Decision making and management of gliomas: practical considerations.

Over the last decade, diagnostic options and introduction of novel treatments have expanded the armamentarium in the management of malignant glioma. Combined chemoradiotherapy has become the standard of care in glioblastoma up to the age of 70 years, while treatment in elderly patients or with lower grade glioma is less well defined. Molecular markers define different disease subtypes and allow for adapted treatment selection. This review focuses on simple questions arising in the daily management of patients.

Computational fluid dynamics of the right ventricular outflow tract and of the pulmonary artery: a bench model of flow dynamics.

OBJECTIVES: The reconstruction of the right ventricular outflow tract (RVOT) with valved conduits remains a challenge. The reoperation rate at 5 years can be as high as 25% and depends on age, type of conduit, conduit diameter and principal heart malformation. The aim of this study is to provide a bench model with computer fluid dynamics to analyse the haemodynamics of the RVOT, pulmonary artery, its bifurcation, and left and right pulmonary arteries that in the future may serve as a tool for analysis and prediction of outcome following RVOT reconstruction. METHODS: Pressure, flow and diameter at the RVOT, pulmonary artery, bifurcation of the pulmonary artery, and left and right pulmonary arteries were measured in five normal pigs with a mean weight of 24.6 ± 0.89 kg. Data obtained were used for a 3D computer fluid-dynamics simulation of flow conditions, focusing on the pressure, flow and shear stress profile of the pulmonary trunk to the level of the left and right pulmonary arteries. RESULTS: Three inlet steady flow profiles were obtained at 0.2, 0.29 and 0.36 m/s that correspond to the flow rates of 1.5, 2.0 and 2.5 l/min flow at the RVOT. The flow velocity profile was constant at the RVOT down to the bifurcation and decreased at the left and right pulmonary arteries. In all three inlet velocity profiles, low sheer stress and low-velocity areas were detected along the left wall of the pulmonary artery, at the pulmonary artery bifurcation and at the ostia of both pulmonary arteries. CONCLUSIONS: This computed fluid real-time model provides us with a realistic picture of fluid dynamics in the pulmonary tract area. Deep shear stress areas correspond to a turbulent flow profile that is a predictive factor for the development of vessel wall arteriosclerosis. We believe that this bench model may be a useful tool for further evaluation of RVOT pathology following surgical reconstructions.

ÉTICA E A TRANSPARÊNCIA NA ADMINISTRAÇÃO PÚBLICA CABO-VERDIANA: QUAIS DESAFIOS?

A nossa sociedade está, visivelmente, em busca de padrões éticos, de padrões de melhoria social, de padrões de melhoria económica. Acredita-se, pois que a ética e a transparência podem se constituir em elementos essenciais no sentido de assegurar que qualquer governo atinja os seus objectivos com eficiência, efectividade e dentro dos preceitos legais da ordem democrática. Tendo o Governo de Cabo Verde eleito a ética e a transparência na gestão da coisa pública como fundamentos de uma “boa governação”, é imprescindível criar mecanismos de controlo, a fim de verificar se tal determinação está sendo efectivada. Para tanto, é fundamental que haja, uma análise criteriosa, considerando não só os aspectos da administração, mas principalmente, os aspectos políticos e sociais envolvidos. Isto se justifica, ademais, pelo facto de haver mais eficiência governativa quando as instituições funcionam com regras, com transparência, com ética, com comprometimento ao serviço público, com profissionalismo e quando estão sujeitas ao controlo social e aos mecanismos de "check and balances". Em Cabo Verde existe uma assimetria entre o governo, a oposição, e a sociedade no que diz respeito à ética e à transparência na Administração Pública. Esta constatação nos motivou a efectuar uma reflexão sobre o assunto, não no intuito de julgar mas, sim, de pesquisar os actos e as regras praticadas na Administração Pública Cabo-verdiana, ou seja, pelo Poder Executivo Cabo-Verdiano, posto que tais actos, em última instância, visam assegurar o alcance do bem comum no âmbito referido. Assim sendo, o objectivo deste trabalho é reflectir sobre a questão da ética e da transparência na Administração Pública Cabo-verdiana, desenvolvendo um pensamento crítico e fundamentado a respeito do tema. O que se busca, neste caso, é assinalar propostas práticas face ao modelo actual de Reforma Administrativa em Cabo Verde, contribuindo para o seu aperfeiçoamento. Em termos de contexto, realça-se que o estudo abrangerá a vertente da Administração Central. Para alcançar o objectivo deste trabalho, fez-se uma pesquisa bibliográfica sobre a ética e Transparência na Administração Pública e sobre diversas teorias relacionadas com a ética nas organizações. Utilizou-se o método inquisitivo baseado em 5 questionário com perguntas fechadas e abertas para se obter a percepção dos dirigentes, funcionários públicos e utentes da Administração Pública, bem como dos políticos que hoje actuam neste âmbito. Os dados recolhidos proporcionam indicações evidentes que é preciso mudar de paradigma no que diz respeito à Ética e à Transparência na Administração Pública Cabo-verdiana.

