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Background Lung and head and neck cancers are widely believed to produce psychologically destructive stigma because they are linked to avoidable risk-producing behaviors and are highly visible, but little research has tested these ideas. We examined cancer-related stigma, its determinants, and its psychosocial impact in lung (n = 107) and head and neck cancer survivors (n = 99) ≤3 years post-diagnosis. We investigated cancer site, self-blame, disfigurement, and sex as determinants, benefit finding as a moderator, and illness intrusiveness as a mediator of the relation between stigma and its psychosocial impact. Methods Prospective participants received questionnaire packages 2 weeks before scheduled follow-up appointments. They self-administered widely used measures of subjective well-being, distress, stigma, self-blame, disfigurement, illness intrusiveness, and post-traumatic growth. Results As hypothesized, stigma correlated significantly and uniquely with negative psychosocial impact, but contrary to common beliefs, reported stigma was comparatively low. Reported stigma was higher in (i) men than women, (ii) lung as compared with head and neck cancer, and (iii) people who were highly disfigured by cancer and/or its treatment. Benefit finding buffered stigma's deleterious effects, and illness intrusiveness was a partial mediator of its psychosocial impact. Conclusions Stigma exerts a powerful, deleterious psychosocial impact in lung and head and neck cancers, but is less common than believed. Patients should be encouraged to remain involved in valued activities and roles and to use benefit finding to limit its negative effects. Copyright © 2011 John Wiley & Sons, Ltd.

BACKGROUND: This study reports the adoption of prophylactic cranial irradiation (PCI) in patients with limited stage small cell lung carcinoma (LS-SCLC) at Princess Margaret Hospital (PMH) and the factors that impact PCI utilization. METHODS: A retrospective review was performed on all patients with LS-SCLC treated at PMH from 1997 to 2007. Clinical details including the rate of PCI utilization were determined and, for patients not receiving PCI, the documented reason was recorded. Brain failure free survival (FFS) and overall survival (OS) were estimated by the Kaplan-Meier method, comparing patients treated with or without PCI. Pearson chi-square test was used to determine factors associated with PCI use. RESULTS: Two hundred seven patients were treated for LS-SCLC and 61.4% (n = 127) of these patients received PCI. The most common documented reason for not receiving PCI was patient refusal, typically because of concerns about PCI toxicity. Patients older than 65 were significantly less likely to receive PCI. Brain FFS and OS rates were significantly higher in patients who received PCI. CONCLUSIONS: Not all eligible patients are receiving PCI, despite its significant effect on reducing brain metastases and improving OS. Emphasizing the benefits of PCI to patients, when discussing potential toxicities, may improve utilization.

The reactions during high-temperature decomposition of Ba(Zn1/2W1/2)O3 double perovskite, a potential microwave dielectric material, were studied by using X-ray diffraction, electron microscopy, and Knudsen effusion combined with mass spectrometry. The results show that above 1200°C, the perovskite decomposes due to the sublimation of ZnO, which results in the formation of BaWO4, Ba2WO5, and amorphous BaO-rich phases. The simultaneous presence of BaWO4 and Ba2WO5 causes the formation of a liquid phase above 1320°C, which in the case of ceramics results in a progressive deterioration of the microstructure. As a consequence, the dielectric losses of Ba(Zn1/2W1/2)O3-based ceramics strongly depend on the processing parameters.

BaO-rich phases with the nominal compositions Ba6NbxW3−xO15−x/2 (x=1, 2), 9L-Ba9Nb2W4O26, 12-layered (12L)-Ba4Nb2WO12, and 27L-Ba9Nb6WO27 were synthesized as polycrystalline powders using solid-state techniques and characterized by X-ray powder diffractometry and transmission electron microscopy. Of these powders only the 5L2-Ba6NbxW3−xO15−x/2 (x=2) and 9L-Ba9Nb2W4O26 were obtained as single-phase materials. The formation of Ba6NbxW3−xO15−x/2 (x=1, 2) started with the occurrence of binary compounds. Thus, 5L1-Ba6NbxW3−xO15−x/2 (x=1) appeared over binary Ba4Nb2O9 in contrast to 5L2-Ba6NbxW3−xO15−x/2 (x=2), which formed through a reaction between Ba5Nb4O15 and other barium–tungsten oxides. 5L2-Ba6NbxW3−xO15−x/2 (x=2) appeared in two different polymorphs structurally related to the hexagonal Ba6Ta2WO14 and the orthorhombic β-Ba4Nb2O9. The structural refinement of the high-temperature 5L2-Ba6NbxW3−xO15−x/2 (x=2) was carried out using the space group P3m1. The fitted parameters of the hexagonal unit cell corresponded to aH=6.030(1) A and cH=12.44(1) A. Additional reflections of variable intensity and strong, diffuse scattering in the electron diffraction patterns indicated a strong structural disorder. The formation of 9L-Ba9Nb2W4O26, 12L-Ba4Nb2WO12, and 27L-Ba9Nb6WO27 started with the reaction between the binary compounds and continued over a series of intermediate hexagonal perovskite-type phases lying on the Ba3W2O9–Ba5Nb4O15 tie line.

