bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Controlled Trial to Determine the Appropriate Time to Initiate Peritoneal Dialysis after Insertion of Catheter (Timely PD Study)
Authors: Ranganathan Dwarakanathan , John George T. , Yeoh Edward , Williams Nicola , O'Loughlin Barry , Han Thin , Jeyaseelan Lakshmanan , Ramanathan Kavitha , Healy Helen
Published: April 2017

Background

The optimal time for the commencement of peritoneal dialysis (PD) after PD catheter insertion is unclear. If dialysis is started too soon after insertion, dialysate leaks and infection could occur. However, by starting PD earlier, morbidity and costs can be reduced through lesser hemodialysis requirements. This is the first randomized controlled trial to determine the safest and shortest interval to commence PD after catheter insertion.

Methods

All consecutive patients undergoing PD catheter insertion at the Royal Brisbane and Women's Hospital and Rockhampton Hospital from 1 March 2008 to 31 May 2013 who met the inclusion and exclusion criteria were invited to participate in the trial. Participants were randomized to 1 of 3 groups. Group 1 (G1) commenced PD at 1 week, group 2 (G2) at 2 weeks and group 3 (G3) at 4 weeks after PD catheter insertion. These groups were stratified by hospital and the presence of diabetes. Primary outcomes were the incidence of peritoneal fluid leaks or PD-related infection during the 4 weeks after commencement of PD.

Results

In total 122 participants were recruited, 39, 42, and 41 randomized to G1, G2, and G3, respectively. The primary outcome catheter leak was significantly higher in G1 (28.2%) compared with G3 (2.4%, p = 0.001) but not compared with G2 (9.5%, p = 0.044), based on intention to treat analysis. These differences were even more marked when analyzed with per protocol method: G1 had a significantly higher percentage (32.4 %) compared with G3 (3.3%, p = 0.003) but not compared with G2 (10.5%, p = 0.040). Event percentages of leak were statistically higher in G1 and occurred significantly earlier compared with other groups ( p = 0.002). Amongst diabetics, technique failure was significantly higher (28.6%) in G3 compared with 0% in G1 and 7.1% in G2 ( p = 0.036) and earlier in G3 at 163.2 days vs 176.8 and 175.8 ( p = 0.037) for G1 and G2, respectively.

Conclusion

Leaks were higher in participants commencing PD at 1 week after catheter insertion compared with the other 2 groups, and technique failure was higher in diabetics starting PD at 4 weeks.
Peritoneal Dialysis Catheter Surgery Using Transversus Abdominis Plane Block
Authors: Markic Dean , Vujičić Božidar , Ivanovski Mladen , Krpina Kristian , Gršković Antun , Rahelić Dražen , Rubinić Nino , Župan Željko , Lasić Hrvoje , Materljan Mauro , Rački Sanjin
Published: April 2017

Background

Peritoneal dialysis (PD) catheter surgery can be performed using regional anesthesia. We present our PD catheter placement and extraction experience using ultrasound-guided transversus abdominis plane (TAP) block.

Methods

In the present study, we analyzed 74 patients from our center with end-stage renal disease (ESRD) who underwent PD catheter placement (60 patients) and removal (14 patients) using a TAP block between June 2011 and December 2015.

Results

The TAP block was successful for 55/60 (91.7%) patients (insertion) and 13/14 (92.9%) patients (extraction). Other patients had pain at the incision site and required general anesthesia. There were no anesthesia-, surgery- or PD catheter-related complications.

Conclusion

The TAP block is a safe and effective technique not only for high-risk ESRD patients but for all patients undergoing PD catheter placement or extraction.
Investigation of Extended Bandwidth Hearing Aid Amplification on Speech Intelligibility and Sound Quality in Adults with Mild-to-Moderate Hearing Loss
Authors: Seeto Angeline , Searchfield Grant D.
Published: April 2017

