Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer.

Post-treatment surveillance of advanced ovarian cancer involves regular testing of asymptomatic patients using the CA125 test. This practice is based on a rationale that is not supported by evidence from clinical trials. This paper aims to stimulate critical reflection concerning the effect of investigative tests on clinical decisions and interactions, and the experience of illness, particularly in the context of advanced malignant disease. Drawing on the idea of the “medical gaze”, and building on previous health communication research, we present an analysis of in-depth interviews and psychometric tests collected in a prospective study of 20 Australian women with advanced ovarian cancer conducted between 2006 and 2009. We describe the demands placed on patients by the use of the CA125 test, some hazards it creates for decision-making, and some of the test’s subjective benefits. It is widely believed that the CA125 test generates anxiety among patients, and the proposed solution is to educate women more about the test. We found no evidence that anxiety was a problem requiring a response over and above existing services. We conclude that the current debate is simplistic and limited. Focussing on patient anxiety does not account for other important effects of post-treatment surveillance, and educating patients about the test is unlikely to mitigate anxiety because testing is part of a wider process by which patients become aware of a disease that – once it has relapsed – will certainly kill them in the near future.National Health and Medical Research Council Project Grant number 40260

The perils of a vanishing cohort: A study of social comparisons by women with advanced ovarian cancer

Objective: To examine the role social comparisons play in the experience of ovarian cancer patients and to consider the implications this may have for provision of supportive care services for ovarian cancer patients. Methods: We conducted a longitudinal qualitative study of women with advanced ovarian cancer in Sydney, Australia. Semi-structured interviews were conducted with women with advanced ovarian cancer over a period of 2.5 years. Social comparisons made by 13 study participants in 33 interviews were extracted and analysed using coding categories based on social comparison theory. Results: Participants favoured downward contrasts and lateral comparisons and avoided downward identifications, upward contrasts and upward identifications. Participants expressed a preference for avoiding contact with ovarian cancer patients, for the company of “normal” others, for normalizing information and information that facilitated upward identifications. Conclusions: We suggest that social comparisons made by women with ovarian cancer are influenced by specific clinical factors associated with their diagnosis – in particular their status as a member of a “vanishing cohort” – and argue for further research examining the specific comparison needs and preferences of patients with advanced disease and types of cancer with poor prognoses. Practice implications: These findings raise questions about uniform approaches to the provision of cancer care and suggest that further research may be required to ensure that interventions are appropriately tailored to the supportive care needs of patients with different types and stages of disease. KEYWORDS Cancer; Oncology; Ovarian neoplasms; Social comparison theory; Social support; Self-help groupsNational Health & Medical Research Council Project Grant 40260

Beyond evidence: reappraising use of CA-125 as post-therapy surveillance for ovarian cancer

omen who have completed primary chemotherapy for ovarian cancer commonly have serial assessment of the serum tumour marker cancer antigen 125 (CA-125).1 This practice has been based on the proven utility of CA-125 in diagnostic algorithms and as a marker of response to therapy. Serial CA-125 assessment is also used because there is evidence that in women who have completed treatment for ovarian cancer, the serum CA-125 rises 2–6 months before symptoms or signs of relapse develop. The assumption underlying this and other similar studies is that serial monitoring of CA-125 would enable early diagnosis and treatment of relapse. This would thus lead to delay or reduction of cancer-related symptoms, psychological reassurance and, in theory, improved survival. Some studies have suggested that CA-125 may have some benefit in post-treatment surveillance. However, many others have demonstrated that although a rising CA-125 level is highly predictive of relapse, surveillance monitoring of CA-125 levels after remission from primary chemotherapy confers little benefit over standard clinical examination and does not improve duration of survival or quality of life

Beyond evidence: reappraising use of CA-125 as post-therapy surveillance for ovarian cancer

omen who have completed primary chemotherapy for ovarian cancer commonly have serial assessment of the serum tumour marker cancer antigen 125 (CA-125).1 This practice has been based on the proven utility of CA-125 in diagnostic algorithms and as a marker of response to therapy. Serial CA-125 assessment is also used because there is evidence that in women who have completed treatment for ovarian cancer, the serum CA-125 rises 2–6 months before symptoms or signs of relapse develop. The assumption underlying this and other similar studies is that serial monitoring of CA-125 would enable early diagnosis and treatment of relapse. This would thus lead to delay or reduction of cancer-related symptoms, psychological reassurance and, in theory, improved survival. Some studies have suggested that CA-125 may have some benefit in post-treatment surveillance. However, many others have demonstrated that although a rising CA-125 level is highly predictive of relapse, surveillance monitoring of CA-125 levels after remission from primary chemotherapy confers little benefit over standard clinical examination and does not improve duration of survival or quality of life

