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Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described.
At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy — General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests.
At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. −19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue.
Significance of results
One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
Geosphere-biosphere interactions are ubiquitous features of the Earth surface, yet the development of interactions between newly exposed lithologic surfaces and colonizing plants during primary succession after glaciation are lacking temporal detail. To assess the nature, rate, and magnitude of vegetation influence on parent material and sediment delivery, we analyzed ecosystem and geochemical proxies from lacustrine sediment cores at a grassland site and a forested site in the northern United States. Over time, terrigenous inputs declined at both sites, with increasing amounts of organic inputs toward present. The similarities between sites were striking given that the grassland sequence began in the Early Holocene, and the forested sequence began after the last glacial maximum. Multiple mechanisms of chemical weathering, hydrologic transport, and changes in source material potentially contribute to this pattern. Although there were strong links between vegetation composition and nitrogen cycling at each site, it appears that changes in forest type, or from oak woodland to grassland, did not exert a large influence on elemental (K, Ti, Si, Ca, Fe, Mn, and S) abundance in the sedimentary sequences. Rather, other factors in the catchment-lake system determined the temporal sequence of elemental abundance.
The Pentland Hills sponge fauna (Llandovery, Telychian) consists of an unusual, aberrant assemblage, but of low diversity. A new specimen of a unique sponge, Eoghanospongia carlinslowpensis gen. et sp. nov., is described from the classic locality of R82. The mushroom-shaped, probably stalked body (peduncle attachment to body not exposed) resembles that of some living rossellids, especially Caulophacus. The sponge also shows prominent projecting pentactins and monaxon derivatives – a spicule type diagnostic of the Rossellidae among living taxa, albeit in a robust form not described from extant sponges, including Caulophacus or other pedunculate lyssacinosidans. Certain attribution to the Rossellidae is not possible from the single specimen, largely because of weak preservation of the primary spicule skeleton, but no other fossil or modern sponges show any significant similarity to it. Although similarly early relatives of the Rossellidae have recently been described from elsewhere, the new sponge is even more unexpected in being from a shallow-water environment, making the absence of rossellids through the rest of the Palaeozoic much more problematic.
Wearable devices such as a wrist actigraph may have a potential to objectively estimate patients’ functioning and may supplement performance status (PS). This proof-of-concept study aimed to evaluate whether actigraphy data are significantly associated with patients’ functioning and are predictive of their survival in patients with metastatic non-small cell lung cancer.
We collected actigraphy data for a three-day period in ambulatory patients with stage IV non-small cell lung cancer. We computed correlations between actigraphy data (specifically, proportion of time spent immobile while awake) and clinician-rated PS, subjective report of physical activities, quality of life (the Functional Assessment of Cancer Therapy – Trial Outcome Index), and survival.
Actigraphy data (the proportion of time awake spent immobile) were significantly correlated with Functional Assessment of Cancer Therapy – Trial Outcome Index (r = −0.53, p < 0.001) and with the Eastern Cooperative Oncology Group PS (ECOG PS) (r = 0.37, p < 0.001). The proportion of time awake spent immobile was significantly associated with worse survival. For each 10% increase in this measure, the hazard ratio (HR) was 1.48 (95% confidence interval [CI95%] = 1.06, 2.06) for overall mortality, and odds ratio was 2.99 (CI95% = 1.27, 7.05) for six-month mortality. ECOG PS was also associated with worse survival (HR = 2.80, CI95% = 1.34, 5.86). Among patients with ECOG PS 0-1, the percentage of time awake spent immobile was significantly associated with worse survival, HR = 1.93 (CI95% = 1.10, 3.42), whereas ECOG PS did not predict survival.
Significance of Results
Actigraphy may have potential to predict important clinical outcomes, such as quality of life and survival, and may serve to supplement PS. Further validation study is warranted.
A modern pedagogical treatment of the latest industry trends in rocket propulsion, developed from the authors' extensive experience in both industry and academia. Students are guided along a step-by-step journey through modern rocket propulsion, beginning with the historical context and an introduction to top-level performance measures, and progressing on to in-depth discussions of the chemical aspects of fluid flow combustion thermochemistry and chemical equilibrium, solid, liquid, and hybrid rocket propellants, mission requirements, and an overview of electric propulsion. With a wealth of homework problems (and a solutions manual for instructors online), real-life case studies and examples throughout, and an appendix detailing key numerical methods and links to additional online resources, this is a must-have guide for senior and first year graduate students looking to gain a thorough understanding of the topic along with practical tools that can be applied in industry.