Background:Advances in digital signal processing have made it possible to provide a wide-band frequency response with smooth, precise spectral shaping. Several manufacturers have introduced hearing aids that are claimed to provide gain for frequencies up to 10‐12 kHz.
However, there is currently limited evidence and very few independent studies evaluating the performance of the extended bandwidth hearing aids that have recently become available.Purpose:This study investigated an extended bandwidth hearing aid using measures of speech intelligibility
and sound quality to find out whether there was a significant benefit of extended bandwidth amplification over standard amplification.Research Design:Repeated measures study designed to examine the efficacy of extended bandwidth amplification compared to standard bandwidth amplification.Study
Sample:Sixteen adult participants with mild-to-moderate sensorineural hearing loss.Intervention:Participants were bilaterally fit with a pair of Widex Mind 440 behind-the-ear hearing aids programmed with a standard bandwidth fitting and an extended bandwidth fitting; the latter
provided gain up to 10 kHz.Data Collection and Analysis:For each fitting, and an unaided condition, participants completed two speech measures of aided benefit, the Quick Speech-in-Noise test (QuickSIN™) and the Phonak Phoneme Perception Test (PPT; high-frequency perception in
quiet), and a measure of sound quality rating.Results:There were no significant differences found between unaided and aided conditions for QuickSIN™ scores. For the PPT, there were statistically significantly lower (improved) detection thresholds at high frequencies (6 and 9 kHz)
with the extended bandwidth fitting. Although not statistically significant, participants were able to distinguish between 6 and 9 kHz 50% better with extended bandwidth. No significant difference was found in ability to recognize phonemes in quiet between the unaided and aided conditions
when phonemes only contained frequency content <6 kHz. However significant benefit was found with the extended bandwidth fitting for recognition of 9-kHz phonemes. No significant difference in sound quality preference was found between the standard bandwidth and extended bandwidth fittings.Conclusions:This
study demonstrated that a pair of currently available extended bandwidth hearing aids was technically capable of delivering high-frequency amplification that was both audible and useable to listeners with mild-to-moderate hearing loss. This amplification was of acceptable sound quality. Further
research, particularly field trials, is required to ascertain the real-world benefit of high-frequency amplification.
Teaching-learning process from service teaching of mental health nursing: experience report
Authors: Correia Analine De Souza Bandeira , Silva Antonia Oliveira , De Oliveira Rayhanna Queiroz , Leonor Gomes Leal Ana Suerda , Pereira Wilma Dias de Fontes , Alves de Arruda Marcia Priscilla , Araujo Mariana Pinto , Vasconcelos Selene Cordeiro
Published: April 2017

Objective: Describe the conceptions of resident nurses about the nurse's role in mental health services.

Method: Descriptive/reflexive study of the experience-report type, carried out from experiences of nurses from the Multiprofessional Residency Program in Mental Health, guided by the theoretical presuppositions of the Brazilian Psychiatric Reform and structured from the Arch of Charles Maguerez.

Results: In-service teaching provided reflections on the residents' conceptions of nurses' performance in mental health services. The key posts were the insertion in the specific nursing care, the construction of the multiprofessional work process, the recognition of their professional identity. Therapeutic relationship and communication, receptiveness, co-responsibility of care and the construction of links with clients, family and work colleagues for the solution of the problems. 

Conclusions: The Arch of Charles Maguerez facilitated the teaching process in service. In addition, it provided the perception of the action-reflection-action movement as essential to understand fundamentals of care practices in nursing and to collaborate to the insertion of the nurse and the process of changes, from the daily services of mental health.
Hospitalizations due to Conditions Sensitive to Primary Care and Performance of the Care Network
Authors: Deininger Layza De Souza Chaves , De Lucena Kerle Dayana Tavares , Oliveira Elaine Cristina Tôrres , De Medeiros Leidyanny Barbosa , Nobrega Bruna Taisa Melo , Meira Roseana Maria Barbosa , Pereira Adriene Jacinto , Da Silva Cesar Cavalcanti
Published: April 2017

Background: This study aimed to investigate, through the perception of the managers, the performance of the care network of the city of João Pessoa-PB from the profile of hospitalizations for Primary Care Sensitive Conditions (ICSAP). 

Methods and Findings: This is an exploratory descriptive research, with a qualitative approach, carried out with technical directors from the sanitary districts of the municipality of João Pessoa-PB. A semi-structured interview was conducted through a questionnaire containing information about personal data and planning and evaluation of management actions. The analysis was performed using Fiorin's speech analysis technique.It was possible to verify, in this research, differentiated knowledge about the health planning process, underutilization of evaluation instruments and distorted conceptions of its execution.There was also evidence of considerable fragility in the health care network and the need to consider lifelong education as a strategic element for the viability of the work process of the actors involved. 

Conclusions: It was observed that the s ICSAP constitute excellent indicators for assessing performance, however underutilized and therefore should direct efforts to improve the skills, organization and integration of activities and services in health.
Comparative Analysis Of Humanization Present In Nursing Assistance Between Brazil And New York: A Lived Experience
Authors: Evangelista Bianka Pereira , Nunes Elicarlos Marques , Barreto Ana Paula Suassuna Veras , Sousa Andréia Rayanne Queroz de , Santos Francisca Lima dos , Oliveira Jordeyanne Ferreira de , Alves Karine Lucena , Lima Mariana Brilhante de , Nogueira Tariana Rodrigues , Nobre Juliane De Oliveira Costa , Martins Edmara Da Nóbrega Xavier , Barbosa Ana Beatriz Alves , Leite Kamila Nethielly Souza , Silva Sheila Da Costa Rodrigues , Ferreira Allan Martins
Published: April 2017

Objetive: The study is an experience report, with the objective of reporting differences in the humanization present in nursing care between a Brazilian city and two cities of the United States of America, highlighting the potentialities and fragility of care provided in both cities frequented by students of Patos Integrated College - FIP.

Method: The study was based on the exchange linked to the Bounce project, funded by the US government, which took place between May 21 and June 20, 2015, and was attended by 8 (eight) FIP scholars from Paraíba, Brazil. Through the study it was possible to perform a comparative analysis between the Brazilian hospital reality, seen in the FIP curriculum internship field, through the Deputy Janduhy Carneiro Regional Hospital, located in the municipality of Patos - Paraíba, Brazil, and the North American, evidenced by the visit to the hospitals of Hudson and New Paltz.

