Nonopioid drugs in the treatment of cancer pain

The WHO analgesic ladder for the treatment of cancer pain provides a three-step sequential approach for analgesic administration based on pain severity that has global applicability. Nonopioids were recommended for mild pain, with the addition of mild opioids for moderate pain and strong opioids for severe pain. Here, we review the evidence for the use of nonopioid analgesic agents in patients with cancer and describe the mode of action of the main drug classes. Evidence supports the use of anti-inflammatory drugs such as acetaminophen/paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild cancer pain. Adding an NSAID to an opioid for stronger cancer pain is efficacious, but the risk of long-term adverse effects has not been quantified. There is limited evidence to support using acetaminophen with stronger opioids. Corticosteroids have a specific role in spinal cord compression and brain metastases, where improved analgesia is a secondary benefit. There is limited evidence for adding corticosteroids to stronger opioids when pain control is the primary objective. Systematic reviews suggest a role for antidepressant and anticonvulsant medications for neuropathic pain, but there are methodologic issues with the available studies. Bisphosphonates improve pain in patients with bony metastases in some tumor types. Denosumab may delay worsening of pain compared with bisphosphonates. Larger studies of longer duration are required to address outstanding questions concerning the use of nonopioid analgesia for stronger cancer pain. © 2014 by American Society of Clinical Oncology

Flexible and Low-Complexity Encoding and Decoding of Systematic Polar Codes

In this work, we present hardware and software implementations of flexible polar systematic encoders and decoders. The proposed implementations operate on polar codes of any length less than a maximum and of any rate. We describe the low-complexity, highly parallel, and flexible systematic-encoding algorithm that we use and prove its correctness. Our hardware implementation results show that the overhead of adding code rate and length flexibility is little, and the impact on operation latency minor compared to code-specific versions. Finally, the flexible software encoder and decoder implementations are also shown to be able to maintain high throughput and low latency.Comment: Submitted to IEEE Transactions on Communications, 201

Obligation de l'État d'aider financièrement les personnes atteintes du VIH par suite d'une transfusion de sang ou de dérivé sanguin

L'État fédéral a récemment approuvé la mise sur pied d'un Régime d'aide extraordinaire destiné aux hémophiles et aux personnes infectées par le V.l.H. à cause d'une transfusion de sang ou de dérivé sanguin (concentré de facteurs de coagulation) infecté. Les auteurs saluent cette initiative et se penchent sur les arguments d'ordre juridique et moral qui obligent les pouvoirs publics provinciaux, en particulier le Québec, à prévoir eux aussi des régimes d'indemnisation ou d'aide financière destinés à ces personnes. Le présent article fait d'abord l'historique du sida puis examine le processus de transmission du V.l.H. lors d'une transfusion de sang ou de dérivé sanguin. Les auteurs se penchent ensuite sur la possibilité pour les hémophiles et les receveurs de transfusion sanguine infectés par le V.l.H. de toucher une indemnité s'ils intentent les recours légaux habituels contre les hôpitaux, les fabricants et les distributeurs en cause, de même que contre l'État fédéral ou provincial. Il est également fait mention des principes de droit international et des chartes canadienne et québécoise, de même que des régimes d'indemnisation mis sur pied au Canada, aux paliers fédéral et provincial, et à l'étranger. Puisque les pouvoirs publics, tant au palier fédéral que provincial, et leurs fonctionnaires ont tardé à prendre les mesures qui s'imposaient pour prévenir la transmission du V.l.H. par voie sanguine, ils ont une obligation morale, voire juridique, envers les personnes qui ont contracté la maladie de cette façon. En effet, leur inaction équivaut à une violation des droits humains les plus fondamentaux, soit le droit à la vie et à la santé et le droit à la protection de ces derniers. L'État fédéral a maintenant reconnu les besoins des hémophiles et des receveurs de transfusion sanguine infectés par le V.l.H. et leur fournit une aide financière. À cause des obligations d'ordre constitutionnel et législatif qui leur incombent, les pouvoirs publics provinciaux sont également tenus de reconnaître leur responsabilité envers ces personnes et de suivre l'exemple du fédéral quant à la création d'un régime d'indemnisation ou d'aide financière à leur intention.The Federal Government recently approved an Extraordinary Assistance Plan for hemophiliacs and blood-transfusion recipients who became H.I.V.-infected through contaminated blood and blood products (clotting factor concentrates). The authors welcome the response of the Federal Government to the needs of such individuals and examine the legal and moral arguments which compel the Provincial Governments, in particular that of Quebec, to provide similar compensation or financial aid to such individuals. The early history of aids and the process of H.I.V.-transmission through blood and blood products is first considered. The authors then assess the potential for H.I.V.-infected hemophiliacs and blood-transfusion recipients to obtain redress through normal legal channels against responsible hospitals, manufacturers and distributors, as well as either level of government. Reference is also made to international legal principles and the Canadian and Quebec Charters. Compensation schemes in other countries for such individuals are described and other types of Provincial and Federal compensation schemes which exist in Canada are considered. Since the Provincial Governments, as well as the Federal Government, and their bureaucracies responded too slowly at the outset to warnings of H.I.V.-transmission through blood, they have a moral, if not a legal duty to those unsuspecting individuals who contracted the disease from contaminated blood. Through their inaction, they breached the most elementary responsibility in the field of human rights; the right to life and to health and to the protection thereof. The Federal Government has since acknowledged the needs of H.I.V.-infected hemophiliacs and blood-transfusion recipients and has provided them with financial assistance. Due to their specific constitutional and legislative duties, the Provinces too must now recognize their responsibility towards these same individuals and follow the lead of the Federal Government in setting up an appropriate compensation or financial assistance scheme for their benefit

