0.38 to 0.56; median survival, 44.7 v 18.3 months; P < .001), biochemical (HR, 0.75; 95% CI, 0.59 to 0.96; 35.3 v 25.7 months; P = .023), and clinical response (HR, 0.68; 95% CI, 0.56 to 0.82; 36.8 v 23.5 months; P < .001). Overall, 142 patients (12.8%) developed grade 3 to 4 transient hematologic toxicities, and 103 patients (9.2%) experienced grade 4 to 5 permanent renal toxicity. Multivariable regression revealed that tumoral uptake in the initial imaging study was predictive for overall survival (HR, 0.45; 95% CI, 0.29 to 0.69; P < .001), whereas the initial kidney uptake was predictive for severe renal toxicity (HR, 1.59; 95% CI, 1.17 to 2.17; P = .003). Conclusion This study documents the long-term outcome of [90Y-DOTA]-TOC treatment in a large cohort. Response to [90Y-DOTA]-TOC is associated with longer survival. Somatostatin receptor imaging is predictive for both survival after [90Y-DOTA]-TOC treatment and occurrence of renal toxicity.
Lymph Nodes, Tumor Deposits, and TNM: Are We Getting Better?
Authors: Nagtegaal Iris D. , Tot Tibor , Jayne David G. , McShane Phil , Nihlberg Anders , Marshall Helen C. , Påhlman Lars , Brown Julia M. , Guillou Pierre J. , Quirke Philip 
Published: May 2011

Purpose New editions of the TNM staging system for colorectal cancer have been subject to extensive criticism. In the current study, we evaluate each edition of TNM and analyze stage migration caused by the different versions. Patients and Methods Two independent test populations were used: participants derived from a randomized surgical trial from the United Kingdom (n = 455) and patients from a population-based series from Sweden (n = 505). All slides from these patient cases were reviewed with special attention for the presence of tumor deposits. Tumor deposits were classified according to the fifth, sixth, and seventh editions of TNM and correlated with prognosis. Results Every change in edition of TNM led to a stage migration of between 33% and 64% in patients with tumor deposits. Reproducibility was best in the fifth edition of TNM. The prognostic value of the seventh edition was best only when all tumor deposits irrespective of size or contour were included as lymph nodes. The prognostic value of the fifth edition was better than that of the sixth. Conclusion We demonstrate there is a place for tumor deposits in the staging of patients with colorectal cancer. However, many questions remain about their definition and the reproducibility and use of this category in special situations, such as after neoadjuvant treatment. These should be the subject of additional research before use as a factor in TNM staging. This work demonstrates the necessity of testing modifications before their introduction.
Treatment of Patients With Metastatic Urothelial Cancer “Unfit” for Cisplatin-Based Chemotherapy
Authors: Galsky Matthew D. , Hahn Noah M. , Rosenberg Jonathan , Sonpavde Guru , Hutson Thomas , Oh William K. , Dreicer Robert , Vogelzang Nicholas , Sternberg Cora N. , Bajorin Dean F. , Bellmunt Joaquim 
Published: May 2011

Purpose Cisplatin-based combination chemotherapy is considered standard first-line treatment for patients with metastatic urothelial carcinoma. However, a large proportion of patients with metastatic urothelial carcinoma are considered “unfit” for cisplatin. The purpose of this review is to define unfit patients and to identify treatment options for this subgroup of patients. Patients and Methods In this review, the criteria used to define unfit patients are explored and the results of prospective clinical trials evaluating chemotherapeutic regimens in unfit patients are summarized. Results Several phase II trials and a single, large phase III trial have explored chemotherapeutic regimens for the treatment of unfit patients with metastatic urothelial carcinoma. Heterogeneous eligibility criteria have been used to define unfit patients in these studies. A uniform definition of unfit is proposed on the basis of the results of a survey of genitourinary medical oncologists. According to this definition, unfit patients would meet at least one of the following criteria: Eastern Cooperative Oncology Group performance status of 2, creatinine clearance less than 60 mL/min, grade ≥ 2 hearing loss, grade ≥ 2 neuropathy, and/or New York Heart Association Class III heart failure. Conclusion Additional studies to optimize treatment for this important subset of patients are needed. A uniform definition of unfit patients will lead to more uniform clinical trials, enhanced ability to interpret the results of these trials, and a greater likelihood of developing a viable strategy for regulatory approval.
Primary breast sarcoma: prevalence, clinical signs, and radiological features
Authors: Surov Alexey , Holzhausen Hans-Jürgen , Ruschke Kathrin , Spielmann Rolf Peter 
Published: May 2011

