SummaryBackgroundWhole brain radiotherapy (WBRT) and dexamethasone are widely used to treat brain metastases from non-small cell lung cancer (NSCLC), although there have been no randomised clinical trials showing that WBRT improves either quality of life or overall survival. Even after treatment with WBRT, the prognosis of this patient group is poor. We aimed to establish whether WBRT could be omitted without a significant effect on survival or quality of life.MethodsThe Quality of Life after Treatment for Brain Metastases (QUARTZ) study is a non-inferiority, phase 3 randomised trial done at 69 UK and three Australian centres. NSCLC patients with brain metastases unsuitable for surgical resection or stereotactic radiotherapy were randomly assigned (1:1) to optimal supportive care (OSC) including dexamethasone plus WBRT (20 Gy in five daily fractions) or OSC alone (including dexamethasone). The dose of dexamethasone was determined by the patients' symptoms and titrated downwards if symptoms improved. Allocation to treatment group was done by a phone call from the hospital to the Medical Research Council Clinical Trials Unit at University College London using a minimisation programme with a random element and stratification by centre, Karnofsky Performance Status (KPS), gender, status of brain metastases, and the status of primary lung cancer. The primary outcome measure was quality-adjusted life-years (QALYs). QALYs were generated from overall survival and patients' weekly completion of the EQ-5D questionnaire. Treatment with OSC alone was considered non-inferior if it was no more than 7 QALY days worse than treatment with WBRT plus OSC, which required 534 patients (80% power, 5% [one-sided] significance level). Analysis was done by intention to treat for all randomly assigned patients. The trial is registered with ISRCTN, number ISRCTN3826061.FindingsBetween March 2, 2007, and Aug 29, 2014, 538 patients were recruited from 69 UK and three Australian centres, and were randomly assigned to receive either OSC plus WBRT (269) or OSC alone (269). Baseline characteristics were balanced between groups, and the median age of participants was 66 years (range 38–85). Significantly more episodes of drowsiness, hair loss, nausea, and dry or itchy scalp were reported while patients were receiving WBRT, although there was no evidence of a difference in the rate of serious adverse events between the two groups. There was no evidence of a difference in overall survival (hazard ratio 1·06, 95% CI 0·90–1·26), overall quality of life, or dexamethasone use between the two groups. The difference between the mean QALYs was 4·7 days (46·4 QALY days for the OSC plus WBRT group vs 41·7 QALY days for the OSC group), with two-sided 90% CI of −12·7 to 3·3.InterpretationAlthough the primary outcome measure result includes the prespecified non-inferiority margin, the combination of the small difference in QALYs and the absence of a difference in survival and quality of life between the two groups suggests that WBRT provides little additional ...

PurposeTo critically assesses the extent to which consumers are being empowered by the internet, focusing specifically on the role of the internet in the context of online pension information provision.Design/methodology/approachA mixed method study involving focus groups and observational research. Focus groups explored consumer meanings of empowerment and pension information needs. Actual information provision was measured using a content analysis of a sample of 20 pension web sites from 1996 to 2004 accessed from the internet archive.FindingsWhile consumers generally feel that the internet is empowering, the sense of empowerment has not been fully realised in the context of pensions. The findings reveal gaps between consumer needs for information and information provision with implications for pension providers and consumers.Research limitations/implicationsRelies on consumers' own reported information needs. Pensions are complex and consumers may not fully appreciate the most relevant information in order to make an informed pension decision. Researching professional financial advisors could close the loop and help understand what information consumers should be using to make decisions.Practical implicationsProvides useful insights for pension providers and employers in understanding the value of pension web sites and the features/facilities that consumers value most in using them.Originality/valueAddresses a key concern of government – insufficient pension provision – and helps to understand how the internet can be used to engage consumers in pensions and encourage them to take greater responsibility for and ownership of their retirement saving.

Our understanding of the mechanisms involved in the formation of the complex arrangement of neurons and their interconnections within the brain has made significant progress in recent years. Current research has uncovered a network of intracellular signaling events that provide precise coordination of a diverse array of cellular responses, including trafficking events, cytoskeletal remodeling, gene transcription, and protein ubiquitination and translation. This chapter considers the specific cellular responses controlled by the phosphatidylinositol 3-kinase (PI3K) signaling pathway, which is instructive with regard to a number of important steps involved in the development of the brain. These range from the mediation of extrinsic signals - such as growth factors, axon guidance cues, and extracellular matrix components - to intrinsic effectors, such as downstream signaling components that act, for example, at the translation level. PI3K signaling is, consequently, at the heart of controlling neuronal migration and neuronal morphogenesis, as well as dendrite and synapse development. Many neurobehavioral disorders arise as a consequence of subtle developmental abnormalities. Unsurprisingly, therefore, aberrant PI3K signaling has been indicated by many studies to be a contributing factor to the pathophysiology of disorders such as schizophrenia and autism. In this chapter, we will focus on the specific, yet divergent, cellular processes that are achieved through PI3K signaling in neurons and are key to brain development.

This paper uses the metaphor of the movie classic the Wizard of Oz to represent the online experiences of young adults. Just like the twister that turns Dorothy’s world upside, down the Internet has arrived to transform our black and white lives into the Technicolor hyper‐reality of the Land of Oz. What are the consequences for young Dorothies of today when they explore the yellow brick information superhighway? Phenomenologically informed qualitative research was used to explore the Internet experiences of older adolescents and young adults. The findings identify, financial, temporal, social, logistical and emotional barriers and indicate that although the Internet is an intrinsic facet of young adults’ lives, it falls well short of an obsession. The implications are that marketing practitioners need to pay closer attention to the genuine fears and concerns directed at the Internet rather than assuming that young adults’ responses are enthusiastic and positive.

Systemic adjuvant chemotherapy may be associated with improved overall survival, but the role of systemic neoadjuvant chemotherapy cannot be determined by the currently available evidence. The delivery of a combination of the two modes of systemic chemotherapy has not been investigated in a randomized controlled trial to date. Further research designed to investigate the role of these modalities in the patient's treatment is required.