Results: It was observed that the difference in care is in the humanization present in the Brazilian nursing care process. It is noteworthy the great work done by these professionals, who are not only concerned with technical-scientific efficiency, but with humanized assistance, based on ethical, moral, affection and for mutual respect precepts. Comparing the assistance provided in the two realities, we observed in our country a predominantly humanistic, rather than mechanical, assistance. Therefore, it is concluded that it is fundamental to seek tools that improve our Health System, consequently, providing benefits both for professionals, as well as for the users assisted.

Conclusion: In this way, it can be said that humanization does not depend only on technological resources to be shared.

Keywords: Nursing care. Humanization. Hospital.
Removal of artificial dental calculus by use of conventional and diamond ultrasound tips.
Authors: Pinho Roberto Carlos Mourão , Amorim Fernanda Benevides Viana de , Tenório Quitéria Maria Wanderley Albuquerque , Pegoraro Thiago Amadei , Penteado Luiz Alexandre Moura , Cimões Renata
Published: April 2017

Introduction: Periodontal disease is considered a public health problem and may lead to serious complications as the general health of patient. The main therapeutic procedure is scaling and root planing, which can be performed by a variety of techniques and instruments

Objective:The aim of the present study was to evaluate the removal of calculus, produced artificially, by using a conventional ultrasonic tip and a diamond – CVD tip.

Method: The calculus was produced with artificial sawdust and glue-based cyanoacrylate and distributed in twenty areas also standardized on two plates of acrylic resin (chemical activated), holding 10 samples per plate. Standards / samples were divided by lot into two simple groups, being A (treated with conventional tip) and B (treated with CVD tip).

Results:The treatment in Group A, promoted an average area of 20.48 ± 4.20 mm2 free of artificial calculus which is significantly higher (p <0.05) than the area removed in Group B (15.37 ± 5.29 mm2).

Conclusion:The results showed that the conventional tip presented higher results than CVD tip for efficacy in the removal of calculus.
Integral Health Care As A Guiding Axis Of Medical Training: Case Studies
Authors: De Lima Neto Alcides Viana , Teixeira Elisangela Medeiros , Cortez de Sena Bruna Aderita , De Araújo Neves Naedja Nara , Albuquerque Ribeiro Lariane Thays , Santos Fernandes Aline Samaya , De Araújo Nunes Vilani Medeiros , Lisboa Maia Damiao Karla Simone , Freitas Lemos Ana Priscila , Barros Rafael Pontes
Published: April 2017

Objective: The aim is to report the experiences during the practical experiences in the territory assigned to a basic health unit provided by the module of Integral Health Care I.

Methods: Case studies resulting from a process of critical reflections about practical experiences by medical students in a basic health unit from August to December 2015.

Results: Through the module of Integral Health Care I, students were allowed to recognize the assigned area of a family health team, as well as to develop the territorialization process and to classify the demographic, epidemiological, socioeconomic and environmental profile in that place; in addition to perform other activities as a singular therapeutic project and intervention project.

Conclusion: The activities developed motivated the students to be able to apply the concepts of family and community medicine in primary health care, in addition to bringing them closer to the reality of this work process.

Descriptors: Integral Health Care; Family Health Strategy; Physician-Patient Relationship; Basic Health Unit.
Frailty Assessment and its Association with Sociodemographic and Health Characteristics in Community Elderly
Authors: Maciel Graciela Maria Carneiro , Silva Heloiza Talita Adriano da , Gonçalves Rafaella Guilherme , Ferreira Josefa Danielma Lopes , Tietre Sarah Vinagre , Menezes Rejane Maria Paiva de
Published: April 2017

Background: Frailty assessment in the elderly and its relationship to sociodemographic and health characteristics.

Method: Quantitative study, descriptive and cross-sectional study, conducted between April to July 2014, at two Family Health Units in Natal, Rio Grande do Norte. The sample consisted of 203 elderly. The data collection procedure occurred through a structured interview, which used two instruments.

Results: The average age of the participants was 68.59 years; among them, 83 (40.89%) did not show weakness, 45 (22.17%) were apparently vulnerable and 75 (36.94%) were frail. The weakness associated with low education, widowhood, heart disease, diabetes mellitus, osteoporosis, respiratory disease, urinary tract infection, depression, six classes of drugs (antidiabetic, antidepressant, anxiolytic, and antacid against osteoporosis) and fall episode.

