bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperatura do solo em função do preparo do solo e do manejo da cobertura de inverno
Authors: Furlani Carlos Eduardo Angeli , Gamero Carlos Antonio , Levien Renato , Silva Rouverson Pereira da , Cortez Jorge Wilson
Published: April 2008

Com o objetivo de avaliar o efeito do preparo do solo e do manejo da cobertura de inverno (consórcio aveia-preta + nabo forrageiro) sobre a temperatura do solo, realizou-se um experimento em um Nitossolo em Botucatu-SP no outono/inverno de 2000. Utilizou-se um delineamento em blocos casualizados em esquema fatorial 3 x 3 (três preparos e três manejos). O preparo do solo constou de: preparo convencional, preparo conservacionista com escarificação e plantio direto, e o manejo da cobertura: consórcio dessecado, rolado e triturado. Foram avaliados a temperatura do solo (termopares) a 5 cm de profundidade, de hora em hora, aos 7, 14, 30, 45 e 60 dias após a emergência das plantas do consórcio; o teor de água do solo na profundidade de 10 cm, nas mesmas épocas; e a cobertura do solo (massa seca e índice de cobertura), imediatamente após aplicação dos tratamentos. O sistema plantio direto apresentou temperaturas do solo menores que as do preparo convencional, até o 14º dia após emergência (DAE) das plantas. A partir do 30° DAE das plantas, a temperatura não foi mais influenciada pelos tratamentos, devido à cobertura do consórcio e ocorrência de boa disponibilidade de água no solo. Os manejos da cobertura com rolo-faca, triturador e herbicida não influenciaram a temperatura do solo. A temperatura do solo não interferiu no crescimento e desenvolvimento das culturas de cobertura.
Utilização de resíduos da indústria de couro como fonte nitrogenada para o capim-elefante
Authors: Oliveira Diana Quintão Lima de , Carvalho Kele Tatiane Gomes , Bastos Ana Rosa Ribeiro , Oliveira Luiz Carlos Alves de , Marques João José Granate de Sá e Melo , Nascimento Robervone Severina de Melo Pereira do
Published: April 2008

Uma grande variedade de produtos tóxicos é emitida durante o processo de tratamento do couro nos curtumes que usam o cromo III para obter o couro wet blue. O resíduo sólido (raspas e aparas) contém cerca de 3 % de Cr III, que representa um sério problema ambiental e não tem, atualmente, destino adequado. O resíduo de couro após extração de Cr (colágeno) foi utilizado como fonte nitrogenada para o capim-elefante (Pennisetum purpureum Schum cv. Napier), em um Latossolo Vermelho-Amarelo, aplicando-se quatro doses do colágeno (4, 8, 16 e 32 t ha-1) e três tratamentos adicionais (testemunha; adubação com N mineral e resíduo de couro wet blue- sem a extração do Cr). O colágeno é uma boa fonte nitrogenada alternativa para crescimento do capim-elefante até a dose de 16 t ha-1. O resíduo de couro wet blue não disponibilizou N durante o cultivo de capim-elefante. Isso mostra que a extração do Cr utilizando-se o ácido fosfórico é fundamental para uso do rejeito de couro como fonte nitrogenada na agricultura. A aplicação do colágeno supriu a necessidade de N para plantas de capim-elefante, semelhantemente à adubação com N mineral.
Associação entre carência social e causas de morte entre idosos residentes no Município de Recife, Pernambuco, Brasil
Authors: Silva Vanessa de Lima , Leal Márcia Carréra Campos , Marino Jacira Guiro , Marques Ana Paula de Oliveira
Published: April 2008

Este trabalho objetivou analisar a associação entre carência social e causas de morte da população idosa residente na cidade do Recife, Pernambuco, Brasil, no ano 2000. Realizou-se um estudo ecológico, cuja unidade de análise foi composta por 94 bairros e cinco estratos de carência social. A variável independente consistiu de um indicador composto de carência social, obtido para cada bairro e calculado através da técnica de formação de escores, a partir de variáveis censitárias: abastecimento de água, instalação sanitária, analfabetismo, anos de estudo e renda do chefe de domicílio. As variáveis dependentes foram: coeficiente de mortalidade em maiores de 60 anos e coeficientes específicos em causa básica do óbito. A associação foi calculada através do coeficiente de correlação de Pearson, regressão linear e razão de mortalidade entre os estratos de carência social formados a partir do agrupamento dos bairros por quintil do indicador. Os dados referem correlação positiva estatisticamente significativa da carência social com a mortalidade de idosos ocasionada por pneumonia, desnutrição protéico-calórica, tuberculose, diarréia/gastroenterite e acidentes de transporte e correlação negativa para mortes por neoplasias de brônquios/pulmões e de mama.
Identidad y riesgos para la salud mental de jóvenes gays en México: recreando la experiencia homosexual
Authors: Granados-Cosme José Arturo , Delgado-Sánchez Guadalupe
Published: April 2008