Pre-stack full waveform inversion of ultra-high-frequency marine seismic reflection data

The full waveform inversion (FWI) of seismic reflection data aims to reconstruct a detailed physical properties model of the subsurface, fitting both the amplitude and the traveltime of the reflections generated at physical discontinuities in the propagation medium. Unlike reservoir-scale seismic exploration, where seismic inversion is a widely adopted remote characterization tool, ultrahigh-frequency (UHF, 0.2–4.0 kHz) multichannel marine reflection seismology is still most often limited to a qualitative interpretation of the reflections’ architecture. Here we propose an elastic FWI methodology, custom-tailored for pre-stack UHF marine data in vertically heterogeneous media to obtain a decimetric-scale distribution of P-impedance, density and Poisson’s ratio within the shallow subseabed sediments. We address the deterministic multiparameter inversion in a sequential fashion. The complex trace instantaneous phase is first inverted for the P-wave velocity to make up for the lack of low frequency in the data and reduce the nonlinearity of the problem. This is followed by a short-offset P-impedance optimization and a further step of full offset range Poisson’s ratio inversion. Provided that the seismogram contains wide reflection angles (>40°), we show that it is possible to invert for density and decompose a posteriori the relative contribution of P-wave velocity and density to the P-impedance. A broad range of synthetic tests is used to prove the potential of the methodology and highlights sensitivity issues specific to UHF seismic. An example application to real data is also presented. In the real case, trace normalization is applied to minimize the systematic error deriving from an inaccurate source wavelet estimation. The inverted model for the top 15 m of the subseabed agrees with the local lithological information and core-log data. Thus, we can obtain a detailed remote characterization of the shallow sediments using a multichannel sub-bottom profiler within a reasonable computing cost and with minimal pre-processing. This has the potential to reduce the need of extensive geotechnical coring campaigns

Treatment of Sciatica Following Uterine Cancer with Acupuncture: A Case Report.

For women, gynaecological or obstetrical disorders are second to disc prolapse as the most common cause of sciatica. As not many effective conventional treatments can be found for sciatica following uterine cancer, patients may seek assistance from complementary and alternative medicine. Here, we present a case of a woman with severe and chronic sciatica secondary to uterine cancer who experienced temporary relief from acupuncture

On the Merits of Meritocracy

We study career choice when competition for promotion is a contest. A more meritocratic profession always succeeds in attracting the highest ability types, whereas a profession with superior promotion benefits attracts high types only if the hazard rate of the noise in performance evaluation is strictly increasing. Raising promotion opportunities produces no systematic effect on the talent distribution, while a higher base wage attracts talent only if total promotion opportunities are sufficiently plentifu

Eligibility of patients with advanced non-small cell lung cancer for phase III chemotherapy trials

<p>Abstract</p> <p>Background</p> <p>Evidence that chemotherapy improves survival and quality of life in patients with stage IIIB & IV non small cell lung cancer (NSCLC) is based on large randomized controlled trials. The purpose of this study was to determine eligibility of patients with advanced NSCLC for major chemotherapy trials.</p> <p>Methods</p> <p>Physicians treating stage IIIB/IV NSCLC at Sydney Cancer Centre assessed patient eligibility for the E1594, SWOG9509 and TAX326 trials for patients presenting from October 2001 to December 2002. A review of the centre's registry was used to obtain missing data.</p> <p>Results</p> <p>199 patients with advanced NSCLC were registered during the 14-month period. Characteristics of 100 patients were defined prospectively, 85 retrospectively: 77% males, median age 68 (range 32–88), 64% stage IV disease. Only 35% met trial eligibility for E1594 and 28% for SWOG9509 and TAX326. Common reasons for ineligibility were: co-morbidities 75(40%); ECOG Performance Status ≥2 72(39%); symptomatic brain metastasis 15(8%); and previous cancers 21(11%). Many patients were ineligible by more than one criterion.</p> <p>Conclusion</p> <p>The majority of patients with advanced NSCLC were ineligible for the large chemotherapy trials. The applicability of trial results to advanced lung cancer populations may be limited. Future trials should be conducted in a more representative population.</p