Conclusions: We conclude that assessment of frailty is important to detect the risk and/or embrittlement process already installed in the elderly.
Trends in Ostracoda and Cladocera distribution and water chemistry in subarctic Canada: Churchill (Manitoba) lakes and ponds revisited
Authors: Viehberg Finn A. , Pienitz Reinhard
Published: April 2017

Ponds and lakes distributed across northern treeline in the Hudson Bay Lowlands near Churchill (Manitoba) were revisited to analyse and document the local ecoclimatic and limnological changes that occurred over the period 1997-2012. Our analyses revealed that single events may cause significant changes in salinity, pH and silicate content because of the limited buffer capacity of the inter-connected waters. Planktic freshwater microcrustaceans (Cladocera) presented less diverse assemblages and appeared to favour waters that are situated in the boreal forest, while the diversity of benthic species assemblages (Cladocera and Ostracoda) was highest in waters located closer to the coastline and in open tundra vegetation. We identified three species that are distinctive for the boreal ecozone (i.e., Candona acuta, Can. acutula and Can. decora) and two species (i.e., Tonnacypris glacialis and Can. rawsoni) that are elements of (sub-)arctic landscapes and potentially endangered as the northern treeline expands due to rapid warming. These species are thought to be useful indicators for future ecosystem quality assessments and/or ecosystem service management programs. Our findings were compared to other studies completed in the boreal Yukon Territory and revealed that species diversity is closely linked to landscape history.
Paleolimnological assessment of nutrient enrichment on diatom assemblages in a priori defined nitrogen- and phosphorus-limited lakes downwind of the Athabasca Oil Sands, Canada
Authors: Laird Kathleen R. , Das Biplob , Hesjedal Brittany , Leavitt Peter R. , Mushet Graham R. , Scott Kenneth A. , Simpson Gavin L. , Wissel Bjorn , Wolfe Jared , Cumming Brian F.
Published: April 2017

As the industrial footprint of the Athabasca Oil Sands Region (AOSR) continues to expand, concern about the potential impacts of pollutants on the surrounding terrestrial and aquatic ecosystems need to be assessed. An emerging issue is whether recent increases in lake production downwind of the development can be linked to AOSR activities, and/or whether changing climatic conditions are influencing lake nutrient status. To decipher the importance of pollutants, particularly atmospheric deposition of reactive nitrogen (Nr), and the effects of climate change as potential sources of increasing lake production, lakes from both within and outside of the nitrogen deposition zone were analyzed for historical changes in diatom assemblages. Lake sediment cores were collected from a priori defined nitrogen (N) - and phosphorus (P) - limited lakes within and outside the N plume associated with the AOSR. Diatom assemblages were quantified at sub-decadal resolution since ca. 1890 to compare conditions prior to oil sands expansion and regional climate warming, to the more recent conditions in each group of lakes (Reference and Impacted, N- and P-limited lakes). Analyses of changes in assemblage similarity and species turnover indicates that changes in diatom assemblages were minimal both within and across all lake groups.  Small changes in percent composition of planktonic taxa, particularly small centric taxa (Discostella and Cyclotella species) and pennate taxa, such as Asterionella formosa and Fragilaria crotonensis, occurred in some of the lakes. While these changes were consistent with potential climate effects on algal growth, water column stability and other factors; the timing and direction of biotic changes were variable among sites suggesting that any apparent response to climate was lake dependent. The absence of a consistent pattern of diatom changes associated with receipt of reactive nitrogen or intrinsic nutrient-limitation status of the lake suggest that downwind AOSR emissions had no demonstrable effect on diatom composition. 
Chemotherapy resistance mechanisms in advanced skin cancer
Authors: Kalal Bhuvanesh Sukhlal , Upadhya Dinesh , Pai Vinitha Ramanath
Published: April 2017

Melanoma is a most dangerous and deadly type of skin cancer, and considered intrinsically resistant to both radiotherapy and chemotherapy. It has become a major public health concern as the incidence of melanoma has been rising steadily over recent decades with a 5-year survival remaining less than 5%. Detection of the disease in early stage may be curable, but late stage metastatic disease that has spread to other organs has an extremely poor prognosis with a median survival of less than 10 months. Since metastatic melanoma is unresponsive to therapy that is currently available, research is now focused on different treatment strategies such as combinations of surgery, chemotherapy and radiotherapy. The molecular basis of resistance to chemotherapy seen in melanoma is multifactorial; defective drug transport system, altered apoptotic pathway, deregulation of apoptosis and/or changes in enzymatic systems that mediate cellular metabolic machinery. Understanding of alterations in molecular processes involved in drug resistance may help in developing new therapeutic approaches to treatment of malignant melanoma.
Locality Restrictions on N-Word Licensing
Authors: Omari Naima
Published: April 2017

The main objective of this paper is to consider the locality restrictions that hold between Negation and N(egative)-words within the framework of the Minimalist Program. The discussions are based on data from Amazigh, in particular the Tashelhit variety spoken in the Southwest of Morocco. By N-words, I intend elements like ‘ħtta+NP’ ( no-one) which are licensed by the negative head ‘ur’.  In the suggested analysis, I show that certain tense- related restrictions as well as island-like locality constraints affect the surface distribution of N-words. I also argue that sensitivity to such locality constraints cannot be accounted for in terms of constraints on movement; rather, it is a property of the chain formed by the negative head and the N-word in- situ.
The Role of HRM Policy on Academic Innovativeness Case of Business School on Saudi Arabia
Authors: Ragmoun Wided , Alwehabie Abdullah
Published: April 2017

