Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life

BACKGROUND: In 1995 a meta-analysis of randomised trials investigating the value of adding chemotherapy to primary treatment for non-small cell lung cancer (NSCLC) suggested a small survival benefit for cisplatin-based chemotherapy in each of the primary treatment settings. However, the metaanalysis included many small trials and trials with differing eligibility criteria and chemotherapy regimens. METHODS: The aim of the Big Lung Trial was to confirm the survival benefits seen in the meta-analysis and to assess quality of life and cost in the supportive care setting. A total of 725 patients were randomised to receive supportive care alone (n = 361) or supportive care plus cisplatin-based chemotherapy (n = 364). RESULTS: 65% of patients allocated chemotherapy (C) received all three cycles of treatment and a further 27% received one or two cycles. 74% of patients allocated no chemotherapy (NoC) received thoracic radiotherapy compared with 47% of the C group. Patients allocated C had a significantly better survival than those allocated NoC: HR 0.77 (95% CI 0.66 to 0.89, p = 0.0006), median survival 8.0 months for the C group v 5.7 months for the NoC group, a difference of 9 weeks. There were 19 (5%) treatment related deaths in the C group. There was no evidence that any subgroup benefited more or less fromchemotherapy. No significant differences were observed between the two groups in terms of the pre-defined primary and secondary quality of life end points, although large negative effects of chemotherapy were ruled out. The regimens used proved to be cost effective, the extra cost of chemotherapy being offset by longer survival. CONCLUSIONS: The survival benefit seen in this trial was entirely consistent with the NSCLC meta-analysis and subsequent similarly designed large trials. The information on quality of life and cost should enablepatients and their clinicians to make more informed treatment choices

Spin-based quantum information processing with semiconductor quantum dots and cavity QED

A quantum information processing scheme is proposed with semiconductor quantum dots located in a high-Q single mode QED cavity. The spin degrees of freedom of one excess conduction electron of the quantum dots are employed as qubits. Excitonic states, which can be produced ultrafastly with optical operation, are used as auxiliary states in the realization of quantum gates. We show how properly tailored ultrafast laser pulses and Pauli-blocking effects, can be used to achieve a universal encoded quantum computing.Comment: RevTex, 2 figure

Integrin activation - the importance of a positive feedback

Integrins mediate cell adhesion and are essential receptors for the development and functioning of multicellular organisms. Integrin activation is known to require both ligand and talin binding and to correlate with cluster formation but the activation mechanism and precise roles of these processes are not yet resolved. Here mathematical modeling, with known experimental parameters, is used to show that the binding of a stabilizing factor, such as talin, is alone insufficient to enable ligand-dependent integrin activation for all observed conditions; an additional positive feedback is required.Comment: in press in Bulletin of Mathematical Biolog

The Role of the Pediatric Nurse Practitioner in the Comprehensive Management of Pediatric Oncology Patients in the Inpatient Setting

The role of the pediatric nurse practitioner (PNP) in the comprehensive management of pediatric oncology patients in the inpatient setting was examined at a large tertiary teaching hospital. This article shows role responsibilities including new diagnosis teaching, procedures, routine chemotherapy, patients' comprehensive medical management, coordination of nursing care across settings, phone triage, and professional development. A PNP's typical day is highlighted to illustrate the innovative merging of traditional ambulatory care roles with that of the PNP as a comprehensive manager of pediatric oncology patients in the inpatient setting. This role provides a more seamless care experience and provides critical links in the delivery of health care to pediatric oncology patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68349/2/10.1177_104345429901600202.pd

Source Dimensions in Ultrarelativistic Heavy Ion Collisions

Recent experiments on pion correlations, interpreted as interferometric measurements of the collision zone, are compared with models that distinguish a prehadronic phase and a hadronic phase. The models include prehadronic longitudinal expansion, conversion to hadrons in local kinetic equilibrium, and rescattering of the produced hadrons. We find that the longitudinal and outward radii are surprisingly sensitive to the algorithm used for two-body collisions. The longitudinal radius measured in collisions of 200 GeV/u sulfur nuclei on a heavy target requires the existence of a prehadronic phase which converts to the hadronic phase at densities around 0.8-1.0 GeV/fm$^3$. The transverse radii cannot be reproduced without introducing more complex dynamics into the transverse expansion.Comment: RevTeX 3.0, 28 pages, 6 figures, not included, revised version, major change is an additional discussion of the classical two-body collision algorithm, a (compressed) postscript file of the complete paper including figures can be obtained from Authors or via anonymous ftp at ftp://ftp_int.phys.washington.edu/pub/herrmann/pisource.ps.

