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We have studied the clinical impact of elective brain irradiation (EBI) in patients with locally advanced, non-small cell lung cancer (LA-NSC). All patients received combination chemotherapy (cyclophosphamide + doxorubicin (Adriamycin) + cisplatin = CAP) or CAP plus radiotherapy as the initial treatment for their active tumor or as an adjuvant therapy. Of 97 evaluable patients, 46 were randomized to receive EBI (3 000 rad in 10 fractions given over two weeks). The characteristics of both groups were comparable by sex, age, performance status, pretherapy weight loss, histologic cell type, clinical staging, and type of prior therapy. EBI significantly decreased the incidence of central nervous system (CNS) metastasis in the treated group compared to the control group (4% vs 27%, p = .002). CNS involvement occurred in the treated group after failure at other sites whereas 12 of 14 control patients had CNS metastases as the first site of relapse. EBI decreased the incidence of CNS metastasis in all prognostic categories. Using multivariate analysis, the beneficial effect was shown to be significant in females, patients with good performance status, weight loss less than 6%, squamous cell histology, state III disease or no prior therapy. EBI significantly increased CNS metastasis-free interval with a beneficial effect that was significant in males, patients with weight loss less than 6%, squamous cell histology or responders. Although no survival benefit was observed for the treated group because of the adverse effect from other relapses, EBI will become more important as better treatment programs are developed.(ABSTRACT TRUNCATED AT 250 WORDS)

SUMMARY Regional cerebral blood flow, blood volume, fractional oxygen extraction and oxygen consumption were measured by positron emission tomography in six patients with sickle cell disease to see how oxygen delivery to the brain is maintain**! in the presence of both anemia and a low oxygen affinity hemoglobin. Both regional cerebral Mood flow and blood volume were found to be markedly increased compared to values obtained from 14 normal subjects in the same age range. The mean fractional oxygen extraction was not significantly different in the two groups. Mean oxygen consumption in the two groups was also not significantly different but low values in individual patients with sickle cell disease and the presence of atrophy on the CT-scans of three of them were suggestive of some neuronal loss in patients without any history of nervous system involvement. In view of the known high values of cerebral blood flow and metabolism in childhood, it b suggested that when compounded by anemia and abnormal red cells, a hyperdrculatory state may make patients In this age-group particularly prone to ischemlc infarction.

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Qualities of personal character would appear to play a significant role in the professional conduct of teachers. It is often said that we remember teachers as much for the kinds of people they were than for anything they may have taught us, and some kinds of professional expertise may best be understood as qualities of character. After (roughly) distinguishing qualities of character from those of personality, the present paper draws on the resources of virtue ethics to try to make sense of the former. In the course of this, it is argued that while the key virtue ethical concept of phronesis or practical wisdom has been widely deployed to account for aspects of professional teacher expertise, it has also been subject to rather un-Aristotelian interpretation as a kind of situationspecific productive reasoning. The present paper seeks to show that it is better employed for understanding character in general and character in teaching in particular. The paper concludes with some observations about the professional education or cultivation of character.

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