This study aims to understand the role of HRM on academic innovativeness. We will try to identify the adequate policy of HRM for the development of academic innovativeness.The most important is the way in which HRM will be treated as a composite construct of many practices, working in synergistic way, to generate a capacity of innovation or innovativeness according to our definition presented here.Our interest is oriented to the academic field due to importance of its role on social development. And our interest is oriented to the ability to innovate rather than innovation which still difficult to identify and measure. Academic innovativeness here is represented by five dimensions: behavior, product, process, market and strategic innovativeness.The analyze of the variance explained for our variables, provides empirical evidence that the academic innovativeness depends in majority on behavioral dimension and process. The HRM policy in this case is a distinct construction which depends on training and promotion. Added to this, some relations here must be revisited specially the link between behavior dimension of academic innovativeness and the policy of HRM as a construct.At the end of this research, we propose what we have called `the one best way` of academic innovativeness. Our theory model can be considered as user`s guide for academics to innovate based on HRM policy.
The Indonesian EFL Learners’ Motivation in Reading
Authors: Salikin Hairus , Bin-Tahir Saidna Zulfiqar , Kusumaningputri Reni , Yuliandari Dian Puji
Published: April 2017

The motivation will drive the EFL learners to be successful in reading. This study examined the Indonesian EFL learners’ motivation in reading activity based on Deci and Ryans’ theory of motivation including intrinsic and extrinsic. This study employed mixed-method design. The data obtained by distributing questionnaire and arranging the group interviewed. The subject of the study involved 42 freshmen students of English department, the faculty of humanities at Jember University in the academic year 2015-2016. The results found that both intrinsic and extrinsic motivations have significant contribution in motivating the learners to read the English text. The intrinsic motivation played the important role in students’ reading activities. Besides, the extrinsic motivation found the teacher’s role as the learners’ motivator in reading the English text through their method implemented in the reading class.
On Culture Infiltration and the Strategy Integrated with Specialty Characteristics in College English Teaching
Authors: Liu Juan
Published: April 2017

Language is an indispensable part of culture, and it is also a major carrier and medium of culture communication and transmission. Learning a foreign language means not only learning basic language knowledge, training and improving the ability of listening, speaking, reading, writing and translating, but enriching the cross-cultural awareness, cultivating cross-cultural communication competence and making the voice of native culture to communicate with the outside world. Thus, more and more educators and teachers at home and aboard have come to realize the importance of culture teaching in language learning. This paper focuses on inputting culture teaching in College English teaching integrated with specialty characteristics. The importance of culture teaching in college English teaching is analyzed and emphasized and several inspirational and referential strategies of culture teaching integrated with specialty characteristics are also provided.
Problems with Object Permanence: Rethinking Traditional Beliefs Associated with Poor Theory of Mind in Autism
Authors: Lawson Wenn B. , Dombroski Brynn A.
Published: April 2017

Poor Theory of Mind (ToM) (or difficulties imputing mental states to self and others) [1], (See also [2-5]) is often blamed for certain responses and behaviour in autism. However, the Theory of Mind Task Battery requires an understanding of language, the use of cognitive skills, as well as the child’s motivation and attention to complete. All of these factors are either weak or under-developed in individuals with autism suggesting that this is not the best means to measure one’s understanding that other people have their own thoughts, plans, beliefs, or point of view. Behaviours like strong defiance, insistence on sameness, fear associated with sudden change and severe anxiety may be related to difficulties seeing beyond the ‘now’ [6]. This paper suggests that some of the stress and anxiety in the autism population may actually be due to delayed object permanence (OP) (knowing something may still exist even if it is out of sight), which can appear as poor ToM. This delay in establishing OP is governed by single focused attention. For more information on this concept see: Lawson, W. (2011) The passionate mind, JKP:London. Although ToM and OP are defined differently, this paper aims to show the relationship between them and how one concept can influence the other using examples in everyday life to illustrate how poor OP is associated with single focused attention, which detracts from the bigger picture.
Study of Cardiac Features in Adults with Down Syndrome
Authors: Condoluci Claudia , Galli Manuela , Cimolin Veronica , Rigoldi Chiara , Albertini Giorgio
Published: April 2017

Down Syndrome (DS) has a significant impact on the development of many tissues, most notably in the heart and in the brain. According to the clinical need to better investigate these aspects, the main aim of this study was to make an overview on the cardiac features in adult individuals with DS.
The following data of 37 individuals with DS (range: 18-60 years) were collected and analysed: age, gender, height, weight, waist to height ratio (WHER), smoking history and cardiac parameters (heart rate and blood pressure), blood glucose level or glycaemia, cholesterol (total, high-density lipoprotein – HDL - and low-density lipoprotein - LDL - cholesterol) and triglycerides. In addition, their gait pattern were quantified with 3D Gait Analysis.
BMI, WHER and cholesterol HDL results were above the upper limits of the recommended range in people with DS; on the contrary, blood pressure, heart rate, glycaemia, cholesterol-LDL and triglycerides were within the recommended range. Comparing males and females in the DS group, the females showed statistically different values for cholesterol-total, and triglycerides values, with lower values in comparison to males. In motor performance, people with DS presented abnormal gait patterns. Some significant correlations were found: age with LDL, WHER with weight and BMI, systolic with diastolic blood pressure, total cholesterol with LDL and triglycerides.
Our results showed that adults with DS suffer from a high prevalence of physical disorders, including overweight and obesity, and abnormal cholesterol values, together with abnormal gait pattern.
Morphosyntactic Development and Implicit Learning in Down Syndrome and Related Conditions
Authors: Rondal Jean
Published: April 2017