En México, los trastornos mentales están mostrando una tendencia importante al incremento, la conducta suicida es uno de los problemas de salud mental más importantes en la población joven, entre sus causas se refiere a la orientación sexual como factor de riesgo, ya que los homosexuales muestran mayores probabilidades de suicidio que los heterosexuales. La presencia de conducta suicida se asocia a daños a la salud previos como la depresión, la ansiedad y bajos niveles de autoestima que se relacionan con factores predisponentes como las experiencias formativas de la personalidad. Este trabajo explora, con un enfoque cualitativo, el riesgo que muestran los homosexuales a daños a la salud mental que se asocian a conducta suicida en base a la experiencia de la homofobia en los ámbitos primarios y secundarios de socialización. Con el análisis discursivo se logra identificar la relación que los entrevistados le asignan al rechazo social a su sexualidad y síntomas clave de depresión (tristeza), ansiedad (temor) y conducta suicida (intento e ideación).
Fatores médicos e não-médicos associados às taxas de cesariana em um hospital universitário no Sul do Brasil
Authors: Freitas Paulo Fontoura , Sakae Thiago Mamôru , Jacomino ; Maria Eduarda M. Lebarbechon Polli
Published: April 2008

O objetivo deste estudo foi descrever fatores associados ao aumento nas taxas de cesariana em um hospital universitário de 2002 e 2004, explorando a contribuição de fatores médicos e não-médicos para este aumento. Um estudo transversal investigou 2.905 partos ocorridos nos anos de 2002 (1.441) e 2004 (1.464). Diferenças nas razões de prevalência ajustadas pela regressão de Poisson e risco atribuível percentual foram estimados para a associação de cesariana com fatores sócio-demográficos; clínicos e reprodutivos; e do parto, institucionais e da prática obstétrica. As taxas de cesariana aumentaram de 28,4% em 2002 para 36,7% em 2004. Escolaridade materna elevada, hora do parto, presença de patologia e maior freqüência ao pré-natal foram os fatores que representaram a contribuição mais expressiva para o excesso em 2004, quando comparado a 2002. O aumento nas taxas de cesariana ao se comparar os dois anos pode ser atribuído, pelo menos em parte, a um crescimento nas indicações relativas e condições não-médicas.
Análise do impacto econômico-assistencial de duas abordagens para redução de custos em um plano odontológico de autogestão
Authors: Costa Filho Luiz Cesar da , Duncan Bruce Bartholow , Polanczyk Carisi Anne , Sória Marina Lara , Habekost Ana Paula , Costa Carolina Covolo da
Published: April 2008

O presente estudo avaliou a assistência odontológica fornecida a cerca de 4 mil funcionários e dependentes de um hospital privado. A análise foi dividida em três momentos: (1) linha de base (controle): quando a assistência odontológica fornecida era terceirizada por uma empresa que operava com rede credenciada, (2) quando houve uma renegociação de preços com a prestadora original e (3) quando a assistência era feita por um serviço de odontologia próprio sem a intermediação de uma prestadora e com profissionais remunerados através de valores fixos. Foram coletados mensalmente dados econômicos e sobre o tipo e número de procedimentos realizados. A renegociação de preços reduziu os custos em cerca de 37% em relação à linha de base, ao passo que o serviço próprio reduziu os custos em 50%. A renegociação de preços provocou uma diminuição de 31% no número de procedimentos realizados sem modificar o perfil da assistência, ao passo que o serviço próprio não causou diminuição na quantidade de serviços, mas modificou o padrão da assistência, pois se aumentaram os procedimentos relacionados com as causas das patologias e reduziram-se os procedimentos cirúrgico-restauradores.
Utilização de serviços de reabilitação pelas crianças e adolescentes dependentes de tecnologia de um hospital materno-infantil no Rio de Janeiro, Brasil
Authors: Gavazza Cláudia Zornoff , Fonseca Vânia Matos , Silva Kátia Silveira da , Cunha Sueli Rezende
Published: April 2008

O objetivo deste estudo é caracterizar descritivamente a dependência tecnológica e a utilização de serviços de reabilitação pela população de crianças e adolescentes de um hospital materno-infantil do Rio de Janeiro, Brasil. O estudo transversal descreveu as características demográficas da criança e sócio-econômicas do cuidador e família, como também o tipo de dependência tecnológica e a utilização de serviços de reabilitação. A população do estudo é composta de pré-escolares (56,3%), do sexo masculino (58,3%), residentes na região metropolitana do Estado do Rio de Janeiro (89,6%). São oriundos de famílias com rendimentos mensais até dois salários mínimos (70,9%), cuidados sobretudo por suas mãe (93,8%), que possuem escolaridade menor ou igual ao ensino fundamental (54,2%) e não trabalham (89,6%). Dos entrevistados, um total de 22,9% depende de três tipos diferentes de tecnologias, sendo o suporte medicamentoso (87,5%) a mais utilizada. O tratamento de reabilitação é financiado preponderantemente pelo Sistema Único de Saúde (SUS) e instituições filantrópicas, sendo o fisioterapeuta motor (60,4%) o profissional de maior demanda nesse tratamento. O hospital estudado concentra todos os atendimentos médicos especializados e a maior parte dos tratamentos em reabilitação.
Information, communication and equitable access to health care: a conceptual note
Authors: Thiede Michael , McIntyre Di
Published: April 2008

This conceptual paper addresses the health policy goal of equitable access to health care from a perspective that highlights the role of choice. It sketches a framework around the three access dimensions availability, affordability, and acceptability. The "degree of fit" with respect to each of these dimensions between the health system and individuals or communities plays a role in determining the level of access to health services by outlining the existing choice set. Yet it is the degree of informedness about the choices that ultimately determines access to health services. Access is therefore defined as the freedom to utilize. The paper focuses on information and its properties, which cut across the dimensions of access. It is argued that equity-oriented health policy should stimulate communicative action in order to empower individuals and communities by expanding their subjective choice sets.
A busca e o uso da informação nas organizações
Authors: Lira Waleska Silveira , Cândido Gesinaldo Ataíde , Araújo Geraldo Maciel de , Barros Marcelo Alves de
Published: April 2008

