Effect of Central Nervous System Metastases on Treatment Discontinuation and Survival in Older Women Receiving Trastuzumab for Metastatic Breast Cancer

Background. Trastuzumab improves survival in HER2-positive women with metastatic breast cancer (MBC). The consequences of longer survival include a higher likelihood of additional metastases, including those in the central nervous system (CNS). The effect of CNS metastases on both trastuzumab discontinuation and survival in older patients has not been described. Patients and Methods. We used the Surveillance Epidemiology and End Results (SEER) Medicare data to identify a cohort of 562 women age 66 or older with MBC who were diagnosed between January 1, 2000 and December 31, 2005, free of CNS metastases, and initiated trastuzumab after MBC diagnosis. Time to discontinuation and time to death were analyzed using proportional hazards models. Results. Newly diagnosed CNS metastases were associated with both higher risk of trastuzumab discontinuation (relative hazard [RH] = 1.78, 95% CI 1.11–2.87) and higher risk of death (RH = 2.49, 95% CI 1.84–3.37). The incidence rate of new CNS metastases was comparable among various sites of metastasis (10.7 to 14.7 per 1,000 patient-months), except for bone which was higher (24.1 per 1,000). Conclusion. The diagnosis of CNS metastases was associated with an increase in both the likelihood of discontinuing trastuzumab therapy as well as the risk of death

Patterns of Hemodialysis Catheter Dysfunction Defined According to National Kidney Foundation Guidelines As Blood Flow <300 mL/min

Blood flow rate (BFR) <300 mL/min commonly is used to define hemodialysis catheter dysfunction and the need for interventions to prevent complications. The objective of this study was to describe patterns of unplanned BFR <300 mL/min during catheter hemodialysis using data from DaVita dialysis facilities and the United States Renal Data System. Patients were included if they received at least eight weeks of hemodialysis exclusively through a catheter between 08/04 and 12/06, and catheter hemodialysis was the first treatment modality following diagnosis of end-stage renal disease (first access), or it immediately followed at least one 30-day period of dialysis exclusively through a fistula or graft (replacement access). Actual BFR <300 mL/min despite a planned BFR ≥300 mL/min defined catheter dysfunction during each dialysis session. There were 3,364 patients, 268,363 catheter dialysis sessions, and 19,118 (7.1%) sessions with catheter dysfunction. Almost two-thirds of patients had ≥1 catheter dysfunction session, and 30% had ≥1 catheter dysfunction session per month. Patients with catheter as a replacement access had a higher rate of catheter dysfunction than those with a catheter as first access (hazard ratio: 1.13; P = 0.04). Catheter dysfunction affects almost one-third of catheter dialysis patients each month and two-thirds overall

Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

Practice guidelines define hemodialysis catheter dysfunction as blood flow rate (BFR) <300 mL/min. We conducted a study using data from DaVita and the United States Renal Data System to evaluate the impact of catheter dysfunction on dialysis and other medical services. Patients were included if they had ≥8 consecutive weeks of catheter dialysis between 8/2004 and 12/2006. Actual BFR <300 mL/min despite planned BFR ≥300 mL/min was used to define catheter dysfunction during each dialysis session. Among 9,707 patients, the average age was 62,53% were female, and 40% were black. The median duration of catheter dialysis was 190 days, and the cohort accounted for 1,075,701 catheter dialysis sessions. There were 70,361 sessions with catheter dysfunction, and 6,33 1 (65.2%) patients had at least one session with catheter dysfunction. In multivariate repeated measures analysis, catheter dysfunction was associated with increased odds of missing a dialysis session due to access problems (Odds ratio [OR] 2.50; P < 0.001), having an access-related procedure (OR 2.10; P < 0.001), and being hospitalized (OR 1.10; P = 0.001). Catheter dysfunction defined according to NKF vascular access guidelines results in disruptions of dialysis treatment and increased use of other medical services

A Merger Scenario for the Dynamics of Abell 665

We present new redshift measurements for 55 galaxies in the vicinity of the rich galaxy cluster Abell 665. When combined with results from the literature, we have good velocity measurements for a sample of 77 confirmed cluster members from which we derive the cluster's redshift z=0.1829 +/- 0.0005 and line-of-sight velocity dispersion of 1390 +/- 120 km/s. Our analysis of the kinematical and spatial data for the subset of galaxies located within the central 750 kpc reveals only subtle evidence for substructure and non-Gaussianity in the velocity distribution. We find that the brightest cluster member is not moving significantly relative to the other galaxies near the center of the cluster. On the other hand, our deep ROSAT high resolution image of A665 shows strong evidence for isophotal twisting and centroid variation, thereby confirming previous suggestions of significant substructure in the hot X-ray--emitting intracluster gas. In light of this evident substructure, we have compared the optical velocity data with N-body simulations of head-on cluster mergers. We find that a merger of two similar mass subclusters (mass ratios of 1:1 or 1:2) seen close to the time of core-crossing produces velocity distributions that are consistent with that observed.Comment: 30 pages and 7 figures. Accepted by the Astrophysical Journal Full resoultion figures 1 and 3 available in postscript at http://www.physics.rutgers.edu/~percy/A665paper.htm

Infused Therapy and Survival in Older Patients Diagnosed with Metastatic Breast Cancer who Received Trastuzumab

We used Surveillance, Epidemiology, and End Results-Medicare data (2000-2006) to describe treatment and survival in women diagnosed with metastatic breast cancer (MBC) who received trastuzumab. There were 610 patients with a mean age of 74 years. Overall, 32% received trastuzumab alone and 47% received trastuzumab plus a taxane. In multivariate analysis, trastuzumab plus chemotherapy was associated with a lower adjusted cancer mortality rate (Hazard Ratio [HR] 0.54; 95% Confidence Interval [CI] 0.39-0.74; p < .001) than trastuzumab alone among patients who received trastuzumab as part of first-line therapy. Adding chemotherapy to first-line trastuzumab for metastatic breast cancer is associated with improved cancer survival