Polymorphic phase transitions in Ba4Nb2O9 were studied by thermal analyses, high-temperature transmission electron microscopy and X-ray powder diffractometry. Two stable polymorphs were isolated, low-temperature α-modification and high-temperature γ-modification, with the endothermic phase transition at 1176°C. The α→γ transformation is accompanied by the formation of a 120° domain structure, which is a consequence of hexagonal→orthorhombic unit cell reconstruction. Reheating the presintered γ-Ba4Nb2O9 results in the formation of a metastable γ′-modification (formerly known as β-polymorph) in the temperature range between 360° and 585°C, before the γ→α transformation at 800°C. Above ∼490°C Ba4Nb2O9 becomes moderately sensitive to a loss of BaO. In air the surface of Ba4Nb2O9 grains decomposes to nanocrystalline Ba5Nb4O15 and BaO, which instantly reacts with atmospheric CO2 to form BaCO3. Surface reaction delays γ→α transformation up to 866°C in air. In vacuum the loss of BaO is even more enhanced and consequently the formation of minor Ba3Nb2O8 phase is observed above 1150°C.

Summary: Morphological anomalies of the spore forming structures in 13 thermotoler-ant strains of aspergilli were studied on two different media (Sabouraud glucose and Czapek-Dox agar) incubated at 28°C, 38°C and 45°C. A few more casual observations in contaminant non-thermotolerant aspergilli were also analysed. A logical classification of these anomalies was given, depending on what part of spore forming structure was affected. Some of these anomalies have either never been described before or not yet reported, i.e. in five additional Aspergillus spp. The incidence and relationship to the culture medium and incubation temperature of these anomalies, as well as possible significance of our observations, were discussed. Zusammenfassung: Es wurden die morpho-logischen Anomalien der sporenbildenden Bauelemente an 13 thermotoleranten As-pergillus-Stammen auf zwei verschiedenen Nahrmedien (Sabouraud-Glucose-Agar und Czapek-Dox-Agar) bei 28°C, 37°C und 45°C Bebrutungstemperatur unter-sucht. Einige Zufallsbeobachtungen an nicht-thermotoleranten Aspergillus-Kon-taminanten wurden in die Studie eingeschlossen. Es wird eine Klassifikation die-ser Anomalien vorgestellt, die auf ihrer je-weiligen Lokalisation an sporenbildenden Bauelementen basiert. Einige dieser Anomalien sind Erstbeschreibungen an 5 Aspergillus-Arten. Haufigkeit und Abhangig-keit dieser Anomalien vom Kulturmedium und von der Bebrutungstemperatur wie auch ihre mogliche Bedeutung werden dis-kutiert.

The goal of this study was to determine what magnitude of change in a patient-reported outcome score is clinically meaningful, so a clinicians' guide may be provided for estimating the minimal important difference (MID) when empiric estimates are not available.Consecutive laryngeal cancer patients (n = 98) rated their quality of life (QOL) relative to other patients. These comparisons were contrasted with arithmetic differences in scores on the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) scale, Functional Assessment of Cancer Therapy-General (FACT-G) scale, 2 utility measures (the time tradeoff [TTO] and Daily Active Time Exchange [DATE]), and performance status (Karnofsky) scores.The FACT-HN score needed to differ by 4% for average patients to rate themselves as "a little bit better" relative to other patients (95% CI, 1%-8%) and by 9% to rate themselves as "a little bit worse" relative to others (95% CI, 4%-13%). The corresponding values for other measures were FACT-G 4% (1%-7%) and 8% (95% CI, 5%-11%); TTO 5% (95% CI, 0%-11%) and 6% (95% CI, 0%-10%); DATE 5% (95%CI, 2%-9%) and 14% (95% CI, 0%-5%); Karnofsky 4% (95% CI, 1%-6%) and 10% (95% CI, 7%-13%). In each case, the minimal important difference (MID) was about 5% to 10% of the instrument range. CONCLUSIONS. One rule of thumb for interpreting a difference in QOL scores is a benchmark of about 10% of the instrument range. Patients appear to be more sensitive to favorable differences, so an improvement of 5% may be meaningful. This simple benchmark may be useful as a rough guide to meaningful change.