Este estudo tem como objetivo mostrar a importância do uso eficiente da informação e do conhecimento nas organizações. Analisa as diferentes abordagens da busca e uso da informação, tendo por referencial os princípios associados à gestão da informação e do conhecimento. Conclui que o diferencial é detectar e gerenciar a informação eficaz, através do processo de busca, seleção, análise, disseminação e transformação dessa informação em conhecimento, com o objetivo de obter um melhor posicionamento no espaço competitivo no qual atua.
Gestão da informação utilizando o método infomapping
Authors: Valentim Marta Lígia Pomim , Carvalho Elisabeth Leão de , Woida Luana Maia , Cassiano Elisete Lopes
Published: April 2008

A gestão da informação é extremamente importante para as organizações. O mapeamento informacional é um instrumento que pode ser utilizado no âmbito da gestão da informação. Para realizar o mapeamento informacional, pode-se utilizar o método denominado "Infomapping", criado por Burk Jr. e Horton Jr., que se constitui em uma valiosa ferramenta para gerenciar os recursos de informação de uma organização. Ele permite descobrir com exatidão o grau de desconhecimento que se tem sobre as fontes, serviços e sistemas com os quais se desenvolve o trabalho informacional da organização. O processo consiste em criar um levantamento de todas as informações, que supostamente constituem-se num recurso informacional gerado internamente ou produzido externamente, que impactam diretamente as atividades corporativas.
Água virtual, escassez e gestão: o Brasil como grande "exportador" de água
Authors: Carmo Roberto Luiz do , Ojima Andréa Leda Ramos de Oliveira , Ojima Ricardo , Nascimento Thais Tartalha do
Published: April 2008

Recentemente, a valoração econômica da água tem sido discutida no cenário político brasileiro. Faz parte dessa discussão a incorporação da água nos produtos que circulam no mercado, especialmente através de commodities, utilizando o conceito de "água virtual". Este trabalho avalia o impacto da utilização do conceito de água virtual no cenário brasileiro, ao mesmo tempo em que discute as decorrências dessa exportação.
A produção científica do J Vasc Bras: conquistas e desafios
Authors: Costa-Val Ricardo , Sousa Filho José Carlos Taveira de
Published: April 2008

CONTEXTO: Sucessor da revista Cirurgia Vascular e Angiologia, o Jornal Vascular Brasileiro (J Vasc Bras) é o órgão científico oficial da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) e vem, ao longo dos anos, progredindo e conquistando importantes metas. No entanto, tais conquistas remetem ao comprometimento ininterrupto capaz de manter um alto padrão de qualidade e implicam constantes desafios, não apenas para que novas conquistas aconteçam, mas também para que o mesmo se perpetue. OBJETIVO: Avaliar criticamente todas as publicações do J Vasc Bras nas versões impressas e/ou eletrônicas entre os anos de 2002 a 2007. MÉTODOS: Trata-se de uma revisão sistemática sobre todas as publicações do J Vasc Bras, tanto impressas quanto eletrônicas, ocorridas no referido período. Os manuscritos foram subdivididos em 12 categorias e analisados em cinco aspectos, a saber: a) tipos de publicações; b) grandes áreas temáticas; c) níveis de evidências científicas; d) citações bibliográficas; e) países de origens das citações bibliográficas. Usaram-se os programas estatísticos SPSS®, versão 13.0 e Microsoft Excel® 2003 para as análises estatísticas. Não há conflito de interesse neste estudo. RESULTADOS: Foram avaliadas 26 edições e quase 400 manuscritos que se enquadraram em todos os níveis de evidências científicas, abrangendo desde editoriais, artigos originais, de revisão, consensos e/ou fóruns científicos e relatos de casos até cartas ao editor e resumos de trabalhos de conclusão. Os textos abordaram todas as grandes áreas temáticas da angiologia e cirurgia vascular, além da bioética, sociologia, filosofia e inovação tecnológica. No entanto, e apesar de uma paulatina mudança de paradigma, percebeu-se que os autores nacionais ainda deixam a desejar no que diz respeito à valorização da produção científica nacional e à do próprio J Vasc Bras, atitude que necessita ser repensada. CONCLUSÃO: Apesar de jovem, o J Vasc Bras vem galgando obstáculos e cumprindo seu papel, seja como órgão oficial da SBACV, seja como revista científica. Suas conquistas permitem deduzir que o mesmo está no caminho certo; entretanto, ainda existem desafios a vencer, particularmente em relação aos próprios autores nacionais, os quais, sem dúvida, foram e sempre serão parte de todas as conquistas. Mais do que estimular, a palavra de ordem é crescer, e de forma conjunta.
Profilaxia da trombose venosa profunda: aplicação prática e conhecimento teórico em um hospital geral
Authors: Pereira Cristiano Almeida , Brito Sérgio Soares de , Martins Antonio Sansevero , Almeida Christiany Moreira
Published: April 2008

