bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the quality of the consenting and education process for patients starting on oral oncology medications.
Authors: Zatarain Lauren Azure , Ashford Jessica , Bivens David
Published: February 2017

82

Background: Oral oncology medication prescribing is on the rise nationwide. Given that these medications are self-administered, drug compliance is a concern. Appropriate patient education directly impacts drug adherence. Prior to the process improvement initiative in our community based medical oncology clinic, implied consent was obtained while educating patients on side effects and written informed consent was documented 0% of the time. This creates a patient safety and risk management problem. Methods: Our clinic implemented a new process for consenting and educating patients starting on new oral oncology medications from April – October 2015. The plan/do/study/act performance improvement technique was utilized. A new consent form was created for oral oncology medications meeting ASCO/ONS safety standards. The consent and education packets were placed centrally in the office and coincided with an initiative to improve consenting for IV chemotherapy. Providers were in-serviced to contact the nurse prior to patients exiting clinic to initiate the new prescription and begin the patient education process. Reminder checklists were placed in exam rooms to trigger the provider to communicate with nursing staff. Outcome measures included data on the percent of patients with written informed consent in health record and percent of patients with patient education handouts in health record prior to drug start. Data on percent of patients for whom the provider notified nurse prior to end of clinic visit were collected as a balance measure. Results: Over a 6 month period, 101 consecutive patients initiated on oral oncology drugs were included in the data analysis. The baseline mean improved from 0% to 75% for obtaining written informed consent (p chart, 3 sigma). The baseline mean improved from 37% to 80% for documenting patient education in health record prior to oral oncology medication start (p chart, 3 sigma). Conclusions: There was significant improvement in obtaining written informed consent and providing patient education prior to oral oncology drug start after implementation of new clinic processes.
Outcomes by schedule and line of therapy in patients (pts) with metastatic breast cancer (MBC) treated with nab-paclitaxel (nab-P): A U.S. retrospective, community-based, real-world cohort analysis.
Authors: Patt Debra A. , Stergiopoulos Sotirios G. , Hippert Rick , Harrell Robyn K. , Espirito Janet L. , Squier Peg , Ko Amy
Published: February 2017

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Background: In a phase III study in MBC, nab-P showed activity across lines of therapy. nab-P is approved for MBC at 260 mg/m2 every 3 weeks (q3w). This analysis evaluated outcomes with use of nab-P in MBC by schedule and line of therapy in a U.S. community setting. Methods: A multicenter, retrospective cohort analysis was conducted using iKnowMed electronic health record data and electronic medical chart review of women with ≥ 5 visits to a site in the US Oncology Network. Vital status was supplemented by the Social Security Death Index. Pts with MBC treated with nab-P between April 1, 2011, and February 1, 2013, were followed through August 1, 2013. Pts diagnosed with another primary cancer or with prior nab-P use were excluded. Data were analyzed by line (first [1L] vs ≥ second [≥2L]) or schedule (weekly [qw] vs q3w) based on the first therapy (index therapy) received in the study period. The usage pattern of index therapy was described by pt demographics and baseline characteristics. Effectiveness of index therapy was assessed by adjusted duration of treatment (DOT; time from first to last date of treatment + 6 days for qw and 20 days for q3w [to reflect true treatment duration]), time to new treatment (TTNT; time from start of index therapy), and overall survival (OS; time from start of index therapy). Analyses of other efficacy/safety endpoints, healthcare utilization, and corresponding costs will be performed. Results: 766 pts were included; 333 and 433 initiated index therapy as 1L and ≥ 2L, and 650 and 116 received index therapy qw and q3w. 76% received nab-P monotherapy. Most pts were < 65 years (64%), HER2− (76%), ER+ (76%), ER+/HER2− (60%), and postmenopausal (79%). 16% had triple-negative MBC. No notable differences in pt characteristics between the 1L/≥ 2L or qw/q3w groups were seen. Sensory neuropathy rates were 35% vs 39% for the 1L and ≥ 2L and 36% vs 45% for qw vs q3w. Conclusions: This analysis of a community-based cohort indicated that nab-P was primarily used as monotherapy on a qw schedule and in the ≥ 2L setting. [Table: see text]
Do survivors of adolescent and young adult cancer value follow-up cancer care?
Authors: Kaul Sapna , Zamora Eduardo , Smits-Seemann Rochelle , Boyle Kevin , Perlman Holly , Kirchhoff Anne C.
Published: February 2017

8

Background: Survivors of adolescent and young adult (AYA) cancer, diagnosed between the ages of 15-39, require life-long medical care. Cost is a known barrier. However, survivors’ valuation of follow-up care has not been investigated. We used willingness to pay (WTP), an economic tool for evaluating monetary values associated with medical services, to examine how survivors value follow-up care. Methods: AYA cancer survivors ≥18 years of age who had completed their primary therapy were identified by the Utah Cancer Registry. Of 137 randomly-selected survivors, 64 agreed to be contacted; 32 participated. We conducted 6 focus groups and 4 interviews from April-August 2015. Participants filled out a mini-survey, discussed cancer-related follow-up care, and responded to WTP questions. Focus group transcripts were coded in NVivo by 2 researchers (percent agreement = 97.8%). An interval regression identified factors associated with higher WTP. Results: 56% of participants were females and average age was 31 years. Over 45% reported ≥1 day of poor physical health in the previous month, with 15% reporting ≥10 days. Yet, 28% and 10% had no routine follow-up visit with a doctor in the previous 1-2 and 2-5 years, respectively. Focus group coding suggested that survivors valued follow-up care for early detection and management of health conditions, although this decreased over time because of other responsibilities (e.g., college/work/family), they felt the medical visits were costly/ineffective, and because they lacked easy access to specialists. WTP analysis showed that married survivors were willing to pay $456 more for an annual follow-up visit than never-married/single/separated (p = .05). Those with recent checkups were willing to pay more than others (p = .07). Insurance did not affect WTP. Conclusions: Targeted survivorship care strategies are needed to address the needs of AYA cancer survivors who are at risk for skipping follow-up care. Survivors with no recent medical visits or who are not married need additional support.
Successful completion of EGFR/ALK testing in non-squamous non-small cell lung cancer (non-sq NSCLC) with the implementation of reflex testing (RT) by pathologists.
Authors: Menjak Ines B. , Winterton-Perks Zoe , Raphael Simon , Cheng Susanna Y. , Verma Sunil , Freedman Ryan , Toor Nevkeet , Perera Joseph , Anaka Matthew , Victor Charles , Cheema Parneet Kaur
Published: February 2017