The illness intrusiveness theoretical framework maintains that illness-induced lifestyle disruptions compromise quality of life in chronic life-threatening conditions and that this effect is moderated by social, psychological, and contextual factors. Considerable evidence indicates that lifestyle disruptions compromise quality of life in cancer and other diseases and that the effects differ across life domains. The hypothesis that contextual factors (e.g. age, education, income, stressful life events) moderate these effects has not been tested extensively. We investigated whether age, income, education, and/or recent stressful life events modify the experience of illness intrusiveness across three central life domains (Relationships and Personal Development, Intimacy, and Instrumental life) in six common cancers. A sample of 656 cancer outpatients with one of six common cancers (breast, prostate, lymphoma, lung, head and neck, and gastrointestinal, all n's>100) completed the Illness Intrusiveness Ratings Scale while awaiting follow-up appointments with an oncologist. Results indicated statistically significant (all p's

Quality of life (QOL) of cancer patients has become the focus of increasing research in oncology, and a frequently measured endpoint in clinical trials. Very little attention has been paid to the perspective of physicians on quality of life information, and its role in clinical decision-making. This report describes the findings of research focused on exploring the perspectives of physicians about quality of life information that is available for cancer patients. On the basis of qualitative data gathered through in-depth interviews with 60 oncologists in the first phase of this project, we have developed a self-administered questionnaire (MD-QOL survey) designed to assess oncologists' views on QOL. This survey was administered to an international group of gynecologic oncologists. The objectives of this study were to assess the face validity of the initial items in the MD-QOL, to expand the pool of items, and to assess the feasibility of utilizing a self-administered questionnaire to assess physicians' perspectives on QOL information. Twenty-eight oncologists responded to the questionnaire. The majority of respondents felt that QOL can be measured and that it should be measured from the patient's own perspective. Half of the physicians felt that currently available QOL information is useful in clinical practice. Ninety-three percent of respondents felt that the greatest benefit of QOL information is 'being able to treat the whole patient'. Forty one percent of respondents felt that length of survival is more important to patients than quality of life. However, only 7% of the respondents felt that the primary job of physicians is to save lives, and that QOL should not be a predominant concern for physicians. The inclusion of QOL in randomized trials was perceived as encouraging both patient and physician participation. The results of this survey are being used to further explore these critical issues.

This paper examines the investor reaction to the use of corporate selloffs as antitakeover devices. The results show that firms subject to takeover speculations prior to the divestiture announcement experience insignificant changes in share prices while firms that have no takeover bid report significant wealth increases. The majority of the firms that undergo defensive divestitures remain independent one year after the selloffs. These findings are consistent with the authors' proposition that investors regard divestitures following rumors of takeover attempt as antitakeover strategies. On the other hand, investors perceive selloffs in a takeover-free environment as a positive net present value decision.

This paper describes the synthesis of a series of 2-amino-4-aryl-4 H ,5 H -[1]benzothiopyrano[4,3- b ]pyran-3-carbonitriles and 2-alkoxy-4-aryl-5 H -[1]benzothiopyrano[4,3- b ]pyridine-3-carbonitriles. All of these products were studied for antifungal activity and many of these compounds displayed good activity against Cryptococcus neoformans, Torulopsis glabrata , and Trichosporon cutaneum .