Implicit learning of morphosyntax is attracting much interest in psycholinguistics. Limited data are available from experimental studies in people with cognitive handicap. The paper presents and discusses central aspects of the implicit learning model as it applies to morphosyntactic development in typical children and children and adolescents with cognitive handicap. Several possible reasons for the delays and difficulties usually observed in the latter are examined. Suggestions are made for further research and language intervention in cognitive handicap.
The effect of biological preparation Fertenat on spring wheat productivity and quality
Authors: Pekarskas Juozas , Gavenauskas Algirdas , Dautartė Anželika
Published: April 2017

The research of the biological preparation Fertenat effect on spring wheat was investigated at the Experimental Station of Aleksandras Stulginskis University in Calc(ar)i-Epihypogleyic Luvisol (LVG-pw-cc) during 2013–2014. Spring wheat was grown according to the requirements of the National Agricultural Products Quality System.
Biological preparation Fertenat had a significant effect on the elements of spring wheat yield structure and the values of chemical composition parameters, influenced by the rates of biological preparation and meteorological conditions. A strong correlation was found between the Fertenat rates and spring wheat plant stem and ear length, grain number per ear, total and productive stem number of one plant and 1 000 grain and hectolitre weight. The correlation between the biological preparation rates and protein, wet and dry gluten was strong as well. A strong correlation between the biological preparation rates and starch amount in grain was found in 2013, while in 2014 this correlation was moderate. The application of biological preparation Fertenat increased the spring wheat yield by 0.05–0.30 t ha–1 or by 2.29–13.76 percent units and by 0.02–0.41 t ha–1 or 0.40–8.23 percent units. The application of 6 l ha–1 and higher Fertenat rates significantly increased the spring wheat yield. Small 1–3 l ha–1 rates are inefficient. The correlation between the Fertenat rates and grain productivity was strong.
Biotechnological esterification of oleic acid with 2-ethylhexanol in biolubricant synthesis technologies
Authors: Čepaitė Ieva , Gumbytė Milda
Published: April 2017

The possibilities of waste materials re-use in biosynthesis of grease were investigated. In this paper, 2-ethylhexanololeate synthesis from 2-ethylhexanol and oleic acid using industrial enzymes is discussed.
In order to select an effective enzyme for the mentioned synthesis, the selection of industrial lipases was carried out. During the reactions, acidity of the substances was measured and a chromatographic analysis was held to observe the reaction rate.
After choosing the suitable lipase (Lipozyme TL IM), an experimental model was created. When all reactions from the plan were completed, optimal conditions were estimated. The process temperature was 41.04 °C, the duration of the process was 26.10 h, the molar ratio of 2-ethylhexanololeate and oleic acid was 2.35:1.16 mol/mol, and the enzyme quantity (according to acid quantity) was 9.91%.
The NCCN Clinical Practice Guidelines in Oncology: A Primer for Users
Authors: Winn Rodger J. , McClure Joan
Published: April 2017

Guidelines are becoming increasingly important as potential tools in improving clinical decision making. Because oncology practice encompasses a large number of tumors and their variants and because each tumor is characterized by heterogeneous presentations and clinical evolutions, an oncology guidelines program must be large in scope. Oncology practice is slowly moving toward evidence-based status, but guideline developers still must rely on less than perfect information to achieve this scope. By formalizing the consensus process, the NCCN program relies on the expertise of a broad range of cancer specialists to interpret the major clinical studies and apply their evaluative skills in assessing the relevance of these studies to clinical practice. In areas in which data are meager or contradictory, these experts are still charged with making recommendations if they believe their collective clinical experience points to a reasonable approach to disease management. It follows, therefore, that guidelines represent one of the most dynamic areas in medicine. The annual review process is designed to incorporate change as new evidence or innovative therapies become available. Therefore, the guidelines should be a true reflection of the state-of-the-art in oncology. The ultimate goal, as always, is improving care for the cancer patient.
New Agents for Colorectal Cancer
Authors: Mulcahy Mary F. , Benson Al B.
Published: April 2017

The past 5 years have seen significant developments in the treatment of colorectal cancer (CRC). New chemotherapy agents with activity in CRC have demonstrated an improvement in survival for patients with advanced CRC. Studies now are focusing on combinations and sequences of chemotherapy agents to prolong survival in second- and even third-line therapies. Oral agents have been developed and are being studied in combination chemotherapy regimens. Development of oral combinations should maintain a survival advantage with the added benefit of convenience for the patient. Drugs designed to act on specific cellular protein targets have also shown activity and are being explored further. Researchers continue to pursue immunotherapy and vaccine therapy. Studies are now focusing on how best to use the available agents. These new agents and new combinations of agents and of approaches have led and should continue to lead to improved outcomes in the treatment of patients with CRC.
The Genetics of Hereditary Non-Polyposis Colorectal Cancer
Authors: Gruber Stephen B. , Kohlmann Wendy
Published: April 2017

Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant condition accounting for 3% to 5% of all colorectal cancer. HNPCC is caused by germline mutations in the mismatch repair system and is recognized by a characteristic clinical phenotype as well as a hallmark of the tumors termed “microsatellite instability.” Microsatellite instability serves as a molecular fingerprint for defective mismatch repair and has proven to be useful in the molecular diagnostic workup for HNPCC. The crystal structure of the DNA mismatch repair protein MutS has been solved, providing insight into the molecular basis of defective mismatch repair. Genetic testing has become a key component of the treatment of patients and families with HNPCC, and enhanced surveillance for HNPCC has been shown to reduce the rate of colorectal cancer by more than half and improve 10-year survival from 68% to 93%.
Counterpoint: Sentinel Lymph Node Biopsy Is Not Indicated for Ductal Carcinoma In Situ
Authors: Edge Stephen B. , Sheldon David G.
Published: April 2017

The purpose of axillary surgery in breast cancer is to provide prognostic information to guide the choice of adjuvant systemic therapy. Axillary surgery for ductal carcinoma in situ (DCIS) was abandoned in the 1980s because of the extremely low risk of lymph node metastases and high survival rates. Most women with metastases probably harbored an unrecognized focus of invasion or had metastases subsequent to an invasive local recurrence. Increased use of the less morbid sentinel node biopsy (SNB) for axillary staging of invasive cancer and the recognition that many patients will harbor micrometastases in nodes only recognized by cytokeratin immunohistochemistry (IHC) led two groups to perform SNB with IHC in women with DCIS. One group included all subtypes of DCIS and found metastases in 13% (half of which were detected only on IHC). The other group studied only patients with “high-risk” DCIS. They found metastases in 12% (7 of 9 by IHC only). These groups recommend SNB for women with DCIS. However, the use of SNB in DCIS should be tempered by the uncertainty of the prognostic significance of IHC-detected metastases, the conflicting results of these 2 studies, and the real potential to cause more harm than good from the morbidity of the procedure, the application of unnecessary axillary dissection, and the use of unwarranted adjuvant systemic chemotherapy. These results should be used to generate hypotheses for clinical trials addressing these problems. However, SNB for DCIS remains investigational and should not be generally applied.
The Aromatase Inhibitors as Adjuvant Therapy for Hormone Receptor-Positive Breast Cancer
Authors: Ligibel Jennifer A. , Winer Eric P.
Published: April 2017

Adjuvant hormonal therapy has been shown to decrease the risk of breast cancer recurrence and overall mortality in patients with hormone receptor-positive breast cancer. Tamoxifen has been used in this setting for many years, both in premenopausal and postmenopausal patients. Tamoxifen is not devoid of toxicity, and attempts have been made to develop newer hormonal agents with better efficacy and less toxicity. The aromatase inhibitors have shown equivalent or superior efficacy to tamoxifen in the treatment of metastatic breast cancer, and efforts are underway to determine the role of these agents in early breast cancer. The ATAC trial recently showed that use of the third-generation aromatase inhibitor anastrozole in the adjuvant setting led to a modest improvement in relapse-free survival as compared with tamoxifen. Patients treated with anastrozole were also less likely to develop uterine cancer or experience a thromboembolic event. However, patients treated with anastrozole were more likely than those treated with tamoxifen to suffer a fracture or other musculosketal problem. An ASCO technology assessment panel reviewed the relevant data and issued a consensus statement regarding the use of aromatase inhibitors in the adjuvant setting. In general, the panel favored the continued use of tamoxifen as adjuvant hormonal therapy for most postmenopausal women. Within the next few years, further data from the ATAC trial and from other trials of aromatase inhibitors in the adjuvant setting should be available to guide treatment recommendations for this patient population.
The Role of Bisphosphonates in Breast Cancer
Authors: Theriault Richard L.
Published: April 2017

Breast cancer frequently metastasizes to bone. Metastases result in skeletal morbidity including pathologic fractures, the need for radiation or surgery to bone, spinal cord compression and hypercalcemia. The pathophysiology of bone destruction is related to activation of osteoclasts by tumor-derived and bone marrow microenvironmental factors. One prominent osteoclast–activating factor associated with breast cancer is parathyroid hormone-related peptide (PTHrP). Bisphosphonates have been shown to impair osteoclast activity by decreasing recruitment from the monocyte macrophage cell line, inhibiting osteoclast function at the bone site and causing osteoclasts to undergo apoptosis. Clinical studies with bisphosphonates show an improvement in the control of hypercalcemia and a reduction in skeletal related morbidity with administration of pamidronate and zoledronic acid. Bisphosphonates have become the standard of care for osteolytic metastases associated with breast cancer. Recent data with zoledronic acid found that skeletal related morbidity may be reduced regardless of the radiographic picture of skeletal metastases. Thus, zoledronic acid may be valuable in osteolytic and osteoblastic disease as well as in disease with an osteolytic or osteoblastic radiographic appearance. In breast cancer with osteolytic disease, zoledronic acid may be more effective than pamidronate in reducing skeletal morbidity and prolonging the time to first skeletal event.
Mental Illness Stigma as a Barrier to Psychosocial Services for Cancer Patients
Authors: Matthews Alicia K. , Corrigan Patrick W. , Rutherford Judith Lee
Published: April 2017