CONTEXTO: Trabalho realizado na área de cirurgia vascular, porém relevante a todas as especialidades clínicas e cirúrgicas devido à importância clínica da trombose venosa profunda e sua principal complicação, a embolia pulmonar. OBJETIVOS: Verificar se a profilaxia para a trombose venosa profunda está sendo utilizada de forma adequada e rotineira em nosso serviço e avaliar o conhecimento dos médicos sobre as indicações de profilaxia medicamentosa. MÉTODOS: Foi realizado um estudo prospectivo com 850 pacientes internados de março a maio de 2007 no Hospital Geral de Roraima. Foram pesquisados fatores clínicos, medicamentosos e cirúrgicos. A estratificação de risco e a avaliação da profilaxia foram estabelecidas conforme a classificação recomendada pela Sociedade Brasileira de Angiologia e Cirurgia Vascular e o protocolo realizado por Caiafa em 2002. Os médicos responderam a um questionário e analisaram três casos clínicos hipotéticos. Os dados foram tabulados e analisados estatisticamente usando o programa de computador Epi-Info 2002®. RESULTADOS: Dos 850 pacientes estudados, 557 (66,66%) eram clínicos e 293 (33,34%) cirúrgicos. Do total, 353 pacientes (41,56%) foram classificados como baixo risco, 411 (48,32%) como médio risco e 86 (10,12%) como alto risco para desenvolver trombose venosa profunda. Dos 497 pacientes que necessitavam receber profilaxia medicamentosa para trombose venosa profunda, apenas 120 (24%) a receberam; destes, 102 (85%) a receberam de forma correta. Dos que não necessitavam de profilaxia, nenhum a recebeu. Os clínicos prescreveram mais e de forma mais correta a profilaxia em relação aos cirurgiões, apesar de estes terem demonstrado possuir um melhor conhecimento teórico do tema. No geral, o conhecimento teórico sobre trombose venosa profunda foi insuficiente. CONCLUSÕES: Em nosso serviço, a profilaxia medicamentosa da trombose venosa profunda é subutilizada em pacientes com indicação para recebê-la, tornando necessária a implementação de um programa de educação continuada sobre o tema.
Tratamento endovascular de aneurisma de artéria poplítea
Authors: Thomazinho Fernando , Silvestre Jose Manoel da Silva , Sardinha Wander Eduardo , Motta Fernando , Perozin Igor Schincariol , Morais Filho Domingos de
Published: April 2008

CONTEXTO: Dos aneurismas periféricos, o da artéria poplítea é o mais freqüente, correspondendo a 70 a 80% dos casos. O tratamento cirúrgico convencional consta de exclusão do aneurisma e interposição de enxerto em ponte ou de ressecção parcial ou total do aneurisma e reconstrução arterial com enxerto em continuidade. O tratamento endovascular surgiu como uma alternativa ao reparo convencional. OBJETIVO: Avaliar o uso de endoprótese para o tratamento endovascular do aneurisma de artéria poplítea. METODOLOGIA: Num total de 17 pacientes, todos do sexo masculino, 11 foram tratados por técnica endovascular, utilizando-se próteses Hemobahn e Viabahn. RESULTADOS: Um paciente apresentou pseudo-aneurisma no pós-operatório imediato. Dentre as complicações tardias, um paciente apresentou endoleak distal da prótese após 7 meses, e houve oclusão da endoprótese em outro. Os nove pacientes restantes apresentaram controle de eco-Doppler satisfatório aos 20 meses, resultando em uma perviedade primária de 90% em um período médio de 27 meses de seguimento. CONCLUSÃO: O tratamento endovascular para aneurisma de artéria poplítea é factível e apresenta algumas vantagens em relação ao tratamento aberto, como menor tempo de internação e de recuperação.
Research Publication by Pharmacist Authors in Major Medical Journals: Changes over a 10‐Year Interval
Authors: Touchette Daniel R. , Bearden David T. , Ottum Sean A.
Published: April 2008

Study Objective.To determine the degree to which pharmacists were involved in major clinical research publications in 1993 and 2003, and to compare the difference in publication rates by pharmacists between these 2 years.

Design.Retrospective analysis.

Data Source.Thirty‐seven medical journals that had high readership, had a focus on original research, were clinically oriented, and were highly regarded by the research community.

Measurements and Main Results.Selection of the medical journals was first determined by those having the highest impact factors. Then journals with regular publication of original clinical research and listings of authors' degrees or licensure were included. All original research articles in these journals were reviewed for both 1993 and 2003. The primary outcome was the presence of a pharmacist as an author of one of their research articles in each of those 2 years. For those articles, the following data were collected: study subjects, study design, authors' affiliations, source of research funding, and position of author (first and/or corresponding). The primary outcome was analyzed by using multivariate logistic regression analysis. Other outcomes were compared between 1993 and 2003 by using a X2test. The number of clinical research articles identified was 8127 in 1993 and 8793 in 2003. The median (mean, interquartile range) number of authors/ article increased from 5 (5.3, 3–7) in 1993 to 6 (6.6, 4–8) in 2003 (p<0.01). There were 191 pharmacist‐authored papers (2.4%) in 1993, compared with 271 (3.1%) in 2003, for a relative increase of 29.2%. Adjusting for the increase seen in the number of authors during that period, the odds ratio that a pharmacist was an author in 2003 compared with 1993 was 1.26 (95% confidence interval 1.04‐1.53). Most (94.2%) pharmacist‐authored papers described studies involving human subjects. The proportion of clinical pharmacists (but not the number) serving as the primary author declined over time, from 36.6% (70/191) in 1993 to 27.3% (74/271) in 2003 (p=0.041). The most frequent funding sources were industry (from 38.2% in 1993 to 39.5% in 2003) and federal (from 25.1% in 1993 to 31.4% in 2003); however, the differences were not statistically significant.

