How Do Elderly Poor Prognosis Patients Tolerate Palliative Concurrent Chemoradiotherapy for Locally Advanced Non–Small-Cell Lung Cancer Stage III? A Subset Analysis From a Clinical Phase III Trial

AbstractBackgroundIn a phase III trial of patients with unresectable, locally advanced, stage III non–small-cell lung cancer (NSCLC) with a poor prognosis, palliative concurrent chemoradiotherapy (CRT) provided a significantly better outcome than chemotherapy alone, except among performance status (PS) 2 patients. In the present subgroup analysis, we evaluated the effect on patients aged ≥ 70 years (42% of all included) compared with patients aged < 70 years enrolled in the trial.Patients and MethodsAll patients received 4 courses of intravenous carboplatin and oral vinorelbine. The experimental arm also received radiotherapy (42 Gy in 15 fractions). The included patients were required to have large tumors (> 8 cm), weight loss (> 10% within the previous 6 months) and/or PS 2.ResultsThe overall survival was increased among the CRT patients in both age groups, but the difference was significant only in patients aged < 70 years (median survival, 14.8 vs. 9.7 months; P = .001; age ≥ 70 years, median survival, 10.2 vs. 9.1 months; P = .09). Patients aged ≥ 70 years experienced better preserved health-related quality of life (QOL) and significantly less hematologic toxicity. The 2- and 3-year survival was significantly increased in both age groups receiving CRT.ConclusionElderly patients aged ≥ 70 years with unresectable, stage III, locally advanced, NSLCL and a poor prognosis can tolerate CRT with the doses adjusted to age and palliative intent. These results indicate that CRT can provide both survival and QOL benefits in elderly patients, except for those with PS 2 or worse. The male predominance in the ≥ 70-year-age group and the reduced chemotherapy intensity for the patients aged > 75 years might explain the lack of significant survival improvement among those patients aged ≥ 70 years

Multiple stressors in a top predator seabird: potential ecological consequences of environmental contaminants, population health and breeding conditions

Environmental contaminants may have impacts on reproduction and survival in wildlife populations suffering from multiple stressors. This study examined whether adverse effects of persistent organic pollutants (POPs) increased with poor population health and breeding conditions in three colonies (60–74°N) of great skua (Stercorarius skua) in the north-eastern Atlantic (Shetland, Iceland and Bjørnøya [Bear Island]). POPs (organochlorines [OCs] and polybrominated diphenyl ethers [BDEs]) were measured in plasma of incubating birds (n = 222), concentrations differing nearly tenfold among colonies: Bjørnøya (2009) &gt; Bjørnøya (2010) &gt; Iceland (2009) &gt; Shetland (2009). Reproductive success (hatching success and chick survival) showed that breeding conditions were favourable in Shetland and at Bjørnøya (2010), but were very poor in Iceland and at Bjørnøya (2009). Biomarkers indicated that health was poor in the Shetland population compared to the other populations. Females whose chicks hatched late had high POP concentrations in all colonies except at Bjørnøya (2010), and females losing their eggs at Bjørnøya (2009) tended to have higher concentrations than those hatching. Moreover, there was a negative relationship between female POP concentrations and chick body condition at hatching in Iceland and at Bjørnøya (2010). Supplementary feeding experiments were conducted, and in Iceland where feeding conditions were poor, significant negative relationships were found between female POP concentrations and daily growth-rate in first-hatched chicks of control nests, but not in food supplemented nests. This suggests that negative impacts of POPs were mitigated by improved feeding conditions. For second-chicks, there was a strong negative relationship between the female POP concentrations and growth-rate, but no effects of supplementary feeding. Lowered adult return-rate between breeding seasons with increasing POP loads were found both at Bjørnøya (2009) and in Shetland, especially related to BDEs. This indicates stronger fitness consequences of POPs following seasons with very poor breeding conditions and/or high reproductive effort. This study suggests that the impacts of POPs may differ depending on population health and breeding conditions, and that even low concentrations of POPs could have ecological consequences during adverse circumstances. This is important with regard to risk assessment of biomagnifying contaminants in marine ecosystems

Marine food consumption by adult Atlantic salmon and energetic impacts of increased ocean temperatures caused by climate change

Atlantic salmon Salmo salar are experiencing widespread population declines, and reductions in growth and survival in the marine environment are contributing factors. Our aims were to estimate marine food consumption of adult salmon and to determine how energetics would be directly afected by the increased ocean temperatures associated with climate change. We tagged previous spawners on outward migration (body size 76–119 cm) with archival tags and used a bioenergetic model to combine in situ temperature recordings with individual data on body growth. Average energy consumption was estimated to be 331–813 kJ per day, which is equivalent to 5–11 prey fsh with an average body mass of ca. 15 g. Energy content of prey was the most important factor determining food consumption required to maintain growth. Conversely, the increases in ocean temperatures expected with climate change were predicted to have limited physiological efects on energy budgets and limited impact on the food consumption needed to maintain growth. We conclude that climatic warming will impact Atlantic salmon primarily through changes in prey availability and ecosystem structure rather than the direct efects of temperature on physiological performance

Feather corticosterone levels on wintering grounds have no carry-over effects on breeding among three populations of great skuas (<i>Stercorarius skua</i>)

Environmental conditions encountered by migratory seabirds in their wintering areas can shape their fitness. However, the underlying physiological mechanisms remain largely unknown as birds are relatively inaccessible during winter. To assess physiological condition during this period, we measured corticosterone concentrations in winter-grown primary feathers of female great skuas (Stercorarius skua) from three breeding colonies (Bjørnøya, Iceland, Shetland) with wintering areas identified from characteristic stable isotope signatures. We subsequently compared winter feather corticosterone levels between three wintering areas (Africa, Europe and America). Among females breeding in 2009, we found significant differences in feather corticosterone levels between wintering areas. Surprisingly, levels were significantly higher in Africa despite seemingly better local ecological factors (based on lower foraging effort). Moreover, contrary to our predictions, females sharing the same wintering grounds showed significant differences in feather corticosterone levels depending on their colony of origin suggesting that some skuas could be using suboptimal wintering areas. Among females wintering in Africa, Shetland females showed feather corticosterone levels on average 22% lower than Bjørnøya and Iceland females. Finally, the lack of significant relationships between winter feather corticosterone levels and any of the breeding phenology traits does not support the hypothesis of potential carry-over effects of winter feather corticosterone. Yet, the fitness consequences of elevated feather corticosterone levels remain to be determined

The Effect of Telemedicine Follow-Up Care on Diabetes-Related Foot Ulcers: A Cluster Randomized Controlled Non- Inferiority Trial

OBJECTIVE To evaluate whether telemedicine (TM) follow-up of patients with diabetes-related foot ulcers (DFUs) in primary health care in collaboration with specialist health care was noninferior to standard outpatient care (SOC) for ulcer healing time. Further, we sought to evaluate whether the proportion of amputations, deaths, number of consultations per month, and patient satisfaction differed between the two groups. RESEARCH DESIGN AND METHODS Patients with DFUs were recruited from three clinical sites in western Norway (2012–2016). The cluster-randomized controlled noninferiority trial included 182 adults (94/88 in the TM/SOC groups) in 42 municipalities/districts. The intervention group received TM follow-up care in the community; the control group received SOC. The primary end point was healing time. Secondary end points were amputation, death, number of consultations per month, and patient satisfaction. RESULTS Using mixed-effects regression analysis, we found that TM was noninferior to SOC regarding healing time (mean difference –0.43 months, 95% CI −1.50, 0.65). When competing risk from death and amputation were taken into account, there was no significant difference in healing time between the groups (subhazard ratio 1.16, 95% CI 0.85, 1.59). The TM group had a significantly lower proportion of amputations (mean difference –8.3%, 95% CI –16.3%, –0.5%), and there were no significant differences in the proportion of deaths, number of consultations, or patient satisfaction between groups, although the direction of the effect estimates for these clinical outcomes favored the TM group. CONCLUSIONS The results suggest that use of TM technology can be a relevant alternative and supplement to usual care, at least for patients with more superficial ulcers.måsjekke

Unpredictable shoe midsole perturbations provide an instability stimulus to train ankle posture and motion during forward and lateral gym lunges

Unstable footwear may enhance training effects to the lower-limb musculature and sensorimotor system during dynamic gym movements. This study compared the instability of an unstable shoe with irregular midsole deformations (IM) and a control shoe (CS) during forward and lateral lunges. Seventeen female gym class participants completed two sets of ten forward and lateral lunges in CS and IM. Ground reaction forces, lower-limb kinematics and ankle muscle activations were recorded. Variables around initial ground contact, toe-off, descending and ascending lunge phases were compared statistically (p < .05). Responses to IM compared to CS were similar across lunge directions. The IM induced instability by increasing the vertical loading rate (p < .001, p = .009) and variability of frontal ankle motion during descending (p = .001, p < .001) and ascending phases (p = .150, p = .003), in forward and lateral lunges, respectively. At initial ground contact, ankle adjustments enhanced postural stability in IM. Across muscles, there were no activation increases, although results indicate peroneus longus activations increased in IM during the ascending phase. As expected, IM provided a more demanding training stimulus during lunge exercises and has potential to reduce ankle injuries by training ankle positioning for unpredictable instability

Decadal increase in vessel interactions by a scavenging pelagic seabird across the North Atlantic

J.H.D.’s position is funded by an Irish Research Council Enterprise Partnership Scheme (EPSPG/2019/469), M.C. is funded by the H2020 X-Rotor project (101007135), and the majority of GLS devices are funded by the SEATRACK program (seatrack.seapop.no, Norwegian Research Council grant no. 192141). We would like to recognize and thank all those who assisted in the deployment and recovery of GLS devices, too many to mention individually. We are indebted to Pat and Liezl Grattan-Bellew for accommodating fieldwork on Little Saltee, Orkney Islands Council for access to Eynhallow, the landowners at Laxamyri for access to the Skjalfandi colony, and the Norwegian Armed Forces for support and accommodation on Jan Mayen. Particular thanks to Françoise Amélineau and Ewan Edwards for helpful input during discussions on this topic at an early stage, and to Vegard Bråthen for collating, curating, and delivering the data for analysis. Thanks to the two anonymous reviewers for exceptionally helpful and constructive feedback.Peer reviewedPublisher PD

Validation of pop-up satellite archival tags (PSATs) on Atlantic cod (Gadus morhua) in a Greenland fjord

Traditional tagging techniques are simple and cost-effective, but inferences require recaptures and data on movement/migration are limited to a start and end position at unpredictable intervals. Pop-up satellite archival tags (PSATs) offer other opportunities, as they provide positions at pre-programmed times and collect on-route data, which can be used to describe position, behavior, and habitat preferences. Species suitability should, however, be documented prior to large-scale studies using PSATs. We deployed PSATs on six relatively large (total length 84–125 cm) Atlantic cod (Gadus morhua) in inshore West Greenland waters. Three tags were physically recovered, providing high-resolution data on depth and temperature (readings every 3 s), while three tags did not report (recovery rate = 50 %). To evaluate the tag’s applicability on Atlantic cod, we made a detailed behavioral analysis by defining swimming behavior, occupied water types and depth phases, which were cross-evaluated in relation to depth, temperature and water stratification to identify behavioral patterns. Distinct and shared patterns in swimming behavior were evident and we found no signs of impaired swimming behavior except for an adaptation period lasting up to 39 h after release. Generally, the three cod were pelagic and preferred waters ranging 2–5 °C. When encountering colder water masses these were avoided. During late summer/early autumn, increased vertical activity could in some cases be linked to darkness and a high-activity event could be linked to possible predator avoidance. All combined, we conclude that PSATs are suitable to monitor natural behavior on large specimens of Atlantic cod for periods of at least four months.publishedVersio