93

Background: EGFR mutation and ALK rearrangement testing is standard in the management of advanced non-sq NSCLC patients (pts). Previously at our centre, EGFR/ALK biomarker testing was requested by medical oncologists (MO). In June 2013 we implemented biomarker RT, defined as pathologists requesting EGFR/ALK at time of diagnosis of non sq-NSCLC irrespective of stage. The objective of this study was to test the hypothesis that if pathologists requested biomarker testing, appropriate tissue would be preserved and selected for testing, which would improve success rates of biomarker testing. Methods: Retrospective review of advanced non-sq NSCLC pts seen by MO at Sunnybrook Odette Cancer Centre from March 2010 to April 2014. Pt and EGFR/ALK test characteristics were compared before and after RT using Chi-square tests of association. Time outcomes were compared using Mann-Whitney U tests. Results: Of the 310 pts included, median age was 68, 44% female, 47% Caucasian, 93% adenocarcinoma, 22% EGFR+, 1% ALK+ and 84% either presented with or developed stage IV. Samples tested for EGFR and ALK were respectively: 53%, 51% core biopsies; 25%, 32% surgical resections; 20%, 16% cytology. The number of biomarker tests across all stages increased with RT (EGFR 70% vs 95%, p < 0.001 / ALK 44% vs 83%, p < 0.001). RT improved the rate of successfully completed tests (EGFR 86% vs 96%, p = 0.04 / ALK 83% vs 97%, p = 0.04). The remainder of tests were unsuccessful due to inconclusive results (EGFR 9% vs 4%, p = 0.25 / ALK 7% vs 2%, p = 0.25), insufficient tissue (EGFR 3% vs 0%, p = 0.33 / ALK 10% vs 0%, p = 0.03) or cancellation due to appropriate tissue not being sent from holding lab to testing lab (EGFR 2% vs 0, p = NS / ALK 0% vs 2%, p = NS). From core biopsies, there was trend to improved success of EGFR testing with RT (82% vs 97%, p = 0.06) and significant improvement of ALK testing (82% vs 100%, p = 0.04), with no impact on success from cytology samples. Rebiopsy rate for biomarker testing was low in both cohorts. Turnaround time for EGFR testing decreased [19 days (IQR 15-25) vs 17 days (IQR 12-21), p = 0.02]; ALK was unchanged. Conclusions: Implementation of RT improved successful completion of EGFR/ALK testing.
How well are cancer centers addressing supportive oncology needs?
Authors: Weldon Christine B. , Obel Jennifer Carrie , Deamant Catherine , Berardi Rosa , Robinson Patricia A. , Dale William , Danciu Oana C. , Gerhart James , Khosla Paramjeet , Patel Urjeet , Savory Colleen , Trosman Julia Rachel
Published: February 2017

96

Background: The IOM 2013 report recommends comprehensive supportive oncology care from diagnosis through survivorship to end of life. The Coleman Foundation supported a baseline assessment of supportive oncology care using key COC, ASCO-QOPI and NQF measures. Methods: Data extracted from medical records at 6 Chicago cancer centers in 2014 (n = 843 patients), including stage I-III (n = 391) and stage IV solid tumor or refractory hematologic malignancy (n = 452). Results: Fifty-four percent of patients had discussions on understanding of illness, 24% were informed of prognosis timeframe, and 5% had a documented healthcare power of attorney. Only 6% of stage IV patients received distress screening within 2 weeks of diagnosis and 15% of Stage IV patients had referrals to palliative care. Among patients with Stage I-III cancer, 38% had a supportive oncology screening, and 2% received treatment summaries and a SCPs. Conclusions: There are still large gaps in important supportive care processes based on IOM 2013 recommendations, COC, and ASCO QOPI measures. Future steps include implementing supportive care processes that address gaps across the 6 cancer centers. [Table: see text]
Protein Intake and Breast Cancer Survival in the Nurses’ Health Study
Authors: Holmes Michelle D. , Wang Jun , Hankinson Susan E. , Tamimi Rulla M. , Chen Wendy Y.
Published: February 2017

Purpose

Greater protein intake has been associated with better breast cancer survival in several prospective studies, including among 1,982 women in the Nurses’ Health Study. We proposed to extend this previous finding. We hypothesized that protein, essential amino acid, branched-chain amino acid, and leucine intakes are associated with improved survival and that these associations are stronger in tumors expressing insulin receptor (IR).

Patients and Methods

We included 6,348 women diagnosed with stage I to III breast cancer between 1976 and 2004. There were 1,046 distant recurrences. Relative risks (RRs) and 95% CIs were calculated according to quintiles of updated postdiagnostic diet using adjusted Cox proportional hazards models based on follow-up until 2010.

Results

There was an inverse association between energy-adjusted protein intake and recurrence. Multivariable RRs for increasing quintiles of intake compared with the lowest were 0.95 (95% CI, 0.79 to 1.15), 0.92 (95% CI, 0.76 to 1.11), 0.75 (95% CI, 0.61 to 0.91), and 0.84 (95% CI, 0.69 to 1.03; trend P = .02). For animal protein intake, the RRs were 0.88 (95% CI, 0.73 to 1.06), 0.85 (95% CI, 0.70 to 1.02), 0.75 (95% CI, 0.62 to 0.92), and 0.78 (95% CI, 0.63 to 0.95; trend P = .003). Neither essential amino acids, branched-chain amino acids, nor any individual amino acid stood out as being the source of the association. The association also did not differ by IR status. There was no clear association with any protein-containing foods.

