305 research outputs found

    Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

    Get PDF
    Item does not contain fulltextIn palliative cancer treatment, the choice between palliative chemotherapy and best supportive care may be difficult. In the decision-making process, giving information as well as patients' values and preferences become important issues. Patients, however, may have a treatment preference before they even meet their medical oncologist. An insight into the patient's decision-making process can support clinicians having to inform their patients. Patients (n=207) with metastatic cancer, aged 18 years or older, able to speak Dutch, for whom palliative chemotherapy was a treatment option, were eligible for the study. We assessed the following before they consulted their medical oncologist: (1) socio-demographic characteristics, (2) disease-related variables, (3) quality-of-life indices, (4) attitudes and (5) preferences for treatment, information and participation in decision-making. The actual treatment decision, assessed after it had been made, was the main study outcome. Of 207 eligible patients, 140 patients (68%) participated in the study. At baseline, 68% preferred to undergo chemotherapy rather than wait watchfully. Eventually, 78% chose chemotherapy. Treatment preference (odds ratio (OR)=10.3, confidence interval (CI) 2.8-38.0) and a deferring style of decision-making (OR=4.9, CI 1.4-17.2) best predicted the actual treatment choice. Treatment preference (total explained variance=38.2%) was predicted, in turn, by patients' striving for length of life (29.5%), less striving for quality of life (6.1%) and experienced control over the cause of disease (2.6%). Patients' actual treatment choice was most strongly predicted by their preconsultation treatment preference. Since treatment preference is positively explained by striving for length of life, and negatively by striving for quality of life, it is questionable whether the purpose of palliative treatment is made clear. This, paradoxically, emphasises the need for further attention to the process of information giving and shared decision-making

    Three-Dimensional Mapping of the Dark Matter

    Full text link
    We study the prospects for three-dimensional mapping of the dark matter to high redshift through the shearing of faint galaxies images at multiple distances by gravitational lensing. Such maps could provide invaluable information on the nature of the dark energy and dark matter. While in principle well-posed, mapping by direct inversion introduces exceedingly large, but usefully correlated noise into the reconstruction. By carefully propagating the noise covariance, we show that lensing contains substantial information, both direct and statistical, on the large-scale radial evolution of the density field. This information can be efficiently distilled into low-order signal-to-noise eigenmodes which may be used to compress the data by over an order of magnitude. Such compression will be useful for the statistical analysis of future large data sets. The reconstructed map also contains useful information on the localization of individual massive dark matter halos, and hence the dark energy from halo number counts, but its extraction depends strongly on prior assumptions. We outline a procedure for maximum entropy and point-source regularization of the maps that can identify alternate reconstructions.Comment: 11 pages, 5 figures, submitted to PR

    The Cyst Nematode SPRYSEC Protein RBP-1 Elicits Gpa2- and RanGAP2-Dependent Plant Cell Death

    Get PDF
    Plant NB-LRR proteins confer robust protection against microbes and metazoan parasites by recognizing pathogen-derived avirulence (Avr) proteins that are delivered to the host cytoplasm. Microbial Avr proteins usually function as virulence factors in compatible interactions; however, little is known about the types of metazoan proteins recognized by NB-LRR proteins and their relationship with virulence. In this report, we demonstrate that the secreted protein RBP-1 from the potato cyst nematode Globodera pallida elicits defense responses, including cell death typical of a hypersensitive response (HR), through the NB-LRR protein Gpa2. Gp-Rbp-1 variants from G. pallida populations both virulent and avirulent to Gpa2 demonstrated a high degree of polymorphism, with positive selection detected at numerous sites. All Gp-RBP-1 protein variants from an avirulent population were recognized by Gpa2, whereas virulent populations possessed Gp-RBP-1 protein variants both recognized and non-recognized by Gpa2. Recognition of Gp-RBP-1 by Gpa2 correlated to a single amino acid polymorphism at position 187 in the Gp-RBP-1 SPRY domain. Gp-RBP-1 expressed from Potato virus X elicited Gpa2-mediated defenses that required Ran GTPase-activating protein 2 (RanGAP2), a protein known to interact with the Gpa2 N terminus. Tethering RanGAP2 and Gp-RBP-1 variants via fusion proteins resulted in an enhancement of Gpa2-mediated responses. However, activation of Gpa2 was still dependent on the recognition specificity conferred by amino acid 187 and the Gpa2 LRR domain. These results suggest a two-tiered process wherein RanGAP2 mediates an initial interaction with pathogen-delivered Gp-RBP-1 proteins but where the Gpa2 LRR determines which of these interactions will be productive