Purpose: To test the efficacy of a simple, robust-inspired intensity modulated radiotherapy (IMRT) planning strategy for lung radiotherapy designed to reduce lung dose and escalate tumor dose using realistic dose accumulation tools. Methods: A deformable image registration tool was used to plan and accumulate dose over all phases of the breathing cycle for conventional and robust-inspired IMRT strategies of eight nonsmall cell lung cancer patients exhibiting peak-to-peak respiratory motion with amplitudes ranging from 1 to 2 cm in the craniocaudal direction. The authors’ robust-inspired plans were designed to have smaller beam apertures based on target location during exhale, combined with edge-enhanced intensity maps to ensure target coverage during inspiration. For these, a new planning target volume defined as the rPTV was generated from a 5-mm isotropic expansion of the clinical target volume (CTV) on end-exhale combined with a boost volume, set to 110% of the prescription dose. Plans were evaluated in terms of (i) lung sparing and (ii) dose escalation for mean lung dose (MLD) isotoxicity. CTV and planning target volumes (PTV) coverage and lung dose were compared to the conventional IMRT approach. Results: Robust-inspired plans showed potential lung dose reductions in seven out of eight patients. For non-GTV lung, percent reductions of 3%–14% in MLD and 6%–15% in V20 were observed. For seven of eight cases, the robust-like approach yielded increased accumulated doses to CTV. Isotoxicity studies for MLD showed increased dose to the CTV and the rPTV, in the range of 104%–118% and 95%–114% of prescription dose, respectively. Conclusions: A 4D dose calculation based on deformable image registration was used to evaluate a robust-inspired planning strategy for lung radiotherapy. This method offers notable reductions to lung dose while improving tumor coverage through the use of reduced geometric margins combined with edge enhancements.

Background For lungcancerradiotherapy, respiratory motion broadens dose penumbra, increasing the amount of normal tissues irradiated and reducing the target dose near the edge. Traditionally, large PTV margins are used to ensure coverage of the tumour in the presence of motion. Unfortunately, organs at risk intersecting with the PTV also receive high doses. The objective of this work was to evaluate a robust lung strategy to account for the effects of respiratory motion on tumour coverage and normal tissue sparing. Hypothesis Accumulating dose from 4DCT phases using a deformable registration tool combined with penumbral and motion compensationIMRT techniques can be used to develop robust lung plans that reduce the dose to normal tissues and maintain therapeutic coverage of the PTV. Methods A deformable image registration tool was used to plan and accumulate dose over 10 phases of the breathing cycle for clinical IMRT plans and robust IMRT plans of 5 NSCLC patients. Robust plans have reduced beam apertures, but added segments which prefentially boost the portion of the target that falls outside of the reference phase (e.g. the exhale phase). The dose to this boost volume was set to 110% of the prescription dose inside the peripheral edge of the PTV. Clinical and robust plans were normalized and compared for CTV coverage and lungdose. Results for the ipsilateral lung showed that on average, V20, V10 and V5 decreased by approximately 3.0% with the robust approach. For all cases, the accumulated dose to CTV was increased. Conclusions Robust lungIMRT allows for reduction of geometric margins sparing ipsilateral lung and enhancing tumour coverage.

A series of 3-benzylidenechroman-4-ones, 3-benzylidenethiochroman-4-ones and 2-benzylidene-1-tetralones have been synthesised and tested for their in vitro antifungal activity. Some of them were inactive; others displayed good activity against Cryptococcus neoformans, Torulopsis glabrata and Trichosporon cutaneum.

Purpose: To determine the variability in diaphragm and tumor motion assessed at planning and for each treatment fraction for patients with inoperable early stage non‐small cell lungcancertreated using stereotactic body radiation therapy(SBRT).Method and Materials: Six patients with upper lobe lungtumors were treated using SBRT. For each patient, tumor motion was assessed initially using fluoroscopy on a conventional simulator. The subsequent scanning session involved a helical scan and a four‐dimensional CT (4DCT) scan to assess tumor motion at the inspiration and expiration phases of breathing. Each of the three treatments was performed under on‐line cone‐beam computed tomography(CBCT)image guidance. Similarly to 4DCT, the projections for the CBCT scans were sorted based on an internal surrogate of the breathing cycle to provide volumetric datasets at the inspiration and expiration phases of breathing for each treatment fraction. Results: For five of the six patients treated,lungtumor and diaphragm motion measured on the treatment unit using CBCT was consistent with the tumor motion measured by 4DCT at planning. However, for the sixth patient, diaphragm motion, and to a lesser extent tumor motion, was markedly different between planning and the three treatment fractions. For this patient, the average tumor motion difference observed between 4DCT and projection‐sorted CBCT scans was 4.5 mm (A/P) and the average diaphragm motion difference was 12.0 mm (A/P) and 9.5 mm (S/I), respectively. Conclusion: Our study has shown that the relative motion and position of the tumor at the time of treatment may not match that of the planning scan. Application of breathing motion data acquired at scanning time to modulate or gate radiation therapy may not be suitable for all patients. Conflict of Interest: Princess Margaret Hospital is part of the Elekta Synergy Consortium. The research is supported, in part, by Elekta Inc.