Demonstrating Agreement between Radio and Fluorescence Measurements of the Depth of Maximum of Extensive Air Showers at the Pierre Auger Observatory

We show, for the first time, radio measurements of the depth of shower maximum (X_{max}) of air showers induced by cosmic rays that are compared to measurements of the established fluorescence method at the same location. Using measurements at the Pierre Auger Observatory we show full compatibility between our radio and the previously published fluorescence dataset, and between a subset of air showers observed simultaneously with both radio and fluorescence techniques, a measurement setup unique to the Pierre Auger Observatory. Furthermore, we show radio X_{max} resolution as a function of energy and demonstrate the ability to make competitive high-resolution X_{max} measurements with even a sparse radio array. With this, we show that the radio technique is capable of cosmic-ray mass composition studies, both at Auger and at other experiments.

A randomized controlled study to assess patients' understanding of and consenting for clinical trials using two different consent form presentations

BACKGROUND

Informed consent is the ethical basis for clinical research. The physical appearance of the consent document may influence patients' willingness to carefully read the consent document. We therefore tested the hypothesis that presentation of consent documents in an enhanced format improves patients' attention, understanding and therefore willingness to consent for clinical research.

METHODS

Patients being asked to participate in three large clinical trials were randomly assigned to enhanced or routine presentation. The enhanced document was printed on 20-pound, cream-colored bond paper and presented in a blue folio. In contrast, patients assigned to routine presentation were given an otherwise identical stapled set of photocopied pages. The primary outcome was the effect of the enhanced format on the proportion of patients consenting; the major secondary outcome was patient's understanding of the presented procedures and risks.

RESULTS

A total of 189 of 251 (75%) patients approached with standard format consenting documents consented for an underlying study, whereas 164 of 248 (66%) approached with enhanced format documents consented; the adjusted odds ratio (95% confidence interval) for consenting (comparing enhanced to standard formats) was 0.64 (0.43, 0.95), P=0.03. About 90% of the patients in each group correctly identified the major study intervention and major associated risk. Neither patients' characteristics nor understanding affected the consenting rate for the presented clinical research.

CONCLUSION

Consent forms in an enhanced format (i.e., printed on fine paper and presented in a folio) did not improve patients' understanding or willingness to consent to participate in clinical trials.

Die Inversio uteri puerperalis

In Europe, one inversion per 25,000 births is expected with present day obstetric management. Faulty management of the third stage of labour may increase the incidence many-fold. North American figures show that the omission of medications during the third stage of labour and traction on the umbilical cord have increased the incidence to 1 in 2,000. Whether cord traction is as free of danger as has been claimed within recent years, needs to be re-evaluated. The classical symptoms and signs of inversion of the uterus are pain, vascular shock and bleeding. If manual reposition of the uterus occurs immediately following the inversion, even without anesthesia, severe complications and post-operative morbidity are low. Following inversion of the uterus, further normal pregnancies can be expected.

Thirty-year follow-up of chemo/hormonal therapy in node-positive breast cancer

Results of a thirty-year follow-up of a clinical trial of chemo-hormonal therapy are reported. Eligible patients had recently diagnosed operable breast cancer, positive lymph nodes, no previous history of cancer, age less than 76 years, and no evidence of metastatic disease. A total of 311 patients were stratified by estrogen receptor (ER) status and number of axillary nodes involved with tumor. After stratification, patients were randomly assigned to one of three treatment regimens: cyclophosphamide, methotrexate and 5-fluorouracil (CMF) for 1 year; CMF chemotherapy combined with anti-estrogen therapy (tamoxifen) for 1 year; or CMF plus tamoxifen with BCG during the second year. The endpoint of the trial was a first recurrence. Factors measured at diagnosis and used in the analyses were age, body mass index, ER status, menopausal status, number of positive nodes, tumor diameter, Charlson comorbidity index, socioeconomic status, and race. Causes of death and incidence of other cancer primaries were obtained from death certificates and medical records. Patients treated with tamoxifen had a marginally longer disease-free survival (hazard ratio (HR)=0.83, 95% CI identical with [0.66, 1.04]) and statistically significant longer overall survival (HR=0.77, 95% CI identical with [0.63, 0.96]) that decreased with time. Incidence of other primary cancers and causes of death were similar for the two treatment groups. The addition of 1 year of tamoxifen to CMF therapy provides an early disease-free and overall survival advantage; however long-term effects are negligible. Similarly, the survival advantage of patients diagnosed with ER+ tumors persists for the first two decades after diagnosis.

[Caesarean section in a dead women (author's transl)]

A case of Caesarean section on a deceased pregnant woman is described. Medical Ethics dictates to carry out this operation as long as their is hope for the delivery of a live infant. A review of the literature suggests to proceed in the following manner: When the mother is with certainty clinically dead and a still viable infant is expected the physician has to proceed with a classical Caesarean section immediately. No preparation is carried out. One scalpel is all that is needed for the operation. Resuscitation methods in the clinically dead mother have to be continued until the infant has been delivered.