Conclusions.An increase was noted in the proportion of publications involving pharmacists as an author in major medical journals in 2003 compared with 1993. Pharmacists must continue to be active in clinical research, with adequate training and funding remaining significant obstacles.
Amino Acid Requirements in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy
Authors: Btaiche Imad F. , Mohammad Rima A. , Alaniz Cesar , Mueller Bruce A.
Published: April 2008

Acute kidney injury in critically ill patients is often a complication of an underlying condition such as organ failure, sepsis, or drug therapy. In these patients, stress‐induced hypercatabolism results in loss of body cell mass. Unless nutrition support is provided, malnutrition and negative nitrogen balance may ensue. Because of metabolic, fluid, and electrolyte abnormalities, optimization of nutrition to patients with acute kidney injury presents a challenge to the clinician. In patients treated with conventional intermittent hemodialysis, achieving adequate amino acid intake can be limited by azotemia and fluid restriction. With the use of continuous renal replacement therapy (CRRT), however, better control of azotemia and liberalization of fluid intake allow amino acid intake to be maximized to support the patient's metabolic needs. High amino acid doses up to 2.5 g/kg/day in patients treated with CRRT improved nitrogen balance. However, to our knowledge, no studies have correlated increased amino acid intake with improved outcomes in critically ill patients with acute kidney injury. Data from large, prospective, randomized, controlled trials are needed to optimize the dosing of amino acids in critically ill patients with acute kidney injury who are treated with CRRT and to study the safety of high doses and their effects on patient morbidity and survival.
Epalrestat: An Aldose Reductase Inhibitor for the Treatment of Diabetic Neuropathy
Authors: Ramirez Mary Ann , Borja Nancy L.
Published: April 2008

Diabetic neuropathy is one of the most common long‐term complications in patients with diabetes mellitus, with a prevalence of 60–70% in the United States. Treatment options include antidepressants, anticonvulsants, tramadol, and capsaicin. These agents are modestly effective for symptomatic relief, but they do not affect the underlying pathology nor do they slow progression of the disease. Epalrestat is an aldose reductase inhibitor that is approved in Japan for the improvement of subjective neuropathy symptoms, abnormality of vibration sense, and abnormal changes in heart beat associated with diabetic peripheral neuropathy. Unlike the current treatment options for diabetic neuropathy, epalrestat may affect or delay progression of the underlying disease process. Data from experimental studies indicate that epalrestat reduces sorbitol accumulation in the sciatic nerve, erythrocytes, and ocular tissues in animals, and in erythrocytes in humans. Data from six clinical trials were evaluated, and it was determined that epalrestat 50 mg 3 times/day may improve motor and sensory nerve conduction velocity and subjective neuropathy symptoms as compared with baseline and placebo. Epalrestat is well tolerated, and the most frequently reported adverse effects include elevations in liver enzyme levels and gastrointestinal‐related events such as nausea and vomiting. Epalrestat may serve as a new therapeutic option to prevent or slow the progression of diabetic neuropathy. Long‐term, comparative studies in diverse patient populations are needed for clinical application.
Prazosin for the Treatment of Posttraumatic Stress Disorder Sleep Disturbances
Authors: Miller Lisa J.
Published: April 2008

An estimated 70–87% of patients who suffer from posttraumatic stress disorder (PTSD) experience sleep disruption. These patients have distressing dreams or nightmares in which the traumatic event is reexperienced, and they also have difficulty in falling or staying asleep. Selective serotonin reuptake inhibitors are the treatment of choice for PTSD, but with the exception of fluvoxamine, they are often ineffective or only partially effective for sleep problems. Sedative‐hypnotics may be helpful in the short term but are associated with tolerance and addiction potential. In the central nervous system, α1‐adrenergic receptors are known to be important in both the startle and sleep responses. Stimulation of these receptors may contribute to PTSD‐related trauma‐content nightmares. Prazosin, a highly lipophilic α1‐adrenergic receptor blocker that is traditionally used to treat hypertension and benign prostatic hyperplasia, has been shown to decrease the occurrence of trauma nightmares in both combat veterans and patients with non‐combat‐related PTSD. The available data, although mostly from open‐label trials, suggest that this agent also improves sleep quality and patients' sense of well‐being and ability to function in daily activities. The optimum dose is unknown; however, a dose‐related response appears to be evident. Clinicians should monitor for orthostatic hypotension, usually seen early in therapy, when prazosin is started in patients with PTSD.
Osteonecrosis of the Jaw in Patients Receiving Intravenous or Oral Bisphosphonates
Authors: King Amber E. , Umland Elena M.
Published: April 2008