The Atacama Cosmology Telescope: Dynamical Masses and Scaling Relations for a Sample of Massive Sunyaev-Zel'dovich Effect Selected Galaxy Clusters

We present the first dynamical mass estimates and scaling relations for a sample of Sunyaev-Zel'dovich effect (SZE) selected galaxy clusters. The sample consists of 16 massive clusters detected with the Atacama Cosmology Telescope (ACT) over a 455 sq. deg. area of the southern sky. Deep multi-object spectroscopic observations were taken to secure intermediate-resolution (R~700-800) spectra and redshifts for ~60 member galaxies on average per cluster. The dynamical masses M_200c of the clusters have been calculated using simulation-based scaling relations between velocity dispersion and mass. The sample has a median redshift z=0.50 and a median mass M_200c~12e14 Msun/h70 with a lower limit M_200c~6e14 Msun/h70, consistent with the expectations for the ACT southern sky survey. These masses are compared to the ACT SZE properties of the sample, specifically, the match-filtered central SZE amplitude y, the central Compton parameter y0, and the integrated Compton signal Y_200c, which we use to derive SZE-Mass scaling relations. All SZE estimators correlate with dynamical mass with low intrinsic scatter (<~20%), in agreement with numerical simulations. We explore the effects of various systematic effects on these scaling relations, including the correlation between observables and the influence of dynamically disturbed clusters. Using the 3-dimensional information available, we divide the sample into relaxed and disturbed clusters and find that ~50% of the clusters are disturbed. There are hints that disturbed systems might bias the scaling relations but given the current sample sizes these differences are not significant; further studies including more clusters are required to assess the impact of these clusters on the scaling relations.Comment: 15 pages, 4 figures. Accepted for publication in The Astrophysical Journal; matches published version. Full Table 8 with complete spectroscopic member sample available in machine-readable form in the journal site and upon request to C. Sif\'o

A measurement of the millimetre emission and the Sunyaev-Zel'dovich effect associated with low-frequency radio sources

We present a statistical analysis of the millimetre-wavelength properties of 1.4GHz-selected sources and a detection of the Sunyaev–Zel’dovich (SZ) effect associated with the haloes that host them. We stack data at 148, 218 and 277GHz from the Atacama Cosmology Telescope at the positions of a large sample of radio AGN selected at 1.4GHz. The thermal SZ effect associated with the haloes that host the AGN is detected at the 5σ level through its spectral signature, representing a statistical detection of the SZ effect in some of the lowest mass haloes (average M 200 ≈ 10 13 M. h −1 70 ) studied to date. The relation between the SZ effect and mass (based on weak lensing measurements of radio galaxies) is consistent with that measured by Planck for local bright galaxies. In the context of galaxy evolution models, this study confirms that galaxies with radio AGN also typically support hot gaseous haloes. Adding Herschel observations allows us to show that the SZ signal is not significantly contaminated by dust emission. Finally, we analyse the contribution of radio sources to the angular power spectrum of the cosmic microwave background

Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey.

BACKGROUND: Individuals' childhood experiences can strongly influence their future health and well-being. Adverse childhood experiences (ACEs) such as abuse and dysfunctional home environments show strong cumulative relationships with physical and mental illness yet less is known about their effects on mental well-being in the general population. METHODS: A nationally representative household survey of English adults (n = 3,885) measuring current mental well-being (Short Edinburgh-Warwick Mental Well-being Scale SWEMWBS) and life satisfaction and retrospective exposure to nine ACEs. RESULTS: Almost half of participants (46.4 %) had suffered at least one ACE and 8.3 % had suffered four or more. Adjusted odds ratios (AORs) for low life satisfaction and low mental well-being increased with the number of ACEs. AORs for low ratings of all individual SWEMWBS components also increased with ACE count, particularly never or rarely feeling close to others. Of individual ACEs, growing up in a household affected by mental illness and suffering sexual abuse had the most relationships with markers of mental well-being. CONCLUSIONS: Childhood adversity has a strong cumulative relationship with adult mental well-being. Comprehensive mental health strategies should incorporate interventions to prevent ACEs and moderate their impacts from the very earliest stages of life

Reconstructing the Inflaton Potential --- an Overview

We review the relation between the inflationary potential and the spectra of density (scalar) perturbations and gravitational waves (tensor perturbations) produced, with particular emphasis on the possibility of reconstructing the inflaton potential from observations. The spectra provide a potentially powerful test of the inflationary hypothesis; they are not independent but instead are linked by consistency relations reflecting their origin from a single inflationary potential. To lowest-order in a perturbation expansion there is a single, now familiar, relation between the tensor spectral index and the relative amplitude of the spectra. We demonstrate that there is an infinite hierarchy of such consistency equations, though observational difficulties suggest only the first is ever likely to be useful. We also note that since observations are expected to yield much better information on the scalars than on the tensors, it is likely to be the next-order version of this consistency equation which will be appropriate, not the lowest-order one. If inflation passes the consistency test, one can then confidently use the remaining observational information to constrain the inflationary potential, and we survey the general perturbative scheme for carrying out this procedure. Explicit expressions valid to next-lowest order in the expansion are presented. We then briefly assess the prospects for future observations reaching the quality required, and consider a simulated data set that is motivated by this outlook.Comment: 69 pages standard LaTeX plus 4 postscript figures. Postscript version of text in landscape format (35 pages) available at http://star-www.maps.susx.ac.uk/papers/infcos_papers.html Modifications are a variety of updates to discussion and reference