Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: a randomised study

Background: Many patients with advanced malignant dysphagia are not suitable for definitive treatment. The best option for palliation of dysphagia varies between patients. This paper looks at a simple technique for enhancing laser recanalisation. Aim: To assess the value of adjunctive brachytherapy in prolonging palliation of malignant dysphagia by endoscopic laser therapy. Patients: Twenty two patients with advanced malignant dysphagia due to adenocarcinoma of the oesophagus or gastric cardia, unsuitable for surgery or radical chemoradiotherapy. Methods: Patients able to eat a soft diet after laser recanalisation were randomised to no further therapy or a single treatment with brachytherapy (10 Gy). Results were judged on the quality and duration of dysphagia palliation, need for subsequent intervention, complications, and survival. Results: The median dysphagia score for all patients two weeks after initial treatment was 1 (some solids). The median dysphagia palliated interval from the end of initial treatment to recurrent dysphagia or death increased from five weeks (control group) to 19 weeks (brachytherapy group). Three patients had some odynophagia for up to six weeks after brachytherapy. There was no other treatment related morbidity or mortality. Further intervention was required in 10 of 11 control patients (median five further procedures) compared with 7/11 brachytherapy patients (median two further procedures). There was no difference in survival (median 20 weeks (control), 26 weeks (brachytherapy)). Conclusions: Laser therapy followed by brachytherapy is a safe, straightforward, and effective option for palliating advanced malignant dysphagia, which is complementary to stent insertion

Candidates for a possible third-generation gravitational wave detector: comparison of ring-Sagnac and sloshing-Sagnac speedmeter interferometers

Speedmeters are known to be quantum non-demolition devices and, by potentially providing sensitivity beyond the standard quantum limit, become interesting for third generation gravitational wave detectors. Here we introduce a new configuration, the sloshing-Sagnac interferometer, and compare it to the more established ring-Sagnac interferometer. The sloshing-Sagnac interferometer is designed to provide improved quantum noise limited sensitivity and lower coating thermal noise than standard position meter interferometers employed in current gravitational wave detectors. We compare the quantum noise limited sensitivity of the ring-Sagnac and the sloshing-Sagnac interferometers, in the frequency range, from 5 Hz to 100 Hz, where they provide the greatest potential benefit. We evaluate the improvement in terms of the unweighted noise reduction below the standard quantum limit, and by finding the range up to which binary black hole inspirals may be observed. The sloshing-Sagnac was found to give approximately similar or better sensitivity than the ring-Sagnac in all cases. We also show that by eliminating the requirement for maximally-reflecting cavity end mirrors with correspondingly-thick multi-layer coatings, coating noise can be reduced by a factor of approximately 2.2 compared to conventional interferometers

Come back Marshall, all is forgiven? : Complexity, evolution, mathematics and Marshallian exceptionalism

Marshall was the great synthesiser of neoclassical economics. Yet with his qualified assumption of self-interest, his emphasis on variation in economic evolution and his cautious attitude to the use of mathematics, Marshall differs fundamentally from other leading neoclassical contemporaries. Metaphors inspire more specific analogies and ontological assumptions, and Marshall used the guiding metaphor of Spencerian evolution. But unfortunately, the further development of a Marshallian evolutionary approach was undermined in part by theoretical problems within Spencer's theory. Yet some things can be salvaged from the Marshallian evolutionary vision. They may even be placed in a more viable Darwinian framework.Peer reviewedFinal Accepted Versio