Background Primary breast sarcoma is very rare. Most reports regarding sarcoma of the breast are clinical observations or pathological series and provide either no or inconstant radiological information. Radiological publications consist predominantly of isolated case reports or small series. Purpose To determine the prevalence, clinical signs, and radiological features of primary breast sarcoma. Material and Methods This is a retrospective review of 21 patients with breast sarcoma. All patients were female and their median age was 66 years (range 27–86). In all patients the diagnosis was confirmed histopathologically. Results The prevalence of breast sarcoma was 0.1% of all identified cases with breast malignancies. Clinically, all patients presented with solitary painless breast lumps. There was no uni- or bilateral axillary lymphadenopathy. On mammography ( n = 19), two mammographic patterns could be identified: breast masses (68%), and architectural distortion (32%). On ultrasound ( n = 8), most lesions were homogeneously hypoechoic, lobular or oval in shape with microlobulated or indistinct margins. On magnetic resonance imaging ( n = 3), marked inhomogeneous contrast enhancement was seen in all investigated cases. Conclusion The imaging findings of primary breast sarcoma are not pathognomonic. However, they should be taken into consideration in the differential diagnosis of breast lesions.
The incidence of peripheral arterial embolism in association with a patent foramen ovale (right-to-left shunt)
Authors: Rushdi Yusuf Ali Kausar , Hina Hina , Patel Bijendra , Cross Frank W 
Published: May 2011

Summary Objectives The aim of this study was to examine a cohort of patients who had suffered an arterial embolism to see whether a patent foramen ovale (PFO) was an identifiable cause. Design This study was conducted in two parts; a retrospective limb involving an audit of patient records over a period of 10 years, and a prospective limb including selected patients from that audit to search for a PFO using an agitated saline test with transcranial Doppler ultrasound monitoring of the anterior cerebral artery. Data on patients with peripheral vascular disease were collected using a structured questionnaire. Setting A clinical vascular department. All patients were seen in the vascular outpatients clinic. Participants Patients who had been identified from a retrospective search based on the headline diagnosis of arterial embolus. Collected data on the 71 patients revealed that 75% had predisposing factors for DVT, 70% were male smokers, and 84.4% had a significant past history of vascular symptoms. Main outcome measures Whether or not patients identified as having a possible PFO actually had one on objective testing with transcranial Doppler assessment of the cerebral circulation with an agitated saline solution. Results Fifteen patients who were suspected of having a PFO were selected from these 71 patients; 12 of these were found to have no PFO on testing, and three had already undergone a percutaneous PFO closure. Conclusion The incidence of a PFO in this small study group is no higher than that found in the general population (3/15, 20%). There was high prevalence of male smokers with associated predisposing factors leading to a DVT.
Predation on Cacajao ouakary and Cebus albifrons (Primates: Platyrrhini) by harpy eagles
Authors: Barnett Adrian A. , Schiel Verena , Deveny Adrian , Valsko Jefferson , Spironello Wilson R. , Ross Caroline 
Published: May 2011

Abstract
Predation of tropical arboreal mammals is rarely observed. Here, we report the first observation of predation of a member of the genus Cacajao, and add to the knowledge of eagle predation in the genus Cebus. We compare responses to predation by Cacajao ouakary and Cebus albifrons with previous studies of congenerics and with other close relatives, and compare the alarm vocalizations of C. ouakary with those of other pitheciines. Reactions to non-predating raptors are reported. Constraints on primate anti-predator responses in flooded and non-flooded habitats are considered.
Privacy in Communications on the Internet
Authors: Panchenko Andriy 
Published: May 2011

Abstract
Privacy on the Internet is becoming a concern as an already significant and ever growing part of our daily activities is carried out online. While cryptography can be used to protect the integrity and confidentiality of contents of communication, everyone along the route on which a packet is traveling can still observe the addresses of the respective communication parties. This often is enough to uniquely identify persons participating in a communication. Anonymous communication is used to hide relationships between the communicating parties. These relationships as well as patterns of communication can often be as revealing as their content. Hence, anonymity is a key technology needed to retain privacy in communications.
This article gives a brief overview of my doctoral dissertation “Anonymous Communication in the Age of the Internet” [Panchenko, RWTH Aachen University, 2010] and then concisely focuses on one randomly selected aspect, namely, on secure node lookup in untrustworthy environments.
Impoverished environment, cognition, aging and dementia
Authors: Volkers Karin M. , Scherder Erik J.A. 
Published: May 2011

