Patient–physician communication concerning participation in cancer chemotherapy trials

Cancer patients demand a high level of involvement in decisions concerning treatment. Many patients are informed about experimental trials, and especially the first consultation may be crucial for the future communication and treatment process. Patients with nonresectable non-small-cell lung cancer or colorectal cancer informed about experimental chemotherapy completed a questionnaire on satisfaction with the communication process, general attitude towards experimental treatments, the substance of information, and personal contact with the physician following their first consultation in a medical oncology unit. Physicians completed a questionnaire on their perception of the patients’ satisfaction. Among 68 physician–cancer patient pairs, 29 patients were informed on chemotherapy in randomised trials and 39 in nonrandomised studies. The general attitude towards experimental treatment was positive or very positive in 71% of patients. Information on the treatment was perceived as completely adequate in 93% of patients informed on randomised and in 67% informed on nonrandomised trials. Physicians underestimated the patients’ satisfaction with the overall communication process, the personal contact, the patients’ perceived sufficiency of the specific treatment information and their ability to decide on study entry. In conclusion, considerable differences were observed between patients informed about experimental chemotherapy in randomised and nonrandomised trials, both with respect to their perception of how adequate the information on the specific treatments were, and whether it was sufficient for decisions on study entry. This study type effect should be accounted for in future evaluations of communication and patient satisfaction. The data also support the fact that cancer patients have a desire for and ability to understand rather detailed and comprehensive treatment information

Determinants of new drugs prescription in the Swiss healthcare market.

Drug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. This study attempts to lift the veil from this important subject by analyzing simultaneously the impact of several variables on the prescription of novelty. Data provided by four Swiss sickness funds were analyzed. These data included information about more than 470,000 insured, notably their drug intake. Outcome variable that captured novelty was the age of the drug prescribed. The overall variance in novelty was partitioned across five levels (substitutable drug market, patient, physician, region, and prescription) and the influence of several variables measured at each of these levels was assessed using a non-hierarchical multilevel model estimated by Bayesian Markov Chain Monte Carlo methods. More than 92% of the variation in novelty was explained at the substitutable drug market-level and at the prescription-level. Newer drugs were prescribed in markets that were costlier, less concentrated, included more insured, provided more drugs and included more active substances. Over-the-counter drugs were on average 12.5 years older while generic drugs were more than 15 years older than non-generics. Regional disparities in terms of age of prescribed drugs could reach 2.8 years. Regulation of the demand has low impact, with little variation explained at the patient-level and physician-level. In contrary, the market structure (e.g. end of patent with generic apparition, concurrence among producers) had a strong contribution to the variation of drugs ages

Magnetic Domain State Diagnosis in Soils, Loess, and Marine Sediments From Multiple First-Order Reversal Curve-Type Diagrams

First-order reversal curve (FORC) diagrams provide information about domain states and magnetostatic interactions that underpin paleomagnetic interpretations. FORC diagrams are a complex representation of remanent, induced, and transient magnetizations that can be assessed individually using additional FORC-type measurements along with conventional measurements. We provide the first extensive assessment of the information provided by remanent, transient, and induced FORC diagrams for a diverse range of soil, loess/paleosol, and marine sediment samples. These new diagrams provide substantial information in addition to that provided by conventional FORC diagrams that aids comprehensive domain state diagnosis for mixed magnetic particle assemblages. In particular, we demonstrate from transient FORC diagrams that particles occur routinely in the magnetic vortex state. Likewise, remanent FORC diagrams provide information about the remanence-bearing magnetic particles that are of greatest interest in paleomagnetic studies

Evolving thermal thresholds explain the distribution of temperature sex reversal in an Australian dragon lizard

Aim: Species with temperature-dependent sex determination (TSD) are particularly vulnerable to climate change because a resultant skew in population sex ratio can have severe demographic consequences and increase vulnerability to local extinction. The Australian central bearded dragon (Pogona vitticeps) has a thermosensitive ZZ male/ZW female system of genetic sex determination (GSD). High incubation temperatures cause reversal of the ZZ genotype to a viable female phenotype. Nest temperatures in the wild are predicted to vary on a scale likely to produce heterogeneity in the occurrence of sex reversal, and so we predict that sex reversal will correlate positively with inferred incubation conditions. Location: Mainland Australia. Methods: Wild-caught specimens of P. vitticeps vouchered in museum collections and collected during targeted field trips were genotypically and phenotypically sexed to determine the distribution of sex reversal across the species range. To determine whether environmental conditions or genetic structure can explain this distribution, we infer the incubation conditions experienced by each individual and apply a multi-model inference approach to determine which conditions associate with sex reversal. Further, we conduct reduced representation sequencing on a subset of specimens to characterize the population structure of this broadly distributed species. Results: Here we show that sex reversal in this widespread Australian dragon lizard is spatially restricted to the eastern part of the species range. Neither climatic variables during the inferred incubation period nor geographic population genetic structure explain this disjunct distribution of sex reversal. The main source of genetic variation arose from isolation by distance across the species range. Main conclusions: We propose that local genetic adaptation in the temperature threshold for sex reversal can counteract the sex-reversing influence of high incubation temperatures in P. vitticeps. Our study demonstrates that complex evolutionary processes need to be incorporated into modelling biological responses to future climate scenarios

Electrical current distribution across a metal-insulator-metal structure during bistable switching

Combining scanning electron microscopy (SEM) and electron-beam-induced current (EBIC) imaging with transport measurements, it is shown that the current flowing across a two-terminal oxide-based capacitor-like structure is preferentially confined in areas localized at defects. As the thin-film device switches between two different resistance states, the distribution and intensity of the current paths, appearing as bright spots, change. This implies that switching and memory effects are mainly determined by the conducting properties along such paths. A model based on the storage and release of charge carriers within the insulator seems adequate to explain the observed memory effect.Comment: 8 pages, 7 figures, submitted to J. Appl. Phy

Tectonic rotations in central Chile: New insights on the southern limit of the Maipo Orocline

The Maipo Transition Zone or Maipo Orocline represents a change in strike of the topography from N–S between 30° and 33°S to an NNE-SSW trend to the south. The southern flank of the Maipo Orocline can be traced along strike to around 38°S. There the Andean margin exposes another orogen bending, the Arauco Orocline. Although the tectonic evolution of this segment of the Andean chain is relatively well constrained, the limit between both oroclines is unclear. In this paper, we show the results of a paleomagnetic study carried out in three plutons of Upper Triassic age located along the Coastal Cordillera of central Chile between 35° and 37°S. Paleomagnetic analysis from Constitución Granite and Cobquecura Pluton shows an increase of clockwise vertical-axis rotations from north to south consistent with previous data, whereas results obtained in the Hualpén Stock, located to the south, shows minors counter-clockwise rotations. This change in the rotation pattern would reflect the Maipo and Arauco Oroclines limit. The similar amounts of tectonic rotations recorded by Mesozoic and Miocene rocks indicate that the whole area behaved as a single block and constrains the maximum possible age for the occurrence of tectonic rotations to Miocene.Fil: Puigdomenech Negre, Carla Gimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Alarcón, S.. Universidad Andrés Bello; ChileFil: Ruiz González, Víctor. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; ArgentinaFil: Rossel, P.. Universidad Andrés Bello; ChileFil: Orts, Darío Leandro. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Zaffarana, Claudia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentin