Cartan subalgebras and the UCT problem, II

We show that outer approximately represenbtable actions of a finite cyclic group on UCT Kirchberg algebras satisfy a certain quasi-freeness type property if the corresponding crossed products satisfy the UCT and absorb a suitable UHF algebra tensorially. More concretely, we prove that for such an action there exists an inverse semigroup of homogeneous partial isometries that generates the ambient C*-algebra and whose idempotent semilattice generates a Cartan subalgebra. We prove a similar result for actions of finite cyclic groups with the Rokhlin property on UCT Kirchberg algebras absorbing a suitable UHF algebra. These results rely on a new construction of Cartan subalgebras in certain inductive limits of Cartan pairs. We also provide a characterisation of the UCT problem in terms of finite order automorphisms, Cartan subalgebras and inverse semigroups of partial isometries of the Cuntz algebra $\mathcal{O}_2$. This generalizes earlier work of the authors.Comment: minor revisions; final version, accepted for publication in Math. Ann.; 26 page

Gemcitabine and carboplatin in carcinoma of unknown primary site: a phase 2 Adelaide Cancer Trials and Education Collaborative study

Cancer of unknown primary site (CUP) represents up to 5% of all cancer diagnoses and is associated with poor survival. We have performed a prospective multicentre phase 2 trial to evaluate efficacy and toxicity of the combination of gemcitabine (G) and carboplatin (C) for patients with CUP. Patients with histologically confirmed metastatic carcinoma in which the primary site of cancer was not evident after prospectively designated investigation and who had ECOG performance status 0–2 were treated with G 1000 mg m−2 intravenously (i.v.) days 1 and 8, and C AUC 5 i.v. on day 8 every 3 weeks to a maximum of nine cycles. The primary end points were response rate, and toxicity, with secondary end points of progression-free survival and overall survival. Fifty-one (23 male, 27 female) patients were enrolled (one patient ineligible), with a median age of 69 years (range 41–83 years). Fifty patients were evaluable for toxicity and 46 patients were evaluable for efficacy. The overall response rate to the GC regimen was 30.5%. With a median follow-up of 24 months, the median progression-free survival was 18 weeks (4.2 months) and the median overall survival was 34 weeks (7.8 months). The frequency of grade 3 or 4 toxicity was low. Nausea/vomiting was the most common side effect, but was usually only mild in severity. Uncomplicated neutropenia (14%), thrombocytopenia (10%) and anaemia (8%) were the most common causes of grade 3–4 toxicity. The regimen was very well tolerated, particularly in the elderly. The GC regimen is an active regimen in CUP with excellent tolerability and should be considered particularly for elderly patients with CUP

The Noise Exposure Structured Interview (NESI): an instrument for the comprehensive estimation of lifetime noise exposure

Lifetime noise exposure is generally quantified by self report. The accuracy of retrospective self report is limited by respondent recall, but is also bound to be influenced by reporting procedures. Such procedures are of variable quality in current measures of lifetime noise exposure, and off-the-shelf instruments are not readily available. The Noise Exposure Structured Interview (NESI) represents an attempt to draw together some of the stronger elements of existing procedures and to provide solutions to their outstanding limitations. Reporting is not restricted to pre-specified exposure activities, and instead encompasses all activities that the respondent has experienced as noisy (defined based on sound level estimated from vocal effort). Changing exposure habits over time are reported by dividing the lifespan into discrete periods in which exposure habits were approximately stable, with life milestones used to aid recall. Exposure duration, sound level, and use of hearing protection are reported for each life period separately. Simple-to-follow methods are provided for the estimation of free-field sound level, the sound level emitted by personal listening devices, and the attenuation provided by hearing protective equipment. An energy-based means of combining the resulting data is supplied, along with a primarily energy-based method for incorporating firearm-noise exposure. Finally, the NESI acknowledges the need of some users to tailor the procedures; this flexibility is afforded and reasonable modifications are described. Competency needs of new users are addressed through detailed interview instructions (including troubleshooting tips) and a demonstration video. Limited evaluation data are available and future efforts at evaluation are proposed

The groupoid approach to Leavitt path algebras

When the theory of Leavitt path algebras was already quite advanced, it was discovered that some of the more difficult questions were susceptible to a new approach using topological groupoids. The main result that makes this possible is that the Leavitt path algebra of a graph is graded isomorphic to the Steinberg algebra of the graph’s boundary path groupoid. This expository paper has three parts: Part 1 is on the Steinberg algebra of a groupoid, Part 2 is on the path space and boundary path groupoid of a graph, and Part 3 is on the Leavitt path algebra of a graph. It is a self-contained reference on these topics, intended to be useful to beginners and experts alike. While revisiting the fundamentals, we prove some results in greater generality than can be found elsewhere, including the uniqueness theorems for Leavitt path algebras

The effectiveness of fermented wheat germ extract as an adjunct therapy in the treatment of cancer: a systematic review

Review question/objective: The objective of this review is to synthesise the best available evidence on effectiveness of fermented wheatgerm extract (Avemar) as an adjunct therapy to conventional cancer treatments such as surgery, chemotherapy, radiotherapy and hormone therapies, in the treatment of haematological and non-haematological cancers. Types of participants: This review will consider studies that include participants of any age or gender. It will include all types of cancer presentations at any stage of the disease. Cancers will be addressed regardless of diagnosis, prognosis or location of cancer. Types of intervention(s)/phenomena of interest: This review will consider studies that evaluate, as intervention, the orally administered Avemar as an adjunct therapy to any conventional cancer treatment such as surgery, hormone therapies, chemotherapy and / or radiotherapy for cancer patients, when compared to conventional cancer treatment alone. The review will consider participants able to take or assisted to take Avemar administered orally or via nasogastric or nasoenteric tube feeding directly into the stomach. Types of outcomes: This review will consider studies that include the following outcome measures: -patients survival, expressed for example as survival rates -disease progression including new metastases and new recurrence of disease -patients mortality, expressed for example as mortality rate -type and severity of side effects experienced by patients, compared between groups -presence of adverse effects in the adjunct therapy groupTracey Yeend, Kai Robinson, Craig Lockwood, Alexa McArthu

Metastatic carcinoid tumor: changing patterns of care over two decades

Background: Metastatic carcinoid tumors (MCTs), an important subgroup of neuroendocrine tumors, occur infrequently and often have an indolent course, limiting data on long-term treatment outcomes. We aimed to assess treatment trends at a single center over time and the impact on the outcome. Study: Patients diagnosed with carcinoid tumors in the North West Adelaide Health Service between January 1, 1985 and March 1, 2007 were identified from the South Australian Cancer Registry. Results: We identified 92 patients with carcinoid tumors; 49 had MCT. Although treatment options increased over time, the most significant change was to access octreotide therapy, with 24 receiving long-acting somatostatin analogs. Survival improved over time and the median overall survival for patients receiving long-acting somatostatin analogs was 112 months compared with 53 months for those who did not (P=0.021, hazard ratio: 2.46). Ten year survival was 40% and 22%, respectively. About 75% of evaluable patients had a biochemical response to initial therapy and a measurable response occurred in 3 of 24 (13%) patients. Conclusions: This single center experience has provided insight into current treatment options for MCT, and suggests the use of long-acting somatostatin analogs may impact on disease control and survival. However, the uptake of other treatment options seems limited and there is a need for agents that target tumor progression.Amanda Townsend, Tim Price, Sue Yeend, Ken Pittman, Kevin Patterson and Colin Luk

Altered pharmacokinetics of piperacillin in febrile neutropenic patients with hematological malignancy

This study assessed the pharmacokinetics and dosing adequacy of piperacillin in febrile neutropenic patients after the first dose. Pharmacokinetic analysis was performed using noncompartmental methods. We observed an elevated volume of distribution (29.7 ± 8.0 liters [mean ± standard deviation]) and clearance (20.2 ± 7.5 liters/h) compared to data from other patient populations. Antibiotic exposure did not consistently result in therapeutic targets. We conclude that alternative dosing strategies guided by therapeutic drug monitoring may be required to optimize exposure.Fekade Bruck Sime, Michael S. Roberts, Morgyn S. Warner, Uwe Hahn, Thomas A. Robertson, Sue Yeend, Andy Phay, Sheila Lehman, Jeffrey Lipman, Sandra L. Peake, Jason A. Robert