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Radiation dermatitis (RD) is a frequent toxicity during radiotherapy (RT) for head and neck cancer (HNC). We report the first use of KeraStat® Cream (KC), a topical, keratin-based wound dressing, in patients with HNC receiving RT.
This pilot study randomized HNC patients treated with definitive or postoperative RT (≥60 Gy) to KC or standard of care (SOC), applied at least twice daily during and for 1-month after RT. Outcomes of interest included adherence to the assigned regimen (at least 10 applications per week of treatment), clinician- and patient-reported RD, and skin-related quality of life.
24 patients were randomized and completed the study. Most patients had stage III-IV disease and oropharynx cancer. Median RT dose was 68 Gy; the bilateral neck was treated in 19 patients, and 18 patients received concurrent chemotherapy. Complete adherence was observed in 7/12 (SOC) vs. 10/12 (KC, p = 0.65). Adherence by patient-week was 61/68 versus 64/67, respectively (p = 0.20). No differences in RD were observed between groups.
A randomized trial of KC versus SOC in HNC patients treated with RT is feasible with good adherence to study agent. An adequately powered randomized study is warranted to test the efficacy of KC in reducing RD.
The final effort of the CLIMAP project was a study of the last interglaciation, a time of minimum ice volume some 122,000 yr ago coincident with the Substage 5e oxygen isotopic minimum. Based on detailed oxygen isotope analyses and biotic census counts in 52 cores across the world ocean, last interglacial sea-surface temperatures (SST) were compared with those today. There are small SST departures in the mid-latitude North Atlantic (warmer) and the Gulf of Mexico (cooler). The eastern boundary currents of the South Atlantic and Pacific oceans are marked by large SST anomalies in individual cores, but their interpretations are precluded by no-analog problems and by discordancies among estimates from different biotic groups. In general, the last interglacial ocean was not significantly different from the modern ocean. The relative sequencing of ice decay versus oceanic warming on the Stage 6/5 oxygen isotopic transition and of ice growth versus oceanic cooling on the Stage 5e/5d transition was also studied. In most of the Southern Hemisphere, the oceanic response marked by the biotic census counts preceded (led) the global ice-volume response marked by the oxygen-isotope signal by several thousand years. The reverse pattern is evident in the North Atlantic Ocean and the Gulf of Mexico, where the oceanic response lagged that of global ice volume by several thousand years. As a result, the very warm temperatures associated with the last interglaciation were regionally diachronous by several thousand years. These regional lead-lag relationships agree with those observed on other transitions and in long-term phase relationships; they cannot be explained simply as artifacts of bioturbational translations of the original signals.
Introduction
Physically the Stokes equations model “slow” flows of incompressible fluids or alternatively isotropic incompressible elastic materials. In Computational Fluid Dynamics, however, the Stokes equations have become an important model problem for designing and analyzing finite element algorithms. The reason being, that some of the problems encountered when solving the full Navier-Stokes equations are already present in the more simple Stokes equations. In particular, it gives the right setting for studying the stability problem connected with the choice of finite element spaces for the velocity and the pressure. It is well known that these spaces cannot be chosen independently when the discretization is based on the “Galerkin” variational form. This method belongs to the class of saddle-point problems for which an abstract theory has been developed by Brezzi [1974] and Babuska [1973]. The theory shows that the method is optimally convergent if the finite element spaces for velocity and pressure satisfy the “Babuska-Brezzi” or “inf-sup” condition. In computations the violation of this condition often leads to unphysical pressure oscillations and a “locking” of the velocity field, cf. Hughes [1987]. During the last decade this problem has been studied thoroughly and various velocity-pressure combinations have been shown to satisfy the Babuska-Brezzi condition. Unfortunately, however, it has turned out that many seemingly natural combinations do not satisfy it. (See Girault and Raviart [1986], Brezzi and Fortin [1991], and references therein.)
In this chapter we will review a recent technique of “stabilizing” mixed methods. In this approach the standard Galerkin form is modified by the addition of mesh-dependent terms which are weighted residuals of the differential equations.
The response of patients with major depressive illness to citalopram of amitriptyline was compared in a double-blind multi-centre trial. No differences in efficacy were observed, but citalopram had less hypnotic effect and a remarkably lower profile of side-effects.
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