Quantum Mechanics of the Vacuum State in Two-Dimensional QCD with Adjoint Fermions

A study of two-dimensional QCD on a spatial circle with Majorana fermions in the adjoint representation of the gauge groups SU(2) and SU(3) has been performed. The main emphasis is put on the symmetry properties related to the homotopically non-trivial gauge transformations and the discrete axial symmetry of this model. Within a gauge fixed canonical framework, the delicate interplay of topology on the one hand and Jacobians and boundary conditions arising in the course of resolving Gauss's law on the other hand is exhibited. As a result, a consistent description of the residual $Z_N$ gauge symmetry (for SU(N)) and the ``axial anomaly" emerges. For illustrative purposes, the vacuum of the model is determined analytically in the limit of a small circle. There, the Born-Oppenheimer approximation is justified and reduces the vacuum problem to simple quantum mechanics. The issue of fermion condensates is addressed and residual discrepancies with other approaches are pointed out.Comment: 44 pages; for hardcopies of figures, contact [email protected]

Zero Modes and the Atiyah-Singer Index in Noncommutative Instantons

We study the bosonic and fermionic zero modes in noncommutative instanton backgrounds based on the ADHM construction. In k instanton background in U(N) gauge theory, we show how to explicitly construct 4Nk (2Nk) bosonic (fermionic) zero modes in the adjoint representation and 2k (k) bosonic (fermionic) zero modes in the fundamental representation from the ADHM construction. The number of fermionic zero modes is also shown to be exactly equal to the Atiyah-Singer index of the Dirac operator in the noncommutative instanton background. We point out that (super)conformal zero modes in non-BPS instantons are affected by the noncommutativity. The role of Lorentz symmetry breaking by the noncommutativity is also briefly discussed to figure out the structure of U(1) instantons.Comment: v3: 24 pages, Latex, corrected typos, references added, to appear in Phys. Rev.

Propagators in Noncommutative Instantons

We explicitly construct Green functions for a field in an arbitrary representation of gauge group propagating in noncommutative instanton backgrounds based on the ADHM construction. The propagators for spinor and vector fields can be constructed in terms of those for the scalar field in noncommutative instanton background. We show that the propagators in the adjoint representation are deformed by noncommutativity while those in the fundamental representation have exactly the same form as the commutative case.Comment: 28 pages, Latex, v2: A few typos correcte

Possible origins of macroscopic left-right asymmetry in organisms

I consider the microscopic mechanisms by which a particular left-right (L/R) asymmetry is generated at the organism level from the microscopic handedness of cytoskeletal molecules. In light of a fundamental symmetry principle, the typical pattern-formation mechanisms of diffusion plus regulation cannot implement the "right-hand rule"; at the microscopic level, the cell's cytoskeleton of chiral filaments seems always to be involved, usually in collective states driven by polymerization forces or molecular motors. It seems particularly easy for handedness to emerge in a shear or rotation in the background of an effectively two-dimensional system, such as the cell membrane or a layer of cells, as this requires no pre-existing axis apart from the layer normal. I detail a scenario involving actin/myosin layers in snails and in C. elegans, and also one about the microtubule layer in plant cells. I also survey the other examples that I am aware of, such as the emergence of handedness such as the emergence of handedness in neurons, in eukaryote cell motility, and in non-flagellated bacteria.Comment: 42 pages, 6 figures, resubmitted to J. Stat. Phys. special issue. Major rewrite, rearranged sections/subsections, new Fig 3 + 6, new physics in Sec 2.4 and 3.4.1, added Sec 5 and subsections of Sec