Conclusion

We found a modest survival advantage with higher intake of protein, regardless of IR status. There was no clear mechanism for this association, although it is consistent with prior studies. Our data suggest that there is likely no advantage for women with a history of breast cancer in restricting protein intake or protein-containing foods.
Morbidity and Mortality Differences Between Hematopoietic Cell Transplantation Survivors and Other Cancer Survivors
Authors: Chow Eric J. , Cushing-Haugen Kara L. , Cheng Guang-Shing , Boeckh Michael , Khera Nandita , Lee Stephanie J. , Leisenring Wendy M. , Martin Paul J. , Mueller Beth A. , Schwartz Stephen M. , Baker K. Scott
Published: February 2017

Purpose

To compare the risks of serious health outcomes among hematopoietic cell transplantation (HCT) survivors versus a matched population of patients with cancer who did not undergo HCT, where the primary difference may be exposure to HCT.

Methods

Two-year HCT survivors treated at a comprehensive cancer center from 1992 through 2009 who were Washington State residents (n = 1,792; 52% allogeneic and 90% hematologic malignancies) were frequency matched by demographic characteristics and underlying cancer diagnosis (as applicable) to non-HCT 2-year cancer survivors, using the state cancer registry (n = 5,455) and the general population (n = 16,340) using driver’s license files. Late outcomes for all three cohorts were ascertained from the state hospital discharge and death registries; subsequent cancers were ascertained from the state cancer registry.

Results

After median follow-up of 7.1 years, HCT survivors experienced significantly greater rates of hospitalization compared with matched non-HCT cancer survivors (280 v 173 episodes per 1,000 person-years, P < .001) and greater all-cause mortality (hazard ratio [HR], 1.1; 95% CI, 1.01 to 1.3). HCT survivors had more hospitalizations or death with infections (10-year cumulative incidence, 31% v 22%; HR, 1.4; 95% CI, 1.3 to 1.6) and respiratory complications (cumulative incidence, 27% v 20%; HR, 1.4; 95% CI, 1.2 to 1.5). Risks of digestive, skin, and musculoskeletal complications also were greater among HCT versus non-HCT cancer survivors. The two groups had similar risks of circulatory complications and second cancers. Both HCT and non-HCT cancer survivors had significantly greater 10-year cumulative incidences of all major organ-system outcomes versus the general population.

Conclusion

History of HCT was associated with late morbidity and mortality among cancer survivors. In particular, clinicians who care for HCT survivors should be aware of their high rates of late respiratory and infectious complications.
Ofatumumab Versus Rituximab Salvage Chemoimmunotherapy in Relapsed or Refractory Diffuse Large B-Cell Lymphoma: The ORCHARRD Study
Authors: van Imhoff Gustaaf W. , McMillan Andrew , Matasar Matthew J. , Radford John , Ardeshna Kirit M. , Kuliczkowski Kazimierz , Kim WonSeog , Hong Xiaonan , Goerloev Jette Soenderskov , Davies Andrew , Barrigón María Dolores Caballero , Ogura Michinori , Leppä Sirpa , Fennessy Michael , Liao Qiming , van der Holt Bronno , Lisby Steen , Hagenbeek Anton
Published: February 2017

Purpose

We compared the efficacy of ofatumumab (O) versus rituximab (R) in combination with cisplatin, cytarabine, and dexamethasone (DHAP) salvage treatment, followed by autologous stem-cell transplantation (ASCT) in patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL).

Patients and Methods

Patients with CD20+ DLBCL age ≥ 18 years who had experienced their first relapse or who were refractory to first-line R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)–like treatment were randomly assigned between three cycles of R-DHAP or O-DHAP. Either O 1,000 mg or R 375 mg/m2 was administered for a total of four infusions (days 1 and 8 of cycle 1; day 1 of cycles 2 and 3 of DHAP). Patients who experienced a response after two cycles of treatment received the third cycle, followed by high-dose therapy and ASCT. Primary end point was progression-free survival (PFS), with failure to achieve a response after cycle 2 included as an event.

Results

Between March 2010 and December 2013, 447 patients were randomly assigned. Median age was 57 years (range, 18 to 83 years); 17% were age ≥ 65 years; 63% had stage III and IV disease; 71% did not achieve complete response (CR) or experience response for < 1 year on first-line R-CHOP. Response rate for O-DHAP was 38% (CR, 15%) versus 42% (CR, 22%) for R-DHAP. ASCT on protocol was completed by 74 patients (33%) in the O arm and 83 patients (37%) in the R arm. PFS, event-free survival, and overall survival were not significantly different between O-DHAP versus R-DHAP: PFS at 2 years was 24% versus 26% (hazard ratio [HR], 1.12; 95% CI, 0.89 to 1.42; P = .33); event-free survival at 2 years was 16% versus 18% (HR, 1.10; P = .35); and overall survival at 2 years was 41% versus 38% (HR, 0.90; P = .38). Positron emission tomography negativity before ASCT was highly predictive for superior outcome.

Conclusion

No difference in efficacy was found between O-DHAP and R-DHAP as salvage treatment of relapsed or refractory DLBCL.
Practical Guidelines for the Prevention, Diagnosis, and Treatment of Osteonecrosis of the Jaw in Patients With Cancer
Authors: Ruggiero Salvatore , Gralow Julie , Marx Robert E. , Hoff Ana O. , Schubert Mark M. , Huryn Joseph M. , Toth Bela , Damato Kathryn , Valero Vicente
Published: February 2017

Purpose

This article discusses osteonecrosis of the jaw (ONJ) and offers health care professionals practical guidelines and recommendations for the prevention, diagnosis, and management of ONJ in cancer patients receiving bisphosphonate treatment.

