Palliative chemotherapy during the last month of life.

BACKGROUND: This study analyses the potential discriminative characteristics for patients with incurable cancer who received palliative chemotherapy during their last month of life. PATIENTS AND METHODS: The study includes all patients with epithelial cancer treated with palliative chemotherapy who died in 2008 in northern Sweden. Demographic parameters and care utilization data were registered. Data were analyzed using nonparametric methods. RESULTS: Of 374 included patients, 87 (23%) received chemotherapy during the last month of life. These patients had a significantly shorter survival time from first palliative treatment to death, were admitted more frequently to hospital, more often lacked a documented decision to cease treatment, and died less frequently at home. CONCLUSIONS: The results indicate covariations between palliative chemotherapy treatments in the last month of life and unfavorable patient outcomes. As almost one of four patients with incurable cancer received their last round of palliative chemotherapy <31 days before death, there is a potential for improved routines.

A study of Cr(VI) in ashes from fluidized bed combustion of municipal solid waste: leaching, secondary reactions and the applicability of some speciation methods.

The use of the fluidized bed technique for the combustion of municipal solid waste is a rather new concept. This type of combustor produces ash residues with somewhat different properties than the residues generated from the traditional mass burn techniques. Therefore, chemical characterization and the investigation of toxic metals behavior during ash water reactions are necessary for the safe disposal of these residues. In the present work, the total elemental composition, mineralogy and leaching behavior of ashes from the combustion of municipal solid waste in a fluidized bed combustion boiler have been investigated. The cyclone ash and, in particular, the filter ash contained considerable amounts of soluble substances, thus giving leachates with high levels of Cl-, Na+, K+, Ca2 + and Al(IIl). On the other hand, the two ash fractions taken in the boiler, the bottom and hopper ashes, were much more stable with respect to the release of salts and heavy metals. Since Cr(VI) is mobile and toxic its release from combustion residues can pose environmental problem. Even though the total Cr contents were similar in all ashes studied, the bottom ash gave about a thousand times higher levels of Cr(VI) in test leachates than the hopper, cyclone and filter ashes. However, it was found that the leached amount of Cr(VI) from the bottom ash decreased significantly when bottom ash was mixed with the hopper ash. The most probable cause for this decrease is the coupled oxidation of Al(0) to Al(III) and reduction of dissolved Cr(VI) to Cr(III). This finding that the mixing of two ash streams from the same boiler could result in the immobilization of Cr may point at a simple stabilization method. Selective extraction of water soluble, exchangeable and sparingly soluble forms of Cr(VI) was also investigated. Extraction methods were evaluated for their suitability for ash matrixes. It was found that interferences due to the presence of reducing substances in some ash materials may occur.

Atmospheric mercury deposition in Guizhou, China

The atmospheric deposition of mercury including total gas phase mercury (TGM), gas phase divalent mercury (Hg2+), and gas phase monomethyl mercury (MMHg) was investigated. Samples were collected from central cities and nature reserve areas across the province. Techniques and equipment including moss bags, KCl-coated denuder and GARDIS-1A portable mercury vapor analyzer were employed for sample collection and analysis. The reliability of techniques and analytical methods used for the project was evaluated. The deposition of atmospheric mercury was reported in species in this important mercury polluted province for the first time. The spatial and temporal variability of mercury emissions were investigated and reported. Contribution of coal mercury emissions to the atmosphere mercury deposition of the province was also investigated.

Distribution equilibrium of mercury (II) chloride between water and air applied to flue gas scrubbing.

In the literature, different values of the distribution coefficient KH for HgCl2 between water and air are present in a range that spans more than 3 orders of magnitude. In order to determine if a waste incineration scrubber solution could become saturated with regard to HgCl2, an accurate experimental determination of the distribution constant of HgCl2 at elevated temperatures is needed. In this work, the coefficient has been determined at four different temperatures between 10 and 50 degrees C. The Arrhenius expression obtained is 5.5 x 10(5) x exp[-(8060 +/- 2200)/T] with a corresponding enthalpy for the process HgCl2(aq)<==>HgCl2(g) of 67 +/- 20 kJ/mole. KH at 293 K was found to be approximately 5 x 10(-7) atm M-1, which is in almost perfect agreement with an earlier study. Applying the obtained KH values to waste incineration scrubber conditions shows that no major saturation effect will occur.

[47-percent 6-months-long survival for intensive care patients over 80]. / Halvårsöverlevnad 47 procent för intensivvårdade över 80 år.

All 112 patients aged 80 and above treated at the intensive care unit at the University Hospital in Lund, Sweden 1994-1995 were followed-up retrospectively in terms of six-month survival (SMS) and for survivors in terms of quality of life. Overall SMS was the same for both men and women--47%. Patients with the poorest SMS were those aged 90 and above with only one patient out of eleven surviving six months. Patients admitted for severe heart failure also showed a very poor outcome with SMS 27%. Patients were grouped in terms of living conditions prior to admission to the ICU, and a significant difference in six-month survival was noted between those living in their own homes (53%) prior to admission compared to those coming from a nursing home (25%). Patients surviving six months were interviewed by telephone regarding their living situation in March 1997. More than 50% of survivors were living in their own homes with external help no more than once a day. The average APACHE II score was 14.9 +/- 8.2. The average score for patients surviving six months was 13.4 +/- 5.9 and for those not surviving six months 16.8 +/- 5.1. No significant statistical difference in APACHE II scores between these two groups was shown.

