Geriatric assessment and treatment outcomes in a Dutch cohort of older patients with potentially curable esophageal cancer

Background Patients with potentially curable esophageal cancer can be treated with neo-adjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy with curative intent. For frail older patients choosing the appropriate oncological treatment can be difficult, and data on geriatric deficits as determinants of treatment outcomes are not yet available. Objectives To describe the prevalence of geriatric deficits and to study their association with treatment discontinuation and mortality in older patients with potentially curable esophageal cancer. Material and Methods A cohort study was conducted in a Dutch tertiary care hospital including patients aged >= 70 years with primary stage I-IVA esophageal cancer. Geriatric screening and assessment data were collected. Outcomes were treatment discontinuation and one year all-cause mortality. Results In total, 138 patients with curable esophageal cancer were included. Mean age was 76.1 years (standard deviation 4.7), 54% had clinical stage III and 24% stage IVA disease. Most patients received neo-adjuvant chemoradiotherapy and surgery (41%), 32% definitive chemoradiotherapy and 22% palliative radiotherapy. Overall, one year all-cause mortality was 36%. Geriatric screening and assessment was performed in 94 out of 138 patients, of which 60% was malnourished, 20% dependent in Instrumental Activities of Daily Living (IADL) and 52% was frail. Malnutrition was associated with higher mortality risk (Hazard Ratio, 3.2; 95% Confidence Interval, 1.3-7.7)) independent of age, sex and tumor stage. Seventy-six out of 94 patients were treated with chemoradiotherapy, of which 23% discontinued treatment. Patients with IADL dependency and Charlson Comorbidity Index >= 1 discontinued treatment more often. Conclusion All-cause mortality within one year was high, irrespective of treatment modality. Treatment discontinuation rate was high, especially in patients treated with definitive chemoradiotherapy. Geriatric assessment associates with outcomes in older patients with esophageal cancer and may inform treatment decisions and optimization in future patients, but more research is needed to establish its predictive value.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

State of the world’s plants and fungi 2020

Kew’s State of the World’s Plants and Fungi project provides assessments of our current knowledge of the diversity of plants and fungi on Earth, the global threats that they face, and the policies to safeguard them. Produced in conjunction with an international scientific symposium, Kew’s State of the World’s Plants and Fungi sets an important international standard from which we can annually track trends in the global status of plant and fungal diversity

Solicited audio diaries in longitudinal narrative research: a view from inside

The use of solicited audio diaries in longitudinal qualitative enquiry is rare. Moreover, an understanding of the unique insights that these diaries might give the qualitative researcher has largely been absent in our consideration of appropriate methods for data collection. This article aims to address this deficit by providing a critical reflection on the use of solicited audio diaries in longitudinal narrative research from practical, theoretical and analytical perspectives. The data is drawn from a longitudinal study investigating medical students' professional identity formation. In an attempt to reach the broadest audience, both structural aspects and communicative elements of talk within the data are considered alongside ethical issues and emotional work that the longitudinal audio-diary researcher might encounter. In addition to presenting extracts from a variety of diary entries, a single event narrative is presented in full, alongside an analysis, in order to demonstrate the powerful utility of this underused method

Phase separation in the large-spin t-J model

We investigate the phase diagram of the two-dimensional t-J model using a recently developed technique that allows one to solve the mean-field model Hamiltonian with a variational calculation. The accuracy of our estimate is controlled by means of a small parameter 1/q, analogous to the inverse spin magnitude 1/s employed in studying quantum spin systems. The mathematical aspects of the method and its connection with other large-spin approaches are discussed in detail. In the large-q limit the problem of strongly correlated electron systems turns into the minimization of a total-energy functional. We have performed this optimization numerically on a finite but large L x L lattice. For a single hole the static small-polaron solution is stable except for small values Of J, where polarons of increasing sizes have lower energy. At finite doping we recover phase separation above a critical J and for any electron density, showing that the Emery et al. picture represents the semiclassical behavior of the t-J model. Quantum fluctuations are expected to be very important, especially in the small-J-small-doping region, where Phase separation may also be suppressed