Methods

A panel of experts representing oral and maxillofacial surgery, oral medicine, endocrinology, and medical oncology was convened to review the literature and clinical evidence, identify risk factors for ONJ, and develop clinical guidelines for the prevention, early diagnosis, and multidisciplinary treatment of ONJ in patients with cancer. The guidelines are based on experience and have not been evaluated within the context of controlled clinical trials.

Results

ONJ is a clinical entity with many possible etiologies; historically identified risk factors include corticosteroids, chemotherapy, radiotherapy, trauma, infection, and cancer. With emerging concern for potential development of ONJ in patients receiving bisphosphonates, the panel recommends a dental examination before patients begin therapy with intravenous bisphosphonates. Dental treatments and procedures that require bone healing should be completed before initiating intravenous bisphosphonate therapy. Patients should be instructed on the importance of maintaining good oral hygiene and having regular dental assessments. For patients currently receiving bisphosphonates who require dental procedures, there is no evidence to suggest that interrupting bisphosphonate therapy will prevent or lower the risk of ONJ. Frequent clinical assessments and conservative dental management are suggested for these patients. For treatment of patients who develop ONJ, a conservative, nonsurgical approach is strongly recommended.

Conclusion

An increased awareness of the potential risk of ONJ in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions.
Racial Differences in Patterns of Care Among Medicaid-Enrolled Patients With Breast Cancer
Authors: Kimmick Gretchen , Camacho Fabian , Foley Kristi Long , Levine Edward A. , Balkrishnan Rajesh , Anderson Roger
Published: February 2017

Purpose

Suboptimal care among minority and low-income patients may explain poorer survival. There is little information describing patterns of health care in Medicaid-insured women with breast cancer in the United States. Using a previously created and validated database linking Medicaid claims and state-wide tumor registry data, we describe patterns of breast cancer care within a low-income population.

Methods

Sample characteristics were described by frequencies and means. Logistic regressions were used to determine predictors of type of surgery, use of radiation therapy after breast-conserving surgery (BCS), and use of adjuvant chemotherapy.

Results

The sample consisted of 974 women. The dataset included only white (58%) and black (42%) women. Sixty-seven percent were treated with mastectomy; 43% received adjuvant chemotherapy; and 67% of women receiving BCS received adjuvant radiation. In multivariate analysis, predictors of BCS were young age, black race, and smaller tumor size. Furthermore, there was a trend toward more black than white women with tumors 4 cm or larger having BCS (18% v 8%; P = .06). Race was not related to use of adjuvant radiation therapy after BCS or to use of adjuvant chemotherapy.

Conclusion

In this group of patients with breast cancer enrolled in Medicaid, black women were more likely than white women to have BCS. Race was not associated with adjuvant radiation therapy or chemotherapy use. Factors affecting the quality of care delivered to low-income and minority patients are complex, and better care lies in exploring areas that need improvement.
Phase II Trial of a Novel Paclitaxel Schedule As Single-Agent, First-Line Therapy for HER-2/neu–Negative Metastatic Breast Cancer: A Community-Based Study
Authors: Loesch David , Robert Nicholas , Jones Stephen , Elkordy Maha , Ilegbodu Des , Asmar Lina
Published: February 2017

Purpose

To determine the response rate (RR), progression-free survival (PFS), and toxicity in patients with HER-2/neu–negative metastatic breast cancer treated with first-line paclitaxel in a de-escalating dosing schedule.

Patients and Methods

Between August 1999 and December 2000, 73 patients were enrolled. Paclitaxel was administered on day 1 (175 mg/m2) and on days 8 and 15 (80 mg/m2 each) in each 4-week cycle (1 week of rest). Doses were de-escalated with the aim of reducing toxicity. An Eastern Cooperative Oncology Group performance status of 0, 1, or 2 was found in 55%, 41%, and 4% of patients, respectively. Median age was 59 years (range, 38 to 84 years), and 86% of patients had received prior surgery; 60%, adjuvant chemotherapy; and 59%, radiation therapy.

Results

Based on an intention-to-treat analysis (N = 73), there were five patients with a complete response (6.8%), 16 with a partial response (21.9%), 17 with stable disease (23.3%), and 23 with progressive disease (31.5%) for an RR of 28.7%. Twelve patients (16.4%) were not assessable for response due to toxicity (seven patients, mainly neuropathy), withdrawal of consent (two patients), early death (two patients), or noncompliance (one patient). Median PFS was 6.5 months (range, < 1 to 36.1 months), median survival was 22.8 months (range, < 1 to 36.1 months), and median duration of response was 8.8 months (range, 3.0 to 31.8 months). Patients (n = 72) were evaluated for toxicity. Grade 3 to 4 treatment-related toxicities occurring in more than 5% of patients included neutropenia (22.2%), neuropathy (18.1%), fatigue (6.9%), and leukopenia (5.6%).

Conclusion

In a unique de-escalating schedule, this study of single-agent paclitaxel produced a response rate similar to other single-agent paclitaxel schedules, in first-line therapy for metastatic breast cancer, published in the literature. However, this schedule is not recommended for the therapy of metastatic breast cancer because of the higher rate of toxicity.
Genetic redundancy of GATA factors in extraembryonic trophoblast lineage ensures progression of both pre and postimplantation mammalian development
Authors: Home Pratik , Kumar Ram Parikshan , Ganguly Avishek , Saha Biswarup , Milano-Foster Jessica , Bhattacharya Bhaswati , Ray Soma , Gunewardena Sumedha , Paul Arindam , Camper Sally A. , Fields Patrick E. , Paul Soumen
Published: February 2017