To identify potential risk factors for the development of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates, we conducted a MEDLINE search. We identified 44 English‐language published case reports and case series describing 481 patients with bisphosphonate‐related ONJ. Our review of these reports indicated that ONJ occurs more frequently in patients receiving intravenous bisphosphonates (453 patients [94.2%]) than in patients receiving oral bisphosphonates (28 patients [5.8%]). Most patients who developed ONJ had cancer (451 patients [93.8%]), with multiple myeloma being the most common diagnosis, followed by breast, prostate, and lung cancers. Nearly one third of patients had a history of glucocorticoid use. The inciting event (reported in 449 patients) preceding the diagnosis of ONJ was a tooth extraction or other surgical or invasive dental procedure in 309 patients (68.8%), whereas 93 patients (20.7%) developed ONJ spontaneously. Guidelines for the prevention and treatment of bisphosphonate‐associated ONJ have been developed but are largely based on anecdotal evidence. Patients receiving bisphosphonates must be counseled on the risks and benefits of therapy. Further studies will help to elucidate the pathophysiology, frequency, and risk factors for development of bisphosphonate‐associated ONJ.
Continued Challenges with the Use of Erythropoiesis‐Stimulating Agents in Patients with Cancer: Perspectives and Issues on Policy‐Guided Health Care
Authors: Arbuckle Rebecca B. , Griffith Niesha L. , Iacovelli Lew M. , Johnson Philip E. , Jorgenson James A. , Kloth Dwight D. , Lucarelli Charles D. , Muller Raymond J.
Published: April 2008

Erythropoiesis‐stimulating agents (ESAs) are approved as an alternative to blood transfusions for treating anemia secondary to chemotherapy in patients with cancer. Recently, ESAs have been a source of controversy and confusion in the oncology community. This began when two European trials—the Breast Cancer Erythropoietin Survival Trial (BEST) and the Advanced Head‐and‐Neck Cancer Treated with Radiotherapy (ENHANCE) Study—raised safety concerns about decreased overall survival and increased venous thromboembolic events. In 2004, the United States Food and Drug Administration (FDA) convened its Oncologic Drugs Advisory Committee (ODAC) to review the data and reassess the risks and benefits of ESAs in patients with cancer. On May 10, 2007, ODAC reconvened when five trials (BEST, ENHANCE, AMG‐20010103, AMG‐20000161, and EPO‐CAN‐20) showed decreased overall survival. The briefing document noted that studies demonstrating detrimental effects on survival and/or tumor outcomes used an unapproved treatment regimen designed to maintain hemoglobin levels above 12 g/dl. On May 14, 2007, just days after the ODAC reconvened, the Centers for Medicare and Medicaid Services (CMS) released a proposed decision memo for a national coverage determination (NCD) imposing restrictions on ESAs. For health care providers, aspects of the proposed NCD were markedly inconsistent with FDA‐approved ESA use and generally were considered ambiguous and unclear. Over objections of several professional associations and members of Congress, on July 30, 2007, CMS posted the final NCD and declared it effective immediately. When compared with FDA‐approved labeling and professional society guidelines, the NCD revealed differences in ESA initiation, dosage escalation, dosage reduction, and definition of response. These discrepancies have generated confusion among health care providers, who are struggling over whether they can feasibly provide a dual system of care—one for Medicare patients and another for non‐Medicare patients—that is evidence based. With this supplement, we hope to educate health care providers on the issues and challenges associated with policy‐guided health care when discrepancies exist between the policy and evidence‐based practice; offer guidance on implementing the NCD; and highlight the important role of pharmacists in the process.
Current Status of Prognostic Profiling in Breast Cancer
Authors: Pusztai Lajos
Published: April 2008

Learning Objectives

After completing this course, the reader will be able to: Assess emerging data on the use of genetic groupings of breast cancer as predictive factors, and examine the efficacy of different therapies aimed at optimizing outcomes of patients within these groups.Examine the clinical value of molecular diagnostic tests being developed to classify breast tumors, and discuss the challenges involved in validating and interpreting the results of these tests.Outline the potential uses of identifying and/or targeting breast cancer stem cells.Discuss the possible effect of genetic classification of breast tumors on the design of future clinical trials.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com

Breast cancer is a clinically heterogeneous disease that can affect individuals with seemingly identical clinicopathologic parameters differently. This clinical heterogeneity is driven to a large extent by abnormal gene expression within tumors. Investigators now have the ability to identify the gene-expression fingerprint of an individual's tumor. This information may be used to rationally design therapeutic targets in the future, and also to predict the clinical course of an individual's disease, including response to a specific treatment. Genetic profiles of tumors are now being correlated with clinical outcome, and several prognostic and predictive indicators have emerged based on this research. There are at least four commercially available predictive or prognostic tests, and several more are looming on the horizon. The data gathered from these tests augment standard diagnostic and prognostic information obtained from traditional clinical pathological variables. The advent of gene-profiling technologies started to change the conduct of clinical trials. In the not too distant future, prospective tissue collection for molecular analysis may become routine in order to stratify patients for treatment arms and to optimize treatment strategies based on molecular features of the cancer. Coordinated efforts among oncologists, pathologists, surgeons, laboratory scientists, statisticians, and regulators will be essential in the quest to incorporate genetic profiling and molecular hypotheses into clinical trial planning and conduct.
Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer: The Con View
Authors: Vergote Ignace , Amant Frederic , Leunen Karin , Cadron Isabelle , Van Gorp Toon , Neven Patrick , Berteloot Patrick
Published: April 2008

Learning Objectives

After completing this course, the reader will be able to: Assess the rationale behind using i.p. chemotherapy for epithelial ovarian cancer patients and critically evaluate the data supporting its use.Interpret the argument that i.p. chemotherapy cannot be accepted as standard of care for first-line systemic treatment of advanced ovarian carcinoma.Determine which epithelial ovarian cancer patients may be appropriate for i.p. chemotherapy.Avoid and/or manage the toxicities observed with i.p. chemotherapy.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com

The CME activity for this article consists of material from both “Intraperitoneal Chemotherapy in Patients with Advanced Ovarian Cancer: The Con View” (Vergote et al.) and “Intraperitoneal Chemotherapy for Women with Epithelial Ovarian Cancer” (Trimble et al.).

