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Objective: To determine how patients with lung cancer value the trade off between the survival benefit of chemotherapy and its toxicities.

Whether people die in the hospital or not is powerfully influenced by characteristics of the local health system but not by patient preferences or other patient characteristics. These findings may explain the failure of the SUPPORT intervention to alter care patterns for seriously ill and dying patients. Reforming the care of dying patients may require modification of local resource availability and provider routines.

The addition of chemotherapy to radiotherapy improves survival in patients with locally advanced, unresectable, non-small-cell lung cancer. The absolute benefit is relatively small, however, and should be balanced against the increased toxicity associated with the addition of chemotherapy.

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Abstract. The architecture for a new large-scale anisotropic constitutive law intended for use in a sea ice dynamics model is presented here. This architecture accounts directly for refrozen lead systems in the pack ice strength (with an anisotropic failure surface) and in the ice thickness distribution (with an oriented thickness distribution). The lower limit (5 km) of the model resolution is controlled by the fracture spacing of old, thicker ice and the maximum lead width. The upper limit of the model resolution (100 km) is controlled by curvature in the lead directions and variations in the lead width. These, in turn, are controlled by the variations in internal ice stress due to driving forces (winds and currents), which set the time resolution. This architecture features abrupt changes in the failure surface and the associated flow rule that cannot be averaged over a time step. In addition, the principal stress normal to a new lead must be zero as it opens. This model has subscale simulations that allow for the inclusion of phenomena such as ridging, rafting, buckling, and fracture on the behavior of the ice. With this new ice constitutive law, it is possible to test directly the ice failure strength, plastic flow rule, and ice thickness distribution. The data most useful for this testing come from ice stress and position buoys together with synthetic aperture radar deformation data. Some data comparisons have already been made.

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