GATA transcription factors are implicated in establishing cell fate during mammalian development. In early mammalian embryos, GATA3 is selectively expressed in the extraembryonic trophoblast lineage and regulates gene expression to promote trophoblast fate. However, trophoblast-specific GATA3 function is dispensable for early mammalian development. Here, using dual conditional knockout mice, we show that genetic redundancy of GATA3 with paralog GATA2 in trophoblast progenitors ensures the successful progression of both pre and postimplantation mammalian development. Stage-specific gene deletion in trophoblasts reveals that loss of both GATA genes, but not either one alone, leads to embryonic lethality prior to the onset of their expression within the embryo proper. Using ChIP-seq and RNA-seq analyses, we define the global targets of GATA2/GATA3 and show that they directly regulate a large number of common genes to orchestrate stem vs. differentiated trophoblast fate. Also, in trophoblast progenitors GATA factors directly regulate BMP4, Nodal and Wnt signaling components that promote embryonic-extraembryonic signaling cross-talk, essential for the development of the embryo proper. Our study provides genetic evidence that impairment of trophoblast-specific GATA2/GATA3 function could lead to early pregnancy failure.
Avaliação do conhecimento sobre Vigilância em Saúde entre os profissionais do Sistema Único de Saúde, Uberlândia, Minas Gerais
Authors: Pinto Daniel Silva , Pereira Boscolli Barbosa , Limongi Jean Ezequiel
Published: February 2017

Introdução: A Vigilância em Saúde (VS) deve estar inserida em todos os serviços ofertados pelo Sistema Único de Saúde (SUS), de modo a garantir atenção integral à saúde. Objetivo: verificar o nível de conhecimento dos profissionais do SUS do município de Uberlândia-MG em relação a VS. Métodos: Os profissionais foram questionados durante o Ciclo Municipal de Vigilância e Atenção Básica em Saúde, curso que tinha como objetivo principal a integração da VS e a Atenção Básica do município. Foram aplicados questionários contendo 17 variáveis sobre VS. Uma escala do tipo Likert foi utilizada para avaliação do conhecimento. O tempo de serviço no SUS e formação do profissional foi relacionado com o conhecimento. Resultados: Entre os participantes do ciclo, 266 responderam completamente o questionário. Destes, 160 (60,2%) possuíam ensino superior completo, e 106 (39,8%) nível fundamental, médio ou técnico. Para todas as variáveis, não houve diferença significativa tanto em relação ao conhecimento dos profissionais de nível superior e não superior, bem como quanto ao tempo de serviço no SUS. Independentemente da formação, em média o conhecimento foi considerado insuficiente em 15 (88,2%) variáveis. Conclusões: Estes resultados nos remetem a duas problemáticas recorrentes no SUS: falha na integração da VS aos serviços de atenção básica a saúde e necessidade de educação permanente efetiva durante a carreira profissional. Esta situação afeta sobremaneira o desenvolvimento de ações de VS, visto que os serviços, sobretudo de atenção básica, compreendem um espaço ideal para sua execução.
Perfil dos pacientes com tuberculose que foram atendidos em uma unidade de referência do município de Santa Cruz do Sul - RS no período de 2009 a 2013
Authors: Chaves Jéssica , Tomilin Betânia Andres , Brun Davi , Fuhr Luís Gustavo , Ourique Flávia , Pilletti Karine , Krummenauer Maria Luiza , Peixoto Simoni Lopes , Fernandes Ramona , Freitas Ana Luisa , Porciúncula Artur Sabbi , Rodrigues Marcelo Tadday
Published: February 2017

Introdução: Anualmente, são notificados cerca de seis milhões de novos casos de Tuberculose em todo o mundo. No Brasil, a doença é um problema de saúde pública. Objetivo: Analisar os aspectos clínico-epidemiológicos dos pacientes com tuberculose que foram notificados no município de Santa Cruz do Sul-RS. Métodos: Estudo retrospectivo, descritivo e transversal, por meio da revisão de prontuários de pacientes atendidos com tuberculose na cidade de Santa Cruz do Sul-RS, durante os anos de 2009 a 2013. Os dados foram analisados no SPSS 22.0. Resultados: No ano de 2013, a taxa de incidência da tuberculose em Santa Cruz do Sul foi de 77,7 casos novos/100.000 habitantes. A amostra foi composta de 288 casos de tuberculose notificados na cidade. A análise revelou que apenas 88 (32,83%) pacientes atendidos eram do sexo feminino. A média de idade dos pacientes foi de 41,03 anos. Houve 222 (82,83%) novos casos da doença e apenas 19 casos de recidivas. Os atendimentos a presidiários foram expressivos, totalizando 52 pacientes. O sintoma mais prevalente foi a tosse com expectoração em 195 (67,7%) casos. A forma clínica predominante foi tuberculose pulmonar em todos os anos analisados, totalizando 278 (96,52%) casos. A prevalência da coinfecção tuberculose/HIV variou de 8% a 18,7% dentro dos cinco anos. Conclusões: O município está entre os 15 prioritários no estado do Rio Grande do Sul para o controle da tuberculose, mostrando que os altos índices da doença no município devem alertar para a importância de medidas eficazes no combate da doença
The Power of Slightly More than One Sample in Randomized Load Balancing
Authors: Ying Lei , Srikant R. , Kang Xiaohan
Published: February 2017

In many computing and networking applications, arriving tasks have to be routed to one of many servers, with the goal of minimizing queueing delays. When the number of processors is very large, a popular routing algorithm works as follows: select two servers at random and route an arriving task to the least loaded of the two. It is well known that this algorithm dramatically reduces queueing delays compared to an algorithm, which routes to a single randomly selected server. In recent cloud computing applications, it has been observed that even sampling two queues per arriving task can be expensive and can even increase delays due to messaging overhead. So there is an interest in reducing the number of sampled queues per arriving task. In this paper, we show that the number of sampled queues can be dramatically reduced by using the fact that tasks arrive in batches (called jobs). In particular, we sample a subset of the queues such that the size of the subset is slightly larger than the batch size (thus, on average, we only sample slightly more than one queue per task). Once a random subset of the queues is sampled, we propose a new load-balancing method called batch-filling to attempt to equalize the load among the sampled servers. We show that, asymptotically, our algorithm dramatically reduces the sample complexity compared to previously proposed algorithms.
Validation of the multiplier method for leg-length predictions on a large European cohort and an assessment of the effect of physiological age on predictions
Authors: Aird J. J. , Cheesman C. L. , Schade A.T. , Monsell F. P.
Published: February 2017

Purpose

The Avon Longitudinal Study of Parents and Children (ALSPAC) prospective cohort was used to determine the accuracy of the Paley multiplier method for predicting leg length. Using menarche as a proxy, physiological age was then used to increase the accuracy of the multiplier.