Empirically validated psychosocial interventions have been shown to improve adjustment and coping among cancer patients. Therefore, an emerging standard of practice is to integrate supportive services for cancer patients into the medical management of the disease. However, unanticipated barriers may negatively influence receptivity to psychosocial services. For example, among the general population, two-thirds of individuals in need of psychiatric services do not receive them. Numerous barriers have been reported that interfere with receipt of mental health services among members of the general population. In addition to access issues, stigma associated with mental illness and its treatment represents a significant barrier to care. Stigma associated with mental illness and mental health services use is an under-researched barrier to the effective management of the psychosocial sequelae of a cancer diagnosis and treatment. This article reviews the relevant literature on mental health stigma and makes recommendations for increasing access to psychosocial services for cancer patients and their families.
Philosophical Oncology: Calling on the Principle of Double Effect
Authors: Brescia Frank J.
Published: April 2017

Reasonable human behavior is based on doing something for a consequence that is perceived as good. Ethical medical decision-making is based on prioritizing values after understanding the relevant facts. There is an ethical obligation to do no harm. This is especially true in relieving the pain and suffering of dying patients; in these cases, treatment has the risk of contributing to a patient's death. The principle of double effect has been helpful as a moral guide in troubling cases to discern what actions are acceptable, even though the action could lead to an end that would seem as immoral as if the effect were directly intended. This principle, though, is not without problems and critics, and some have pointed out its shortcomings as an ethical guide.
Myelotoxicity and Dose Intensity of Chemotherapy: Reporting Practices From Randomized Clinical Trials
Authors: Dale David C. , McCarter Gordon C. , Crawford Jeffrey , Lyman Gary H.
Published: April 2017

Delivery of cancer chemotherapy is often limited by myelotoxicity, primarily neutropenia. As part of an effort to create a model to predict the risk of chemotherapy-induced neutropenia, we reviewed the reports of randomized clinical trials with more than 50 patients per arm in early-stage breast cancer (ESBC) and non-Hodgkin's lymphoma (NHL) published between 1990 and 2000. We observed that no hematologic toxicity data were reported in 39% and 34% of the ESBC and NHL trials, respectively. The remaining trials reported on hematologic toxicity in 16 different ways. When reported, rates of neutropenia, leukopenia, and hematotoxicity varied widely with the same and similar chemotherapy regimens. Dose-intensity data were not reported in 39% and 54% of ESBC and NHL trials, respectively. The majority of the remaining studies reported incomplete dose-intensity data such as percentages of patients completing all cycles or receiving a given percentage of planned dose intensity. Only 28% reported the mean or median relative dose intensity received by patients. Based on this review, we conclude that current practices for reporting chemotherapy treatments are inadequate for describing the risk of chemotherapy to patients or for quantitatively assessing the risk of treatment alternatives. We recommend that standard procedures for documenting and reporting hematologic toxicity and dose intensity in cancer chemotherapy trials be required for publication of chemotherapy trials.
New Agents in Chronic Myelogenous Leukemia
Authors: Cortes Jorge , Giles Francis
Published: April 2017

Multiple new agents are currently being developed in chronic myelogenous leukemia (CML). Most of these agents are now being investigated in patients who have developed resistance to imatinib. Their mechanisms of action are diverse and many may be synergistic with imatinib. These agents will be used soon in different combinations, most likely including imatinib, with the hope of obtaining a complete blockade of the intracellular pathways that are triggered by Bcr-Abl. If this is successful, complete eradication of disease may become a reality for the majority of patients with CML.
Predictive Molecular Markers: Has the Time Come for Routine Use in Lung Cancer?
Authors: Davies Angela M. , Mack Philip C. , Lara Primo N. , Lau Derick H. , Danenberg Kathleen , Gumerlock Paul H. , Gandara David R.
Published: April 2017

Although some evidence exists to support the use of clinical factors such as performance status and weight loss to predict response and toxicity to therapy in non-small cell lung cancer (NSCLC) patients, researchers have shown little prospective data on the use of molecular markers to facilitate selection of specific chemotherapy or new molecularly targeted agents in this patient population. Breast cancer exemplifies the growing role that molecular markers are playing, not only as prognostic factors, but also in predicting response to targeted treatments such as hormonal therapy, and more recently, trastuzumab (Herceptin). Although several studies have examinedmolecular markers in lung cancer and have shown promising potential value, these studies were retrospective and require prospective validation. To identify molecular markers that reliably predict response and to be able to individualize cytotoxic and targeted therapy for NSCLC patients are the ultimate goals of future trials. This article focuses on a selected number of promising markers under study in lung cancer, including those thought to play roles in response to DNA damaging chemotherapy (excision repair cross-complementing [ERCC1], xeroderma pigmentosum group D [XPD]), taxane resistance (-tubulin III), antimetabolite therapy (RRM1), irinotecan metabolism (UGT1A1) and epidermal growth factor receptor (EGFR) pathway inhibition. To date, none of these markers can be recommended for routine use in clinical practice.