Objectives.

In this paper we wish to present the reasons why i.p. chemotherapy cannot be accepted as standard of care for first-line systemic treatment of advanced ovarian carcinoma.

Methods.

The recent literature on i.p. chemotherapy is critically reviewed. All possible arguments against i.p. chemotherapy are reviewed.

Conclusions.

Intraperitoneal chemotherapy is associated with a higher toxicity rate than i.v. chemotherapy. For this reason, none of the regimens investigated in the three Gynecologic Oncology Group (GOG) studies can be used as standard treatment outside clinical protocols. The trials on i.p. chemotherapy have suggested a survival difference. However, in the two most recent trials, i.p. chemotherapy or not was not the only research question because different schedules and dosages were used. In addition, the significance of the most recent GOG 172 study was only weak (p = .03), and the result was nonsignificant for progression-free survival. Intraperitoneal chemotherapy should be used only in the context of properly designed clinical trials. These trials must either assess i.p. therapy in comparison with the standard treatment or address the issue of route of administration for equivalent dosages and schedules of the same drugs, and not a mosaic of these questions. In addition, these trials should investigate i.p. regimens that are less toxic than the regimens used in the three GOG trials, and which can be combined with molecular targeted therapies.
Dexrazoxane (Totect™): FDA Review and Approval for the Treatment of Accidental Extravasation Following Intravenous Anthracycline Chemotherapy
Authors: Kane Robert C. , McGuinn W. David , Dagher Ramzi , Justice Robert , Pazdur Richard
Published: April 2008

Learning Objectives

After completing this course, the reader will be able to: Evaluate anthracycline tissue injury resulting from drug extravasation.Administer dexrazoxane in its new role of reducing extravasation tissue injury.Describe the proposed mechanism of action of dexrazoxane for this use.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com

Management of anthracycline extravasation is problematic and most reports are anecdotal. On September 6, 2007, the U.S. Food and Drug Administration approved Totect™ 500 mg (dexrazoxane hydrochloride for injection) for the treatment of extravasation resulting from i.v. anthracycline chemotherapy. In two studies, a total of 57 evaluable patients experienced extravasation from peripheral vein or central venous access sites with local swelling, pain, or redness. The presence of anthracycline in skin biopsy tissue was confirmed by tissue fluorescence, and treatment with a 3-day schedule of dexrazoxane began within 6 hours of the event. The primary endpoint was a reduction in the need for surgical intervention. Only one patient required surgical repair of the injury site, and late sequelae in the remainder were absent or mild. Also, the sponsor, TopoTarget A/S, Copenhagen, Denmark, performed controlled nonclinical studies in support of dexrazoxane dose and timing for the reduction of tissue injury resulting from anthracycline extravasation. For this uncommon but serious complication of anthracycline therapy, the need for surgical intervention was 1.7% with this regimen.
Systemic Therapy for Biliary Tract Cancers
Authors: Hezel Aram F. , Zhu Andrew X.
Published: April 2008

Learning Objectives

After completing this course, the reader will be able to: Assess the clinical and molecular heterogeneity of BTCs.Exploit the chemotherapy responsiveness of these tumors to improve the quality of life and extend the survival of patients with BTC.Administer the most current systemic therapy in BTC patients, including the appropriate first-line treatment options.Explain the rationale for developing and discuss the current status of molecularly targeted agents in BTC.

CME Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com

Biliary tract cancers (BTCs) are invasive carcinomas that arise from the epithelial lining of the gallbladder and bile ducts. These include intrahepatic, perihilar, and distal biliary tree cancers as well as carcinoma arising from the gallbladder. Complete surgical resection offers the only chance for cure; however, only 10% of patients present with early-stage disease and are considered surgical candidates. Among those patients who do undergo “curative” resection, recurrence rates are high; thus, for the majority of BTC patients, systemic chemotherapy is the mainstay of their treatment plan. Patients with unresectable or metastatic BTC have a poor prognosis, with a median overall survival time of <1 year. Despite a paucity of randomized phase III data, a consensus on first-line systemic therapy is emerging. In this review, we discuss the clinical experience with systemic treatment of BTC, focusing on the rationale for a first-line regimen as well as future directions in the field.
Commentary: Can Circulating HER-2 Extracellular Domain Predict Response to Trastuzumab in HER-2–Negative Breast Cancer?
Authors: Esteva Francisco J.
Published: April 2008

This commentary evaluates the study of Ardavanis et al. in this issue and makes recommendations for further studies of HER-2 extracellular domain circulating levels as a prognostic indicator in metastatic breast cancer.
The occurrence and effects of wave impacts
Authors: Müller G. , Allsop W. , Bruce T. , Kortenhaus A. , Pearce A. , Sutherland J.
Published: April 2008

