PAK-104P, a pyridine analogue, reverses paclitaxel and doxorubicin resistance in cell lines and nude mice bearing xenografts that overexpress the multidrug resistance protein

For ethical decision-making near the end of life, autonomy is the moral North Star. At the same time, for some treatments, the burdens so clearly outweigh benefits that physicians may make a judgment not to offer the treatment. This is often clearer in surgery. A person with colon cancer and metastases may not insist on resection of the metastases. For some reason, some treatments have escaped these logical constraints. Attempted resuscitation of a dying patient is a good example. The circumstances in which a physician may make choices on behalf of a competent, terminally-ill patient without consent, and even without notification, are hotly debated, but data suggest that physicians do so frequently. Patients who lack capacity present even more difficult challenges. Advance directives, when available, can be extremely helpful, but even with them difficult problems can remain. If advance directives have not been established, family and close friends are an obvious source of guidance. Their legal role varies in different jurisdictions; in practice, they are crucial in bedside decision-making. Guardianship and alternatives to it remain a poor last resort. Euthanasia is a very difficult problem. We believe it is semantically misleading to lump under the term "passive euthanasia" those circumstances where potentially life-sustaining treatment is withheld or withdrawn. The tension between patient autonomy and medical common sense remains unresolved within the "futility" controversy. The authors believe it serves no purpose to discuss carefully with dying patients propositions that are nonsense. At the same time, physicians must not confuse decisions about quality of life with judgements about treatment effectiveness. We believe that what many, although not all, dying patients want are physicians with intelligent compassion who can take care of them through the dying process.     

Primary metastatic carcinoma of the prostate in younger men: a plea to think over usual therapeutic strategies

METHOD: The time from first diagnosis of primary multiple metastatic prostate carcinoma until progression and until death in patients less than 60 years old under two different therapeutic regimens was evaluated. RESULTS: In the group with pure androgen deprivation (n = 21), the mean time until progression was 11.3 (6-55) months, the mean survival time being 21.4 (11-75) months. In the group with androgen deprivation plus cytostatic therapy (n = 10), progression was noted after 26.7 (15-77) months with a medium survival time of 26.2 (16-82) months. CONCLUSION: The data argue in favor of changing the usual treatment strategy to combination therapy in "young' patients with primary metastatic prostatic cancer.     

Infrared temperature measurement in the ear canal with the DIATEK 9000 Instatemp and the DIATEK 9000 Thermoguide. Comparison with methods of temperature measurement in other body parts

Temperature of the tympanic membrane is recommended as a "gold standard" of core-temperature recording. However, use of temperature probes in the auditory canal may lead to damage of tympanic membrane. Temperature measurement in the auditory canal with infrared thermometry does not pose this risk. Furthermore it is easy to perform and not very time-consuming. For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice. We evaluated two infrared thermometers-the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp-regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites. In addition, we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature. MATERIALS AND METHODS: In 20 volunteers we evaluated the influence of three factors: duration of the devices in the auditory canal before taking temperature (0 or 5 s), interval between two following recordings (30, 60, 90, 120, 180 s) and positioning of the grip relative to the auditory-canal axis (0, 60, 180 and 270 degrees). Agreement with tympanic contact probes (Mon-a-therm tympanic) in the contralateral ear was investigated in 100 postoperative patients. Comparative readings with rectal (YSI series 400) and esophageal (Mon-a-therm esophageal stethoscope with temperature sensor) probes were done in 100 patients in the ICU. The method of Bland and Altman was taken for comparison. RESULTS: Shortening of the interval between two consecutive readings led to increasing differences between the two measurements with the second reading decreasing. A similar effect was seen when positioning the infrared thermometers in the auditory canal before taking temperatures: after 5 s the recorded temperatures were significantly lower than temperature recordings taken immediately. Rotation of the devices out of the telephone handle position led to increasing lack of agreement between infrared thermometry and contact probes. Mean differences between infrared thermometry (Instatemp and Thermoguide, CAL-Mode) and tympanic probes were -0.41 +/- 0.67 degree C (2 SD) and -0.43 +/- 0.70 degree C, respectively. Mean differences between the Thermoquide (Rectal-Mode) and rectal probe were -0.19 +/- 0.72 degree C, and between the Thermoguide (Core Mode) and esophageal probe -0.13 +/- 0.74 degree C. DISCUSSION: Although easy to use, infrared thermometry requires careful handling. To obtain optimal recordings, the time between two consecutive readings should not be less than two min. Recordings should be taken immediately after positioning the devices in the auditory canal. Best results are obtained in the 60 degrees position with the grip of the devices following the ramus mandibulae (telephone handle position). The lower readings of infrared thermometry compared with tympanic contact probes indicate that the readings obtained represent the temperature of the auditory canal rather than of the tympanic membrane itself. To compensate for underestimation of core temperature by infrared thermometry, the results obtained are corrected and transferred into core-equivalent temperatures. This data correction reduces mean differences between infrared recordings and traditional core-temperature monitoring, but leaves limits of agreement between the two methods uninfluenced.     