AbstractAnimals living in an impoverished environment, i.e., without the possibility of physical and social activity, perform worse on cognitive tests compared to animals in an enriched environment. The same cognitive difference is also observed in humans. However, it is not clear whether this difference is caused by a decrease in cognition due to an impoverished environment or an increase due to an enriched environment. This review discusses the impact of an impoverished environment on cognition in animal experimental studies and human experimental studies with community-dwelling and institutionalized older people. Results show that the cognitive functioning of old rats is more affected by an impoverished environment than young rats. Similarly, sedentary and lonely people (impoverished environment) have worse cognitive functioning and show a faster cognitive decline than physically and socially active people. Institutionalization further aggravates cognitive decline, probably due to the impoverished environment of nursing homes. In institutions, residents spend an unnecessary and excessive amount of time in bed; out of bed they show mainly sedentary or completely passive behavior. In conclusion, older people, especially those that have been institutionalized, have poor levels of physical and social activity, which in turn has a negative impact on cognitive functioning.
Development of a Substructure Instrumentation System at the New I-10 Twin Span Bridge and Its Use to Investigate the Lateral Behavior of Batter Piles
Authors: Abu-Farsakh Murad , Yoon Sungmin , Ha Da , Marr W. Allen , Zhang Zhongjie , Yu Xinbau 
Published: May 2011

AbstractThis paper presents the development of the substructure instrumentation system that was installed at a selected pier (M19 Eastbound) of the new I-10 Twin Span Bridge for short-term and long-term health monitoring of the bridge, and its use to monitor the behavior of the pier during a lateral load test. The selected pier is supported by 24–36 in. diameter batter pile foundation. The substructure instrumentation for the M19 Eastbound pier includes sister bar strain gauges and MEMS In-Place Inclinometers (IPI) installed inside the foundation piles, triaxial accelerometers to measure lateral movements pile cap, water pressure cells to measure wave forces, tiltmeters, and corrosion meters on the pile cap rebar. A unique lateral load test was designed and conducted to investigate the lateral behavior of the pier and to assess the validity of the analysis method used to design the batter pile foundations using the FB-MultiPier software. Two high strength steel strand tendons were used to impose about 1900 kips of lateral load. The horizontal movements of the pier caps and bents were monitored using an automated survey station with prisms. The strains and deformations within the foundation piles were measured using the strain gauges and IPI inclinometers. This paper will discuss the substructure instrumentation plan and the novel approaches to preparation and design of lateral load testing of batter pile group foundation. The results of lateral load tests will be presented, discussed and compared with the predicted values using FB-MultiPier software. The soils’ p-y curves were also back-calculated and presented.
Effects of the Environment on the Crack Propagation Behavior of IN718 in the Temperature Range of the Dynamic Embrittlement
Authors: Wackermann Ken , Krupp Ulrich , Christ Hans-Jürgen 
Published: May 2011

Abstract
IN718 is a standard nickel-base alloy for high temperature usage, e.g., as forged gas turbine disks. At elevated temperatures IN718 is prone to cracking by dynamic embrittlement. Dynamic embrittlement is caused by oxygen diffusion along the grain boundaries, resulting in a time-dependent intergranular decohesion. The result is a fast brittle intercrystalline crack propagation. In contrast, vacuum testing shows a drastic reduction of the crack propagation rate and a ductile, transcrystalline fracture morphology. Objective of this investigation is to gain a better understanding of the dynamic embrittlement process. In the present study the crack growth rate has been measured with an alternate current potential drop system (ACPD) and a far-field microscope during dwell-time testing at 650°C, a positive stress ratio and two different load schemes.
Ghrelin does not orchestrate the metabolic changes seen in fasting but has significant effects on lipid mobilisation and substrate utilisation
Authors: Huda M S B , Dovey T M , Wong S P , English P J , Halford J C G , McCulloch P , Cleator J , Martin B , Cashen J , Hayden K , Ghatei M A , Bloom S R , Wilding J P H , Pinkney J H 
Published: May 2011