The determination of design parameters for coastal structures has historically often involved the definition of maximum water levels, the highest significant wave height and the longest wave periods. The design then proceeds with these values using numerical models, direct design methods or physical model studies. Design studies have often been conducted with maximum water levels, using random seas with previously determined parameters, a chosen wave spectrum and a sufficiently large number of waves. Parametric analysis methods using multiple parameters have identified that different combinations of water level; wave condition; perhaps fluvial discharge; or sea bed condition; may all influence the response. Recent research into the most important responses of vertical structures (plunging wave impact, toe scouring, overtopping and overtopping-induced loading) indicates that these mechanisms are all linked to the occurrence of violent wave impacts. Wave breaking is a depth-limited phenomenon, with plunging breakers occurring only for a limited range of wave height to water depth ratios. For given storm wave heights, but tidally varying water levels, this wave-breaking regime will often only prevail for a limited amount of time, leading to the conclusion that the duration of maximum exposure, namely the length of time that a coastal structure is exposed to the most important wave-induced damage mechanisms, is a function of the combined probability of (at least) water level (tidal + storm surge) and wave height/storm profile characteristics. This may have significant consequences for the definition of critical design parameters and the parameter variations employed in model tests.
Combating Tsunami Disaster Through EMDR
Authors: Jayatunge Ruwan M.
Published: April 2008

After the 2004 tsunami devastation in Sri Lanka, many citizens experienced severe psychological reactions. The effectiveness of EMDR is illustrated in the treatment of seven of these individuals: 3 children and 2 adults with posttraumatic stress disorder (PTSD) symptoms and 2 adults with depressive symptoms. After 3–8 sessions of EMDR the symptoms were eradicated and these clients were free from their depressive feelings, anxieties, intrusions, and nightmares, were able to function normally, and were able to lead productive lives. These outcomes replicate those in the research literature demonstrating that EMDR is an efficacious treatment for PTSD in general, with specific utility for disaster-related PTSD. It is recommended that future controlled studies be conducted to evaluate the effectiveness of EMDR in the immediate aftermath of disasters and to assess its effectiveness with major depressive disorder.
EMDR After a Critical Incident: Treatment of a Tsunami Survivor With Acute Posttraumatic Stress Disorder
Authors: Fernandez Isabel
Published: April 2008

Research indicates that EMDR is effective for the treatment of posttraumatic stress disorder (PTSD), with numerous studies showing a high percentage of symptom remission after 3 sessions. The case of a tsunami survivor with acute PTSD is presented. Treatment for overt trauma symptoms was completed within 3 sessions, including all 8 phases and the 3-pronged protocol (i.e., past, present, future targets). One EMDR session was sufficient to process the trauma and alleviate the related symptoms, while another session was necessary for re-evaluation and processing present triggers and future templates. Resource installation was particularly helpful to prepare him for those future situations that had been generating anxiety as a result of his traumatization.
Dimensions of Sexual Orientation and HIV-Related Risk Among Adolescent Females: Evidence From a Statewide Survey
Authors: Goodenow Carol , Szalacha Laura A. , Robin Leah E. , Westheimer Kim
Published: April 2008

Objectives. We examined the relationship of 2 dimensions of sexual orientation—sexual identity and sex of partners—with self-reported behaviors and experiences to identify factors that may place adolescent females at risk of HIV/AIDS.

Methods. We gathered data on sexually experienced female high school students from 4 waves of a population-based survey. We used logistic regression analyses to investigate the association between their sexual identity (3666 heterosexual; 184 lesbian, gay, or bisexual; 113 not sure) and sex of partners (3714 male only, 79 female only, and 180 both males and females) with HIV-related risk behaviors.

Results. Self-defined sexual identity was often inconsistent with sex of sexual partners. Sexual identities other than heterosexual and having same-sex partners (either exclusively or in addition to male partners) were associated with high rates of several HIV-related risk behaviors. Coerced sexual contact was significantly associated with every risk outcome. AIDS education in school predicted lower HIV risk on 4 of 6 indicators.

Conclusions. Programs to prevent HIV infection among adolescent females should take into account the complexity of sexual orientation and should address the needs and behaviors of sexual-minority youths.
Risk for Reassault in Abusive Female Same-Sex Relationships
Authors: Glass Nancy , Perrin Nancy , Hanson Ginger , Bloom Tina , Gardner Emily , Campbell Jacquelyn C.
Published: April 2008

Objectives. We revised the Danger Assessment to predict reassault in abusive female same-sex relationships.

Methods. We used focus groups and interviews to evaluate the assessment tool and identify new risk factors and telephone interviews at baseline and at 1-month follow-up to evaluate the revised assessment.

Results. The new assessment tool comprised 8 original and 10 new items. Predictors included increase in physical violence (relative risk ratio [RRR]=1.95; 95% confidence interval [CI]=0.84, 4.54), constant jealousy or possessiveness of abuser (RRR = 4.07; 95% CI = 0.61, 27.00), cohabitation (RRR = 1.96; 95% CI = 0.54, 7.12), threats or use of gun by abuser (RRR=1.93; 95% CI=0.79, 4.75), alcoholism or problem drinking of abuser (RRR=1.47; 95% CI=0.79, 2.71), illegal drug use or abuse of prescription medications by abuser (RRR = 1.33; 95% CI = 0.72, 2.46), stalking by abuser (RRR=1.39; 95% CI=0.70, 2.76), failure of individuals to take victim seriously when she sought help (RRR=1.66; 95% CI=0.90, 3.05), victim’s fear of reinforcing negative stereotypes (RRR=1.42; 95% CI=0.73, 2.77), and secrecy of abuse (RRR=1.72; 95% CI=0.74, 3.99). Both unweighted (P < .005) and weighted (P < .004) versions of the revised assessment were significant predictors of reassault.

Conclusions. The revised Danger Assessment accurately assesses risk of re-assault in abusive female relationships.