    First light of VLT/HiRISE: High-resolution spectroscopy of young giant exoplanets

    Get PDF
    A major endeavor of this decade is the direct characterization of young giant exoplanets at high spectral resolution to determine the composition of their atmosphere and infer their formation processes and evolution. Such a goal represents a major challenge owing to their small angular separation and luminosity contrast with respect to their parent stars. Instead of designing and implementing completely new facilities, it has been proposed to leverage the capabilities of existing instruments that offer either high-contrast imaging or high-dispersion spectroscopy by coupling them using optical fibers. In this work, we present the implementation and first on-sky results of the High-Resolution Imaging and Spectroscopy of Exoplanets (HiRISE) instrument at the Very Large Telescope (VLT), which combines the exoplanet imager SPHERE with the recently upgraded high-resolution spectrograph CRIRES using single-mode fibers. The goal of HiRISE is to enable the characterization of known companions in the H band at a spectral resolution on the order of R = λ/∆λ = 100 000 in a few hours of observing time. We present the main design choices and the technical implementation of the system, which is constituted of three major parts: the fiber injection module inside of SPHERE, the fiber bundle around the telescope, and the fiber extraction module at the entrance of CRIRES. We also detail the specific calibrations required for HiRISE and the operations of the instrument for science observations. Finally, we detail the performance of the system in terms of astrometry, temporal stability, optical aberrations, and transmission, for which we report a peak value of ~3.9% based on sky measurements in median observing conditions. Finally, we report on the first astrophysical detection of HiRISE to illustrate its potential

    First light of VLT/HiRISE: High-resolution spectroscopy of young giant exoplanets

    Full text link
    A major endeavor of this decade is the direct characterization of young giant exoplanets at high spectral resolution to determine the composition of their atmosphere and infer their formation processes and evolution. Such a goal represents a major challenge owing to their small angular separation and luminosity contrast with respect to their parent stars. Instead of designing and implementing completely new facilities, it has been proposed to leverage the capabilities of existing instruments that offer either high contrast imaging or high dispersion spectroscopy, by coupling them using optical fibers. In this work we present the implementation and first on-sky results of the HiRISE instrument at the very large telescope (VLT), which combines the exoplanet imager SPHERE with the recently upgraded high resolution spectrograph CRIRES using single-mode fibers. The goal of HiRISE is to enable the characterization of known companions in the HH band, at a spectral resolution of the order of R=λ/Δλ=100 000R = \lambda/\Delta\lambda = 100\,000, in a few hours of observing time. We present the main design choices and the technical implementation of the system, which is constituted of three major parts: the fiber injection module inside of SPHERE, the fiber bundle around the telescope, and the fiber extraction module at the entrance of CRIRES. We also detail the specific calibrations required for HiRISE and the operations of the instrument for science observations. Finally, we detail the performance of the system in terms of astrometry, temporal stability, optical aberrations, and transmission, for which we report a peak value of ∼\sim3.9% based on sky measurements in median observing conditions. Finally, we report on the first astrophysical detection of HiRISE to illustrate its potential.Comment: 17 pages, 15 figures, 3 tables. Submitted to A&A on 19 September 202
    • …
    corecore