Methods

Chronological age was corrected in female patients over the age of eight years with documented date of first menses. Final sub-ischial leg length and predicted final leg length were predicted for all data points.

Results

Good correlation was demonstrated between the Paley and ALSPAC data. The average error in prediction depended on the time of assessment, tending to improve as the child got older. It varied from 2.2 cm at the age of seven years to 1.8 cm at the age of 14 years. When chronological age was corrected, the accuracy of multiplier increased. Age correction of 50% improved multiplier predictions by up to 28%.

Conclusion

There appears to have been no significant change in growth trajectories of the two populations who were chronologically separated by 40 years. While the Paley data were based on extracting trends from averaged data, the ALSPAC dataset provides descriptive statistics from which it is possible to compare populations and assess the accuracy of the multiplier method. The data suggest that the accuracy improves as the patient gets close to the average skeletal maturity but that results need to be interpreted in conjunction with a radiological assessment of the growth plates. The magnitude of the errors in prediction suggest that when using the multiplier, the clinician must remain vigilant and prepared to perform a contralateral epiphyseodisis if the prediction proves to be wrong. The data suggest a relationship between the multiplier and menarche. There appears to be a factorisation and when accounting for physiological age, one needs to correct by 50% of the difference between chronological and physiological age.
Väljennyshakkuut
Authors: Nyyssönen Aarne
Published: February 2017

Uudistuskypsien ja niiksi varttuvien metsien määrä on etenkin maamme eteläisissä osissa kasvanut niin suureksi, ettei näiden metsien uudistaminen ohjekiertoaikojen edellyttämässä tahdissa ole mahdollista. Katsauksessa on tarkasteltu, onko tässä tilanteessa perusteltua palauttaa miltei unohdetut väljennyshakkuut metsien käsittelyn vaihtoehtoihin. Sitä varten on vertailtu varttuneiden männiköiden ja kuusikoiden erilaisten käsittelytapojen antamia tuloksia ja saatu käsitys syntyvistä tuottoeroista. Rajallisten tuottotappioiden vastineeksi väljennyshakkuut tuovat varmuutta hoidettujen metsien luontaiseen uudistamiseen ja ovat myönteinen tekijä myös metsien maisemallisen arvon kannalta. Sen johdosta väljennyshakkuilla on oltava sijansa taitavan metsänkäsittelijän keinovalikoimassa.
Kuusen- ja koivuntaimien alkukehitys korven uudistamisaloilla
Authors: Moilanen Mikko , Ferm Ari , Issakainen Jorma
Published: February 2017

Taimien alkukehitystä tutkittiin 1980-luvulla viidellä korpisuon uudistusalalla Pohjois-Karjalassa, Kainuussa ja Lapissa. Avohakkuun seurauksena tutkimuskohteille vakiintui runsaasti hieskoivua ja vaihtelevasti kuusialikasvosta sisältänyt taimikko. Hakkuualueen mätästysmuokkaus lisäsi kasvualustan taimettumisherkkyyttä. Muutama vuosi maanpinnan käsittelyn jälkeen seurasi kuusella hyvä siemensatovuosi, minkä vuoksi kuusen luontainen taimettuminen oli voimakasta muokkausaloilla reunametsän läheisyydessä. Muokkauspinnoille kehittyi kuitenkin nopeasti karhunsammalkasvusto, mikä ilmeisesti ehkäisi luontaista taimettumista jatkossa tehokkaasti. Jo kahden vuoden kuluttua kasvillisuus peitti 78–97 % muokkauspinnasta. Muokatuilla aloilla olivat yleisiä kasvillisuuden pioneerilajit, kun taas muokkaamattomalla alalla kasvillisuus säilytti aiemman metsä- ja kliimaksluonteensa.
Hyönteistuhot metsätaloudessa – taustaa tuhojen taloudelliselle analyysille
Authors: Uotila Esa
Published: February 2017

Metsähyönteisten aiheuttamien tuhojen taloudellista merkitystä ei Pohjoismaissa ole juurikaan tutkittu. Vaikka metsänomistajille tuhojen taloudellinen merkitys voi olla suuri, ei metsien hyönteistuhoilla ole puuhuollon kannalta ollut merkitystä Suomessa.
Vuorovaikutteinen heuristinen optimointi yksityismetsien suunnittelussa
Authors: Kangas Jyrki , Pukkala Timo , Pykäläinen Jouni
Published: February 2017

Artikkelissa esitetään HERO-nimisen heuristisen optimointimenetelmän sovellus vuorovaikutteiseen metsäsuunnitteluun. Vuorovaikutteisessa eli interaktiivisessa yksityismetsien suunnittelussa metsänomistaja ja suunnittelija käyttävät suunnitteluohjelmistoa yhteisessä suunnitteluistunnossa toistaen suunnittelulaskelmia tarvittaessa useaan kertaan.
Sysmän yksityismetsänomistajien suhtautuminen metsäluonnon suojeluun ja hoitoon
Authors: Jokinen Mikko , Heinonsalo Jussi , Mether Jesse , Saario Tiina
Published: February 2017

Tutkimuksessa selvitettiin Sysmän yksityismetsien omistajien suhtautumista maa- ja metsätalousministeriön ja ympäristöministeriön laatimiin, ympäristönäkökulmat huomioon ottaviin metsänhoito-ohjeisiin. Tämän lisäksi selvitettiin metsänomistajien metsiin liittämiä aineettomia merkityksiä sekä suhdetta luontoon. Tutkimus toteutettiin lomakekyselynä.
Nuorten metsien metsänhoidollinen tila ennen kunnostushakkuuta ja sen jälkeen Keski-Pohjanmaan ojitusalueilla
Authors: Jylhä Paula
Published: February 2017

