Purpose Venous thromboembolism (VTE) is common in cancer patients. Evidence has suggested that low molecular weight heparin (LMWH) might improve survival in patients with cancer by preventing both VTE and the progression of metastases. No trial in a single cancer type has been powered to demonstrate a clinically significant survival difference. The aim of this trial was to investigate this question in patients with lung cancer. Patients and Methods We conducted a multicenter, open-label, randomized trial to evaluate the addition of a primary prophylactic dose of LMWH for 24 weeks to standard treatment in patients with newly diagnosed lung cancer of any stage and histology. The primary outcome was 1-year survival. Secondary outcomes included metastasis-free survival, VTE-free survival, toxicity, and quality of life. Results For this trial, 2,202 patients were randomly assigned to the two treatment arms over 4 years. The trial did not reach its intended number of events for the primary analysis (2,047 deaths), and data were analyzed after 2,013 deaths after discussion with the independent data monitoring committee. There was no evidence of a difference in overall or metastasis-free survival between the two arms (hazard ratio [HR], 1.01; 95% CI, 0.93 to 1.10; P = .814; and HR, 0.99; 95% CI, 0.91 to 1.08; P = .864, respectively). There was a reduction in the risk of VTE from 9.7% to 5.5% (HR, 0.57; 95% CI, 0.42 to 0.79; P = .001) in the LMWH arm and no difference in major bleeding events but evidence of an increase in the composite of major and clinically relevant nonmajor bleeding in the LMWH arm. Conclusion LMWH did not improve overall survival in the patients with lung cancer in this trial. A significant reduction in VTE is associated with an increase in clinically relevant nonmajor bleeding. Strategies to target those at greatest risk of VTE are warranted.

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The present article argues for what is essentially a return to the functionalist approach to investigation of memory. Two experiments demonstrate that the effects of level of processing depend on scaled meaningfulness of the material and study time. Data from those experiments along with data currently in the literature are then reanalyzed to examine the effect of repetitions. Of particular interest is the form of the function relating number of repetitions to retention performance, and the manner in which that function is influenced by variations in level of processing and scaled meaningfulness. It is argued that task demands operate to change the form of the function relating repetitions to retention performance. The functionalist approach that dominated memory research for years promoted a search for relationships between rather easily measured indices of the task and retention performance. Many experiments investigated the effects of study time, number of repetitions, meaningfulness of the material, and so on. The apparent goal of these experiments was to find a unique mathematical function relating each of the task indices to retention. In contrast to this emphasis on functional relationships, the early Gestalt approach and the more recent levels-ofprocessing approach (Craik & Lockhart, 1972) cast doubt on the existence of functional relationships that remain invariant across different tasks and contexts. These latter approaches emphasize the role of context and task demands as determinants of retention; an implication is that the effect of task parameters, such as number of repeti-Although Wayne Bartz died of cancer prior to the writing of this article, prior discussions in which he was involved contributed greatly to the work reported here. Requests for reprints should be sent to Larry