ObjectiveShort-term fasting is associated with increased GH pulsatility and mobilisation of fats, but underlying mechanisms are unclear. We studied ghrelin's role during fasting and the effects of exogenous ghrelin on lipid mobilisation.DesignRandomised placebo-controlled study.MethodsIn this study, ten controls (body mass index (BMI) 23.3±3.2), ten morbidly obese subjects (BMI 50.1±10.6) and six post-gastrectomy subjects (BMI 25.2±1.0) were fasted for 36 h undergoing regular blood sampling. On a separate occasion, subjects were infused with either i.v. ghrelin (5 pmol/kg per min) or saline over 270 min.ResultsObese and post-gastrectomy subjects had lower ghrelin compared with controls (ANOVA, P=0.02) during the fast. Controls and gastrectomy subjects showed a similar increase in GH pulsatility, circulating non-esterified fatty acids (NEFA) and 3β-hydroxybutyrate (3 HB). Obese subjects had an impaired GH response (P<0.001), reduced excursions of 3 HB (P=0.01) but no change in NEFA excursions (P=0.09) compared with controls. Ghrelin infusion increased GH, NEFA and ketone bodies (ANOVA, P<0.0001) in all the three groups, but GH response was impaired in the obese subjects (P=0.001). Ghrelin also induced a significant (ANOVA, P=0.004) biphasic NEFA response to meals in all the subjects.ConclusionsDespite low circulating ghrelin, gastrectomy subjects maintain a normal metabolic response to fasting, implying that ghrelin plays a minimal role. In contrast, infused ghrelin has significant effects on lipid mobilisation and induces a marked biphasic NEFA response to meals. Hence, ghrelin may play a significant role in meal-related substrate utilisation and metabolic flexibility.
Clonidine Extended-Release Tablets as Add-on Therapy to Psychostimulants in Children and Adolescents With ADHD
Authors: Kollins Scott H. , Jain Rakesh , Brams Matthew , Segal Scott , Findling Robert L. , Wigal Sharon B. , Khayrallah Moise 
Published: May 2011

OBJECTIVE:
To assess the efficacy and safety of clonidine hydrochloride extended-release tablets (CLON-XR) combined with stimulants (ie, methylphenidate or amphetamine) for attention-deficit/hyperactivity disorder (ADHD).

PATIENTS AND METHODS:
In this phase 3, double-blind, placebo-controlled trial, children and adolescents with hyperactive- or combined-subtype ADHD who had an inadequate response to their stable stimulant regimen were randomized to receive CLON-XR or placebo in combination with their baseline stimulant medication. Predefined efficacy measures evaluated change from baseline to week 5. Safety was assessed by spontaneously reported adverse events, vital signs, electrocardiogram recordings, and clinical laboratory values. Improvement from baseline for all efficacy measures was evaluated using analysis of covariance.

RESULTS:
Of 198 patients randomized, 102 received CLON-XR plus stimulant and 96 received placebo plus stimulant. At week 5, greater improvement from baseline in ADHD Rating Scale IV (ADHD-RS-IV) total score (95% confidence interval: −7.83 to −1.13; P = .009), ADHD-RS-IV hyperactivity and inattention subscale scores (P = .014 and P = .017, respectively), Conners' Parent Rating Scale scores (P &lt; .062), Clinical Global Impression of Severity (P = .021), Clinical Global Impression of Improvement (P = .006), and Parent Global Assessment (P = .001) was observed in the CLON-XR plus stimulant group versus the placebo plus stimulant group. Adverse events and changes in vital signs in the CLON-XR group were generally mild.

CONCLUSIONS:
The results of this study suggest that CLON-XR in combination with stimulants is useful in reducing ADHD in children and adolescents with partial response to stimulants.
Self-Embedding Behavior: A New Primary Care Challenge
Authors: Bennett Gregory H. , Shiels William E. , Young Adam S. , Lofthouse Nicholas , Mihalov Leslie 
Published: May 2011

OBJECTIVE:The goal of this study was to define self-embedding behavior (SEB), develop a clinical profile of adolescents who engage in SEB, and emphasize the importance of rapid, targeted, and effective identification and intervention.METHODS:As part of a retrospective study with a database evaluating 600 patients percutaneously treated for soft-tissue foreign body removal, adolescents were identified with self-embedded soft-tissue foreign bodies. We describe patients' gender, age, and psychiatric diagnoses; SEB age of onset, frequency, and self-reported reasons; and the number, type, location of, and removal technique for objects.RESULTS:Eleven patients (9 females) who engaged in SEB were identified. Ten of the 11 patients were members of a group home or psychiatric facility at the time they engaged in SEB. All patients had previous and multiple psychiatric diagnoses. SEB mean age-of-onset was 16 years, and mean number of SEB episodes per patient was 1.9. The most common self-reported purpose for SEB was suicidal ideation (6 of 8 [75%]) versus nonsuicidal ideation (2 of 8 [25%]), with 3 cases lacking this documentation. The mean number of objects embedded in a single episode was 2.4, usually composed of metal and embedded in the arm. Seventy-six foreign bodies were percutaneously removed (using ultrasound or fluoroscopic guidance), including metal, glass, wood, plastic, graphite, and crayon.CONCLUSIONS:SEB is an extreme form of self-injury requiring aggressive and timely interdisciplinary assessment and treatment. An understanding of SEB allows medical professionals to pursue rapid, targeted, and effective intervention to interrupt the cycle of self-harm and institute appropriate long-term therapy.