Obtaining tissue diagnosis in lung cancer patients with poor performance status and its influence on treatment and survival

Introduction: 25% of patients with lung cancer have performance status 3 or 4. A pragmatic approach to investigative procedures is often adopted based on the risks and benefits in these patients and whether tissue diagnosis is necessary for anticipated future treatment. This cohort study investigated factors influencing a clinician's decision to pursue a tissue diagnosis in patients with lung cancer and performance status 3 and 4 and to examine the association of tissue diagnosis with subsequent management and survival. Methods: All patients with lung cancer diagnosed in North Glasgow from 2009 to 2012 were prospectively recorded in a registry. We investigated the relationships between achieving a tissue diagnosis, treatment and survival. Results: Of 2493 patients diagnosed with lung cancer, 490 patients (20%) were PS 3 and 122 patients (5%) were PS 4. Tissue diagnosis was attempted in 60% and 35% patients with PS 3 and PS 4 respectively. Younger age, better performance status and having stage 4 disease were independently associated with a diagnostic procedure being performed. Only 5% of patients with poor performance status received treatment conventionally requiring a tissue diagnosis. Age, stage and performance status were independent predictors of mortality. Achieving a tissue diagnosis was not associated with mortality. Receiving treatment requiring tissue diagnosis is associated with survival benefit. Conclusions: The majority of patients with poor fitness undergo a diagnostic procedure which does not influence further treatment or affect survival. However, the cohort of patients who do undergo therapy determined by tissue diagnosis have improved survival

The Limits of Intention in the Common Law

In criminal law, intention functions as the concept whereby human actions, and the reasons for them, are understood in relation to a criminal system. If there is no law, then there can be no punishment; but what if there is law, what then? How are the actions of the accused supposed to be understood in relation to the criminal law? One is very much aware that the criminal law, as it is presently conducted, generally pits the smallness of an individual against the corporate greatness and might of the state. What ought to serve to balance these competing interests? In any philosophical exploration one attempts to return to the source of the issue under scrutiny. In this exploration of intention the sources have been wide and varied and, at times, rare and difficult to obtain. There seem to be no clear and precise links from one moment of legal history to another. One is required to make educated guesses, thoughtful assumptions, and proffer what seem to be reasonable links from one epoch into the next. One reading of the sources suggests that intention is a volitive concept. Its beginnings as malice aforethought suggest that the accused had been moved to break the law (a law which was believed to have a moral foundation) because of his own disruption of character and moral disquietude. One did the deed, not thought the deed. However, the violation of a law which had a moral foundation leads one to ask further questions about both law and morals. Law and morals have distinct spheres. Is it possible that there is a common link between the ability to break a social law, and the ability to break a moral law? From history one will remember how both Bracton and Fleta admitted how both spheres could surround a human act. At times the spheres overlap, and at other times they are separate. Common, however, to each sphere is the ability and capacity of mankind to move within those spheres. This leads into the old and common effort to inquire into the nature of mankind. Without doubt, it is true that mankind possesses a nature. Whether that nature can be deciphered, decoded, and put into well defined, nonambiguous sets of linguistic propositions has been and is the rub. Historic modes of thought about human nature identified two broad differences: intellect and will. For centuries these broad conceptual differences seemed to take on concrete forms of their own. One\u27s will and intellect seemed to be reified in moral and theological writings, as if each were possessed of its own distinct identity, acting for its own distinct ends. Added to this reification of will and intellect, one further distinction was set forth that something about man\u27s nature put him into both a world of matter (mass and extension) and of spirit (energy and infinitude). Could any more contradictory sets of postulates have been integrated into a growing legal system

How Black Holes Form in High Energy Collisions

We elucidate how black holes form in trans-Planckian collisions. In the rest frame of one of the incident particles, the gravitational field of the other, which is rapidly moving, looks like a gravitational shock wave. The shock wave focuses the target particle down to a much smaller impact parameter. In turn, the gravitational field of the target particle captures the projectile when the resultant impact parameter is smaller than its own Schwarzschild radius, forming a black hole. One can deduce this by referring to the original argument of escape velocities exceeding the speed of light, which Michell and Laplace used to discover the existence of black holes.Comment: 8 pages, 3 .eps figures, essa

Merino ewes that are genetically fatter lose less weight when nutrition is restricted

Ewes that lose less weight when there is a shortage of paddock feed are potentially more profitable because they require less supplementary feeding or can be grazed at higher stocking rates during autumn/winter (Young et al. 2011). Adams et al. (2006) have shown that sheep genotypes which lose more weight when underfed have lower metabolic reserves including fat. This paper tested the hypothesis that selection for increased fatness would reduce the rate of liveweight loss in adult Merino ewes when nutrition was restricted