Search For Trapped Antihydrogen

We present the results of an experiment to search for trapped antihydrogen atoms with the ALPHA antihydrogen trap at the CERN Antiproton Decelerator. Sensitive diagnostics of the temperatures, sizes, and densities of the trapped antiproton and positron plasmas have been developed, which in turn permitted development of techniques to precisely and reproducibly control the initial experimental parameters. The use of a position-sensitive annihilation vertex detector, together with the capability of controllably quenching the superconducting magnetic minimum trap, enabled us to carry out a high-sensitivity and low-background search for trapped synthesised antihydrogen atoms. We aim to identify the annihilations of antihydrogen atoms held for at least 130 ms in the trap before being released over ~30 ms. After a three-week experimental run in 2009 involving mixing of 10^7 antiprotons with 1.3 10^9 positrons to produce 6 10^5 antihydrogen atoms, we have identified six antiproton annihilation events that are consistent with the release of trapped antihydrogen. The cosmic ray background, estimated to contribute 0.14 counts, is incompatible with this observation at a significance of 5.6 sigma. Extensive simulations predict that an alternative source of annihilations, the escape of mirror-trapped antiprotons, is highly unlikely, though this possibility has not yet been ruled out experimentally.Comment: 12 pages, 7 figure

Employment Changes following Breast Cancer Diagnosis: The Effects of Race and Place

The financial implications of breast cancer diagnosis may be greater among rural and black women. Women with incident breast cancer were recruited as part of the Carolina Breast Cancer Study. We compared unadjusted and adjusted prevalence of cancer-related job or income loss, and a composite measure of either outcome, by rural residence and stratified by race. We included 2435 women: 11.7% were rural; 48.5% were black; and 38.0% reported employment changes after diagnosis. Rural women more often reported employment effects, including reduced household income (43.6% vs 35.4%, two-sided ?2 test P =. 04). Rural white, rural black, and urban black women each more often reported income reduction (statistically significant vs. urban white women), although these groups did not meaningfully differ from each other. In multivariable regression, rural differences were mediated by socioeconomic factors, but racial differences remained. Programs and policies to reduce financial toxicity in vulnerable patients should address indirect costs of cancer, including lost wages and employment

First-person narratives around sexuality in residential healthcare settings: a meta-ethnographic synthesis

The aim of this review is to identify, critically appraise, and synthesise the existing literature exploring adults’ narratives around sexuality within residential healthcare settings from a first-person perspective. A systematic literature review was undertaken. Six databases were searched. A meta-ethnographic approach was used to synthesise studies’ findings. Thirteen studies using qualitative methodology that met the inclusion criteria were identified. The synthesis revealed six key themes: how service users define sexuality, sexuality as something not to be discussed (“privates are private”), sexuality as a separate aspect of the self (“sectionality”), hopes and fears for the future, the impact of the environment (“physicality of being physical”), and adapted sexuality. The studies included were of varying quality. Sexuality remains an important aspect for many residents, yet is rarely noted or discussed with them by healthcare staff. The residential healthcare environment presents implicit and explicit barriers to sexuality expression, causing residents to adapt how they experience their sexuality. Findings from this review highlight the importance of considering service users’ perspectives, and the need for open communication between residents and practitioners to facilitate care provision that acknowledges the barriers of the environment on sexuality and considers the person beyond the presenting illness

Field-friendly serological tests for determination of M. leprae-specific antibodies

Microscopic imaging and technolog

Can Racial Identity Be Promotive of Academic Efficacy?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89953/1/oyserman__harrison__bybee__2001.pd

Study of the B^0 Semileptonic Decay Spectrum at the Upsilon(4S) Resonance

We have made a first measurement of the lepton momentum spectrum in a sample of events enriched in neutral B's through a partial reconstruction of B0 --> D*- l+ nu. This spectrum, measured with 2.38 fb**-1 of data collected at the Upsilon(4S) resonance by the CLEO II detector, is compared directly to the inclusive lepton spectrum from all Upsilon(4S) events in the same data set. These two spectra are consistent with having the same shape above 1.5 GeV/c. From the two spectra and two other CLEO measurements, we obtain the B0 and B+ semileptonic branching fractions, b0 and b+, their ratio, and the production ratio f+-/f00 of B+ and B0 pairs at the Upsilon(4S). We report b+/b0=0.950 (+0.117-0.080) +- 0.091, b0 = (10.78 +- 0.60 +- 0.69)%, and b+ = (10.25 +- 0.57 +- 0.65)%. b+/b0 is equivalent to the ratio of charged to neutral B lifetimes, tau+/tau0.Comment: 14 page, postscript file also available at http://w4.lns.cornell.edu/public/CLN