A mildly exponential approximation algorithm for the permanent

A new approximation algorithm for the permanent of ann ×n 0,1-matrix is presented. The algorithm is shown to have worst-case time complexity exp(O(n ^1/2 log² n)). Asymptotically, this represents a considerable improvement over the best existing algorithm, which has worst-case time complexity exp((n)).Supported by SERC Grant GR/F 90363; work done in part while visiting DIMACS (Center for Discrete Mathematics and Computer Science).Supported by an NSF PYI grant, with matching equipment grant from the AT&T Foundation; work done in part while visiting DIMACS.     

基于物联网和云计算的智能城市体研究

在智能小区、城市综合体的基础上,从服务集成的角度提出了"智能城市体"的概念。将物联网与云计算结合应用于智能城市公共服务系统,对其应用模式进行了研究,并设计了完整的智能城市体系统架构。为智能城市建设功能集成的、可扩展的、开放统一标准的智能化服务系统提供了解决方案。     

Numerical study of the mixture formation process in a four-stroke GDI engine for two-wheel applications

Guidelines for managing the mixture formation process in a high-performance four-stroke Gasoline Direct Injection (GDI) engine for two-wheel applications are discussed, as derived from a multidimensional modelling of the in-cylinder processes. Gasoline adduction from a multi-hole injector is simulated by resorting to a properly developed model that accounts for the dependence of the initial droplets size distribution upon injection pressure. The model portability is preliminary demonstrated by comparison with experimental measurements carried out on sprays entering a confined vessel at controlled conditions.The simulation of different engine operating conditions highlights the capability to work under the so-called “mixed mode” boosting with spray guided mixture formation.     

An application of the technology acceptance model to the level of Internet usage by older adults

In this cross-sectional study, the principles of a technology acceptance model were used to identify variables related to the level of Internet usage by older adults. Community-dwelling older adults aged 60–88 years completed a postal questionnaire survey that elicited responses on the use of the Internet. Out of a sample of 592 older adults (236 males and 356 females), 50.7% used the Internet. A multiple linear regression analysis was carried out on the Internet users sample using the self-reported number of hours of Internet usage per week as the dependent variable. The results indicated that attitude toward using the Internet and good health status were statistically significant predictors of the level of Internet usage. A second multiple regression analysis using Internet activity as the dependent variable showed that attitude, usefulness, good health, and gender (males) were significant predictor variables.     

Conduction mechanisms in SnO2 based polycrystalline thick film gas sensors exposed to CO and H2 in different oxygen backgrounds

The conduction mechanism in polycrystalline SnO₂ thick sensing films was modeled and experimentally investigated by means of simultaneous DC electrical resistance and work function changes measurements under CO and H₂ exposure in different oxygen backgrounds. It was shown that, according to the composition of the ambient atmosphere, the conduction changes from the case in which it is controlled by the surface depletion layers to a situation in which the main contribution comes from free charge transport in the surface accumulation layer. This is significant for the interpretation of work function changes measurements results because the relation between the different measured electrical resistance and surface band bending depends on the conduction model. Furthermore, the CO sensing mechanism dependence on the oxygen amount in the ambient was explained.