Groundwater Depletion and Agricultural Land Use Change in Wichita County, Kansas

Though researchers have documented groundwater and land use changes in the High Plains, few studies have investigated their interactions. This paper examines the relationship between groundwater depletion and agricultural land use change in greater detail than previous studies. Water well measurements and satellite imagery were used to detect changes in groundwater and land cover in Wichita County, Kansas, between 1975 and 2001. Analysis of these changes using GIS indicated that areas experiencing the greatest decline in groundwater were indeed being removed from irrigation, while areas with limited groundwater decline were experiencing fewer land use changes

Explicit Formulas for Neumann Coefficients in the Plane-Wave Geometry

We obtain explicit formulas for the Neumann coefficients and associated quantities that appear in the three-string vertex for type IIB string theory in a plane-wave background, for any value of the mass parameter mu. The derivation involves constructing the inverse of a certain infinite-dimensional matrix, in terms of which the Neumann coefficients previously had been written only implicitly. We derive asymptotic expansions for large mu and find unexpectedly simple results, which are valid to all orders in 1/mu. Using BMN duality, these give predictions for certain gauge theory quantities to all orders in the modified 't Hooft coupling lambda'. A specific example is presented.Comment: 28 pages, 2 figures, v2: reference added, new comments and appendix, typos fixed in eqs. (86) and (89

On the need for cultural sensitivity in digital wellbeing tools and messages: A UK-China comparison

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020. The excessive and obsessive use of the internet and digital technologies, known as Digital Addiction (DA), is becoming a social issue. Given that it inherently involves the use of technological devices this provides the opportunity to deliver interactive, intelligent prevention and intervention strategies in real-time. However, for any large-scale, multi-national prevention campaign to be optimised cultural differences within the target population must be considered. This study aimed to contribute towards this literature by exploring cultural differences in the acceptance of DA prevention messages in the UK vs China. An initial series of exploratory interviews were conducted with a sample within the UK to determine what strategies may be used to address the overuse of digital devices. These interviews were subjected to content analysis, which was then used as the basis for an online survey that was disseminated throughout the UK and China. A total of 373 useable surveys were returned. There were several statistically significant differences in preferences over how an intervention system should operate. UK participants wished for the system to be easily under their control, whilst behaving largely autonomously when needed, and to also be transparent as to why a message had been triggered. Chinese participants, on the other hand, were less likely to state a preference for such a high degree of control over any such system. Overall, the preferred implementation of such systems does appear to vary between the UK and China, suggesting that any future prevention and intervention strategies take cultural dimensions into consideration

On the center-vortex baryonic area law

We correct an unfortunate error in an earlier work of the author, and show that in center-vortex QCD (gauge group SU(3)) the baryonic area law is the so-called $Y$ law, described by a minimal area with three surfaces spanning the three quark world lines and meeting at a central Steiner line joining the two common meeting points of the world lines. (The earlier claim was that this area law was a so-called $\Delta$ law, involving three extremal areas spanning the three pairs of quark world lines.) We give a preliminary discussion of the extension of these results to $SU(N), N>3$. These results are based on the (correct) baryonic Stokes' theorem given in the earlier work claiming a $\Delta$ law. The $Y$-form area law for SU(3) is in agreement with the most recent lattice calculations.Comment: 5 pages, RevTeX4, 5 .eps figure

Standing Without Gravity: the Use of Lower Body Negative Pressure for Research and Reconditioning in Spaceflight

Weightlessness during spaceflight causes cephalad redistribution of intravascular and extravascular fluid, provoking cardiovascular and autonomic nervous system adaptations. The resulting functional state is appropriate for weightlessness but can result in orthostatic hypotension and intolerance during and after return to a persistent acceleration or gravitational environment. Lower body negative pressure (LBNP) applies subambient air pressure to the legs and lower abdomen inside a volume sealed at the waist, and decompression by 4050 mmHg reverses the spaceflightinduced cephalad shift. LBNP has been used both to test the state of cardiovascular system during spaceflight and as a countermeasure by all spacefaring nations. Two configurations have thus far been used in spaceflight since the first LBNP flew on the first Soviet Salyut station in 1971. The Soviet and Russian configuration, used in four Salyut stations, the Mir space station and the Russian segment of the International Space Station, has no saddle to support the body so during decompression the feet press against the bottom of the collapsible chamber which shortens and applies force against the feet proportional to the decompression level. Thus, activation of the skeletal musculature partially counteracts vascular and venous pooling in the enclosed body segments, stimulating the orthostatic compensatory mechanisms as they would be standing on Earth. In the American configuration, used aboard Skylab and the Space Shuttle, a saddle supported the astronaut so the feet did not contact the bottom of the chamber, and vascular engorgement was not countered by muscular contraction. This minimized skeletal muscle involvement, unmasked vascular compensatory mechanisms for research purposes, and allowed measurements of changes in leg volume and muscle sympathetic nerve activity. Both variants have demonstrated research and therapeutic value in appropriately designed protocols. LBNP continues to be used for research and countermeasures on ISS, and future versions may explore the value of exercise during LBNP as an integrated countermeasure. This paperwill review the history and development of LBNP for spaceflight research and therapeutic purposes