Modified on-line monitoring of total gaseous mercury in flue gases using Semtech Hg 2000 analyzer.

The Semtech Hg 2000 analyzer continuously monitors the Hg0 content in flue gas. An on-line measurement method of total gaseous mercury in flue gas developed in our laboratory is described, which uses the absorption cell of the Semtech Hg Analyzer connected to a converter that is located in a furnace heated up to 650 degrees C. The converter can be heated up to 800 degrees C by both the furnace and an extra heating of a Ni-Cr alloy heating wire. Both the absorption cell and the converter are made of quartz. All gaseous Hg2+ species in flue gas are thermally reduced to Hg0 by the converter and detected by the Semtech Hg 2000 analyzer. The thermal reduction efficiencies of different conversion materials, which were filled in the converter, such as quartz chips, granular MgO, Ni and CoO powder, were tested using different flue gas conditions. Studies have shown that HCI is the major factor to inhibit the thermal reduction of Hg2+ to Hg0, and in the converter and the absorption cell Hg0 will react readily with HCl to form HgCl2. Both MgO and Ni could be used in the converter to absorb HCl in the flue gas, but Ni has better absorption efficiency. By using an original Semtech and a modified one, both Hg0 and total gaseous Hg contents in flue gas could be monitored simultaneously and continuously.

Improved determination of gaseous divalent mercury in ambient air using KCl coated denuders.

An improved method for the determination of gaseous divalent mercury (GDM) in ambient air using KCl coated denuders has been developed and tested. GDM collected in the KCl coated denuders can be quantitatively desorbed at 450 degrees C in 10 min. After being complete thermally reduced to Hg0 at 900 degrees C, all mercury released from the denuder is pre-concentrated on the analytical Au trap, and detected by cold vapor atomic fluorescence spectrometry (CVAFS). The absolute detection limit of the method is less than 3 pg. Preliminary data of GDM concentration in ambient air from different sampling stations show that GDM concentrations in the urban air of Göteborg are much higher than in rural air (Rörvik and Sasetta), which indicates the anthropogenic origin of GDM.

Measurements of fractionated gaseous mercury concentrations over northwestern and central Europe, 1995-99.

Although it makes up only a few per cent. of total gaseous mercury (TGM) in the atmosphere, the fraction of oxidised (divalent) mercury plays a major role in the biogeochemical cycle of mercury due to its high affinity for water and surfaces. Quantitative knowledge of this fraction present in mixing ratios in the parts-per-10(15) (ppq) range is currently very scarce. This work is based on approximately 220 data for divalent gaseous mercury (DGM) collected during 1995-99 in ambient air. Over the course of the measurements, the sampling and analytical methods were modified and improved. This is described here in detail and includes transition from wet leaching and reduction procedures to thermo-reductive desorption, the use of annular as well as tubular denuders and adoption of an automated sampling system. The concentration of DGM exhibited a strong seasonal behaviour in contrast to atomic gaseous mercury, with low values in winter and maximum values in summer. The DGM/TGM ratios were frequently found to be below the detection limit (< or = 1%) and in the range 1-5%. A trend of diurnal DGM patterns was observed and implies photolytically induced sources. Scavenging of DGM during rain events was also noticed.

Atmospheric mercury deposition on Fanjing Mountain Nature Reserve, Guizhou, China.

Fanjing Mountain Nature Reserve (FMNR) is surrounded with several Hg emission sources within distances of 100-200 km. At the two sites studied, Tongren and Danzai, Hg emission and deposition fluxes, Hg concentration in the air, soil and other samples are all several hundred times higher than at other relatively clean areas. Hg accumulation in soil and moss at FMNR varies with the sampling heights. Total Hg deposition to this area has been estimated to be 115 micrograms m-2 y-1 using moss bag technique. Dry deposition was determined to be about 5.2 micrograms m-2 month-1 during March to June, corresponding to more than 50% of the total deposition.

Uptake and distribution of radioiodine, and the effect of ambient nitrate, in some fish species.

125I uptake by the thyroid was most pronounced in the smelt (Osmerus eperlanus), perch (Perca fluviatilis), rainbow trout (Salmo gairdneri), roach (Rutilus rutilus) and bleak (Alburnus alburnus). Unlike other tissues, only the muscle in the species studied no relative accumulation of 125I as compared to the ambient water. The Crusian carp (Cyprinus carassius) indicated the lowest levels of accumulation of 125I among the species tested. Thyroid radioiodine concentration was independent of the length of the fish in the rainbow trout and perch. In the rainbow trout, however, the liver and muscle radioiodine concentrations decreased significantly with increasing length of the fish. Exposure of rainbow trout to water containing supranormal concentration of nitrate (1500 micrograms/l) resulted in lowered 125I uptake. The same phenomenon was observed for the perch and Crusian carp, with low nitrate concentrations, while with higher nitrate concentrations, the uptake levels were again increased. Thyroid function, as judged from the conversion ratio and T/S ratio, was not affected by nitrate.