Tutkimuksessa inventoitiin 26 mäntyvaltaista ja 17 hieskoivuvaltaista nuoren metsän kunnostuskohdetta Keski-Pohjanmaalla. Tavoitteena oli arvioida ylitiheänä kasvaneiden puustojen elpymiskykyä kunnostushakkuiden jälkeen sekä kuvailla kunnostushakkuutarpeeseen vaikuttavia tekijöitä.
Yksityismaiden metsätuhot vuosina 1992–93 ja metsätuhorekisteri
Authors: Väkevä Jouni , Lipponen Katriina
Published: February 2017

Metsätuhorekisterin käyttötarkoituksena on toimia eri lähteistä koottujen tuhohavaintojen keskusrekisterinä, josta voidaan tulostaa karttapohjaista tietoa tuhojen esiintymisestä ja merkityksestä. Rekisteri toteutettiin relaatiotietokantana, ja aineiston visualisointia varten rakennettiin paikkatietojärjestelmäsovellus. Tuhojen määrää tarkasteltiin metsälautakunnissa v. 1992–93 tehtyjen havaintojen perusteella. Tutkitun alueen osuus Suomen metsämaan kokonaispinta-alasta oli v. 1992 3,2 % ja v. 1993 3,9 %. Tuhoja havaittiin v. 1992 1,4 %:lla ja v. 1993 1,1 %:lla inventoidusta pinta-alasta. Yleisimpiä tuhonaiheuttajia olivat hirvi ja lahottajasienet. Tuloksia voidaan pitää aliarviona tuhojen todellisesta määrästä, mikä johtuu mm. tuhojen kirjaamiskäytännöstä. Metsäsuunnittelusta saadaan tuhojen seurantaan soveltuvaa aineistoa koko maan alueelta vuosittain ja suhteellisen lyhyellä viiveellä, mikä on merkittävä etu verrattuna muista lähteistä saatavaan tietoon.
Etelä-Suomen raakapuuvarat laskennalliseen pölkytykseen perustuen
Authors: Ahonen Olli-Pekka , Mäkelä Helena
Published: February 2017

Tutkimuksessa selvitettiin Etelä-Suomen havutukkipuun jakautuminen eri laaturyhmiin. Mänty- ja kuusirungoilla laaturyhminä olivat oksaton ja kyhmytön tyvitukki, kuivaoksainen väli- tai tyvitukki sekä terveoksainen latvatukki. Lisäksi kuusirungoista erotettiin omaksi ryhmäkseen latvaläpimitaltaan yli 40 cm:n tukit.
Metsänomistajien metsätaloudellinen käyttäytyminen ammattiasemaryhmittäin
Authors: Ripatti Pekka
Published: February 2017

Tutkimuksessa tarkastellaan metsänomistajien taustapiirteitä ja metsätaloudellista käyttäytymistä ammattiasemaryhmittäin. Vuonna 1990 eläkeläisiä oli 36 prosenttia, palkansaajia noin kolmasosa, maatalousyrittäjiä runsas neljäsosa ja muita yrittäjiä viisi prosenttia metsänomistajien lukumäärästä.Yksityismetsien pinta-alasta maatalousyrittäjät omistivat suurimman osuuden, runsaat 40 prosenttia. Maatalousyrittäjien tilojen taustapiirteitä luonnehtivat perinteiselle maatilametsätaloudelle tunnusomaiset piirteet, kuten perheomistus ja vakinaisesti asuttu tila. Maatalousyrittäjät myivät puuta säännöllisesti ja runsaasti. Lisäksi he olivat metsänhoidollisesti aktiivisia. Eläkeläiset sen sijaan käyttäytyivät metsätaloudellisesti passiivisesti. Eläkeläiset myivät puuta harvoin ja vähän. Lisäksi heidän tiloillaan tehtiin vähän metsänhoitotöitä. Ammattiasemaluokitus tarkentaa metsänomistajakunnan rakenteesta ja metsätaloudellisesta käyttäytymisestä saatavaa kuvaa, koska ryhmien välillä ilmeni merkittäviä eroja. Hyödyllistä myös on, että ammatin ja sosioekonomisen aseman perusteella metsänomistajat voidaan samanaikaisesti luokitella ammattiasemaryhmiin.
Prologo
Authors: Vallejos Oscar R.
Published: February 2017

Prologo Número 16
Una nota (borgiana) en el palimpsesto de la literatura occidental
Authors: Liñán Alejandra
Published: February 2017

Este artículo toma como punto de partida el palimpsesto generado por Jorge Luis Borges en «El inmortal» y ensaya una puesta en relación de la tradición clásica con la literatura comparada, como una perspectiva para analizar la recepción de los clásicos grecolatinos en la literatura argentina contemporánea.Procediendo por «raspaduras» de las aparentemente innumerables capas del texto, se desprenden aportes sobre modos de apropiarse y de leer la cultura griega en textos de otras literaturas. Después de atravesar este recorrido, se concluye, borgianamente, que el texto homérico permanece y revive siempre y cuando sea «hablado» o «escrito» por otros.Además, la inclusión de una nota argentina evidencia el posicionamiento del lector–escritor que interviene desde un lugar marginal, pero con pleno derecho, en el diálogo incesante de los textos.
A Hydrothermally Processed Maize Starch and Its Effects on Blood Glucose Levels During High-Intensity Interval Exercise
Authors: Hetrick Megan M. , Naquin Mildred R. , Gillan Wynn W. , Williams Brian M. , Kraemer Robert R.
Published: February 2017