Large-Scale CO Maps of the Lupus Molecular Cloud Complex

Fully sampled degree-scale maps of the 13CO 2-1 and CO 4-3 transitions toward three members of the Lupus Molecular Cloud Complex - Lupus I, III, and IV - trace the column density and temperature of the molecular gas. Comparison with IR extinction maps from the c2d project requires most of the gas to have a temperature of 8-10 K. Estimates of the cloud mass from 13CO emission are roughly consistent with most previous estimates, while the line widths are higher, around 2 km/s. CO 4-3 emission is found throughout Lupus I, indicating widespread dense gas, and toward Lupus III and IV. Enhanced line widths at the NW end and along the edge of the B228 ridge in Lupus I, and a coherent velocity gradient across the ridge, are consistent with interaction between the molecular cloud and an expanding HI shell from the Upper-Scorpius subgroup of the Sco-Cen OB Association. Lupus III is dominated by the effects of two HAe/Be stars, and shows no sign of external influence. Slightly warmer gas around the core of Lupus IV and a low line width suggest heating by the Upper-Centaurus-Lupus subgroup of Sco-Cen, without the effects of an HI shell.Comment: 54 pages, 27 figures, 5 tables. To appear in ApJS. Preprint also available (with full-size figures) from http://www.astro.ex.ac.uk/people/nfht/publications.html Datacubes available from http://www.astro.ex.ac.uk/people/nfht/resources.htm

Form Geometry and the 'tHooft-Plebanski Action

Riemannian geometry in four dimensions, including Einstein's equations, can be described by means of a connection that annihilates a triad of two-forms (rather than a tetrad of vector fields). Our treatment of the conformal factor of the metric differs from the original presentation of this result, due to 'tHooft. In the action the conformal factor now appears as a field to be varied.Comment: 12pp, LaTe

The scalar gluonium correlator: large-beta_0 and beyond

The investigation of the scalar gluonium correlator is interesting because it carries the quantum numbers of the vacuum and the relevant hadronic current is related to the anomalous trace of the QCD energy-momentum tensor in the chiral limit. After reviewing the purely perturbative corrections known up to next-next-to-leading order, the behaviour of the correlator is studied to all orders by means of the large-beta_0 approximation. Similar to the QCD Adler function, the large-order behaviour is governed by the leading ultraviolet renormalon pole. The structure of infrared renormalon poles, being related to the operator product expansion are also discussed, as well as a low-energy theorem for the correlator that provides a relation to the renormalisation group invariant gluon condensate, and the vacuum matrix element of the trace of the QCD energy-momentum tensor.Comment: 14 pages, references added, discussion of IR renormalon pole at u=3 extended, similar version to appear in JHE

Hard X-ray Luminosities of Multinuclei Infrared Luminous Galaxies Showing a Radio/Far-Infrared Excess

We report the results of hard X-ray observations of four multinuclei merging infrared luminous galaxies (IRLGs). We selected these four sources for their excess of radio to far-infrared luminosity ratio compared with starburst galaxies. This excess suggests that activity associated with a supermassive black hole (SMBH) contributes strongly to the IRLGs' bolometric luminosities. Although we expect strong hard X-ray emission from the SMBH-driven activity, the radio-excess multinuclei merging IRLGs show considerably smaller hard X-ray luminosities relative to far-infrared (40$-$500 $\mu$m) and infrared (8$-$1000 $\mu$m) luminosities than active galactic nuclei (AGNs) showing a similar radio-excess. This result may demonstrate that emission in the hard X-ray region from SMBH-driven activity in the multinuclei merging IRLGs is severely suppressed compared to a typical spectral energy distribution of SMBH-driven activity in AGNs. If this is a common property of merging IRLGs, without its correction, hard X-ray observations underestimate the contribution of SMBH-driven activity to the bolometric luminosities of merging IRLGs.Comment: 25 pages of text, 4 figures, aaspp4.sty, Astrophysical Journal, in press (1999, Volume 527

Axial Vector JPC=1++J^{PC}=1^{++} Charmonium and Bottomonium Hybrid Mass Predictions with QCD Sum-Rules

Axial vector $(J^{PC}=1^{++})$ charmonium and bottomonium hybrid masses are determined via QCD Laplace sum-rules. Previous sum-rule studies in this channel did not incorporate the dimension-six gluon condensate, which has been shown to be important for $1^{--}$ and $0^{-+}$ heavy quark hybrids. An updated analysis of axial vector charmonium and bottomonium hybrids is presented, including the effects of the dimension-six gluon condensate. The axial vector charmonium and bottomonium hybrid masses are predicted to be 5.13 GeV and 11.32 GeV, respectively. We discuss the implications of this result for the charmonium-like XYZ states and the charmonium hybrid multiplet structure observed in recent lattice calculations.Comment: 10 pages, 7 figures. Updated to match published versio

Lessons from Outside and Within: Exploring Advancements in Methodology for Naturopathic Medicine Clinical Research

© 2019, Mary Ann Liebert, Inc. Introduction: Naturopathy is a mixture of both traditional and complementary medicine. It incorporates a broad set of health care practices that may or may not be traditional to that country or conventional medicine and are not fully integrated into the dominant health care system. Research required to evaluate or substantiate naturopathic medicine may not fall under the testing of randomized clinical trials, which opens up discussions on what is the best practice for research in naturopathic medicine. Discussion: Not only do advances in health research methodology offer important opportunities to progress naturopathic research, there are also areas where the unique characteristics of naturopathic philosophy and practice can impact other areas of health research. Some of the new advances in health research methodology involve whole-system research, pragmatic trials, template for intervention description and replication protocols for complex interventions, patient-centered care models, and the pragmatic-explanatory continuum indicator summary tool for designing pragmatic trials. Discussion and critique of these health-related methodologies shows that these research methods are more suited for the philosophy and treatment options that naturopathy is based on. Conclusions: Successful implementation of naturopathic research methodologies, and translation and dissemination of research will require a substantial paradigm shift in which naturopathic practitioners adopt a greater level of responsibility for developing an evidence base for naturopathic medicine