Hetrick, MM, Naquin, MR, Gillan, WW, Williams, BM, and Kraemer, RR. A hydrothermally processed maize starch and its effects on blood glucose levels during high-intensity interval exercise. J Strength Cond Res 32(1): 3–12, 2018—A hydrothermally processed maize starch (HPMS) has been shown to blunt initial blood glucose and insulin response during endurance activity at 70% maximal oxygen uptake (V̇o
2max). High-intensity interval training (HIIT) is a form of exercise that has many health benefits although it is only performed for short periods of time with interspersed rest periods. The purpose of this study was to compare the blood glucose and associated metabolic stress responses to a sprint interval cycling (SIC) exercise protocol (a form of HIIT) with and without an HPMS in a healthy population. Fourteen subjects completed a total of 4 sessions: a preliminary session, an SIC session with HPMS, an SIC session without HPMS, and a control session in which only HPMS was ingested. Blood glucose, blood lactate, respiratory exchange ratio, oxygen consumption, and rating of perceived exertion responses were recorded during the sessions. There was a significant and progressive rise in blood glucose levels during each of the cycle sprints of both exercise sessions, but not a significant difference between treatment or nontreatment SIC sessions. This is the first study to determine blood glucose responses to SIC after each sprint interval and to report that ingestion of HPMS does not affect glucose responses to SIC. The findings provide some preliminary evidence suggesting subjects at risk for glucose excursions could use SIC to improve health through monitoring blood glucose concentrations during SIC and if necessary, modifying number, intensity, and duration of sprints completed.
Intrinsic Circuits in the Lateral Central Amygdala
Authors: Hunt Sarah , Sun Yajie , Kucukdereli Hakan , Klein Rüdiger , Sah Pankaj
Published: February 2017

Network activity in the lateral central amygdala (CeL) plays a crucial role in fear learning and emotional processing. However, the local circuits of the CeL are not fully understood and have only recently begun to be explored in detail. Here, we characterized the intrinsic circuits in the CeL using paired whole-call patch-clamp recordings, immunohistochemistry, and optogenetics in C57BL/6J wild-type and somatostatin-cre (SOM-Cre) mice. Our results revealed that throughout the rostrocaudal extent of the CeL, neurons form inhibitory connections at a rate of ∼29% with an average amplitude of 20 ± 3 pA (at −40 mV). Inhibitory input from a single neuron is sufficient to halt firing in the postsynaptic neuron.Post hocimmunostaining for protein kinase Cδ (PKCδ) in wild-type mice and paired recordings in SOM-Cre mice demonstrated that the most common local connections were PKCδ(−) → PKCδ(−) and SOM(+) → SOM(+). Finally, by optogenetically activating either SOM(+) or SOM(−) neurons, we found that almost all neurons in the CeL were innervated by these neuronal populations and that connections between like neurons were stronger than those between different neuronal types. These findings reveal a complex network of connections within the CeL and provide the foundations for future behavior-specific circuit analysis of this complex network.
Girl Power: Back to the Future of Feminist Science Fiction with Into the Forest and Arrival
Authors: Mayer Sophie
Published: February 2017

Arrival (Denis Villeneuve, 2016) memed before it even hit the cinema screen. One image from the trailer was shared widely online: Dr. Louise Banks (Amy Adams) making first linguistic contact with the aliens who have appeared in low Earth orbit by holding up a whiteboard saying HUMAN. This single shot appeared to sum up both Arrival's premise of communication above all and its promise to correct all that has gone wrong with mainstream genre cinema of late: a female protagonist—a scientist, no less—making lo-tech peace, rather than CGI war, with alien visitors. The trailer, like the film, boasts a female voice-over (still a rarity), and shows that Dr. Banks is not only a professional, but a working mother. Like Ryan (Sandra Bullock) in Gravity (Alfonso Cuarón, 2013), Louise is defined by maternity and the loss of a child as much as by her scientific and communications ability as a professor of languages.

The film consistently wants to have it both ways: it backs, at different moments, both the Sapir-Whorf hypothesis that linguistic difference changes you and Noam Chomsky's claim that language has a universal grammar, even cosmically so. Similarly, it claims to be changing the genre landscape—through the difference of a (solo, isolated) female lead bent on making peace (and babies)—while actually keeping it much the same. It vaunts technology (and limited female competence therewith), particularly the screenality of the military-industrial complex, but also romanticizes and domesticates the embodied and haptic.
Olhar o cotidiano: percursos para uma psicologia social do trabalho
Authors: Coutinho Maria Chalfin , Oliveira Fábio de , Sato Leny
Published: February 2017

Resumo: O artigo esboça os percursos de pesquisas que têm levado a psicologia social do trabalho ao estudo do cotidiano laboral. Apresenta o cotidiano como campo de apreensão do real, partindo de uma discussão interdisciplinar sobre o tema, salientando seus aspectos de repetição e de ruptura e as relações entre dimensões micro e macrossociais. Localiza os esforços de constituir o cotidiano como objeto da psicologia social e aponta para as dificuldades de teorização desse objeto. Finalmente, discute as razões do reconhecimento do cotidiano como campo privilegiado de investigação para o projeto de uma psicologia social do trabalho, na medida em que favorece o reconhecimento das singularidades dos sentidos e dos significados construídos pelos trabalhadores, das formas de interação social, dos processos organizativos, da micropolítica, das práticas astuciosas construídas no interior de relações assimétricas de poder.
A mediação semiótica da "responsabilidade": um estudo sobre a construção de valores na transição para a vida adulta
Authors: Mattos Elsa de
Published: February 2017

Resumo: A construção de valores é vista como um processo intensamente dinâmico envolvendo internalização e externalização de significados coletivos, além de ser fundamental para a construção de uma síntese pessoal. O presente artigo parte da Psicologia Cultural e da Teoria do Self-Dialógico e propõe que a "responsabilidade" pode ser entendida como um valor, como um campo afetivo semiótico carregado de sentidos. Um estudo de caso ilustra como uma jovem (Jane) navega na cultura coletiva e constrói um novo significado pessoal de si mesma como uma "pessoa responsável". O valor da "responsabilidade" vai sendo integrado ao sistema pessoal de valores da jovem através de continuidades e mudanças nos seus posicionamentos ao longo do tempo e em diferentes espaços, especificamente a família, o trabalho e a religião. Os resultados mostram a dinâmica dos posicionamentos e o surgimento de novas perspectivas para o futuro.