Factores que condicionam a participação dos pais/encarregados de educação na vida escolar dos seus filhos

Tendo em conta que a educação é um bem de natureza colectiva, não pode ser regulada apenas pelas leis. Há necessidade de haver a intervenção de todos e uma reflexão conjunta procurando a melhor forma de o fazer. É nesse contexto que a participação dos pais/ encarregados de educação na vida escolar dos seus filhos, é um Lema que traduz, nos dias de hoje, um desafio para o Sistema Educativo. A importância da participação dos pais reflecte-se não só nos educandos, mas também em toda a sociedade. Mas isso não configura sem que a comunidade educativa (professores gestores pais encarregados de educação, ou seja, comunidade em geral) se reconhecerem a importância desse facto e consciencializem de que deve estabelecer uma correlação entre eles de modo a criar condições necessárias para garantir o bem-estar dos educandos visando educa-los com identidade pessoal e cultural, capazes de compreender a sociedade na qual vivem, Nesse sentido a escola tem um dever importantíssimo de reflectir sobre as suas acções e procurando consciencializar a si mesmo e fazer algo que possa consciencializar a sociedade.

Dietary vitamin D and cancers of the oral cavity and esophagus.

BACKGROUND: Data on the association between vitamin D and upper digestive tract neoplasms are limited. METHODS: In two case-control studies in Italy, we examined the relation between dietary vitamin D intake and squamous cell carcinoma of the esophagus (SCCE; 304 cases) and oral/pharyngeal cancer (804 cases). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression. RESULTS: Adjusted ORs for SCCE and oral/pharyngeal cancer were 0.58 (95% CI 0.39-0.86) and 0.76 (95% CI 0.60-0.94), respectively, for the highest tertile of vitamin D intake. Using a reference group of those in the highest tertile of vitamin D who were never/former smokers, ORs were 8.7 (95% CI 4.1-18.7) for SCCE and 10.4 (95% CI 6.9-15.5) for oral/pharyngeal cancer among heavy smokers in the lowest vitamin D tertile; similarly, compared with those in the highest tertile of vitamin D who drank <3 alcoholic drinks/day, corresponding ORs were 41.9 (95% CI 13.7-128.6) for SCCE and 8.5 (95% CI 5.7-12.5) for oral/pharyngeal cancer, among heavy alcohol drinkers in the lowest vitamin D tertile. CONCLUSION: We observed inverse associations between dietary vitamin D intake and risk of SCCE and, perhaps, oral/pharyngeal cancer, which were most pronounced among heavy current smokers and heavy consumers of alcohol.

Dietary folates and cancer risk in a network of case-control studies.

Background Folate deficiency leads to DNA damage and inadequate repair, caused by a decreased synthesis of thymidylate and purines. We analyzed the relationship between dietary folate intake and the risk of several cancers. Patients and methods The study is based on a network of case-control studies conducted in Italy and Switzerland in 1991-2009. The odds ratios (ORs) for dietary folate intake were estimated by multiple logistic regression models, adjusted for major identified confounding factors. Results For a few cancer sites, we found a significant inverse relation, with ORs for an increment of 100 μg/day of dietary folate of 0.65 for oropharyngeal (1467 cases), 0.58 for esophageal (505 cases), 0.83 for colorectal (2390 cases), 0.72 for pancreatic (326 cases), 0.67 for laryngeal (851 cases) and 0.87 for breast (3034 cases) cancers. The risk estimates were below unity, although not significantly, for cancers of the endometrium (OR = 0.87, 454 cases), ovary (OR = 0.86, 1031 cases), prostate (OR = 0.91, 1468 cases) and kidney (OR = 0.88, 767 cases), and was 1.00 for stomach cancer (230 cases). No material heterogeneity was found in strata of sex, age, smoking and alcohol drinking. Conclusions Our data support a real inverse association of dietary folate intake with the risk of several common cancers.

Human capital and regional development

We investigate the determinants of regional development using a newly constructed database of 1569 sub-national regions from 110 countries covering 74 percent of the world s surface and 97 percent of its GDP. We combine the cross-regional analysis of geographic, institutional, cultural, and human capital determinants of regional development with an examination of productivity in several thousand establishments located in these regions. To organize the discussion, we present a new model of regional development that introduces into a standard migration framework elements of both the Lucas (1978) model of the allocation of talent between entrepreneurship and work, and the Lucas (1988) model of human capital externalities. The evidence points to the paramount importance of human capital in accounting for regional differences in development, but also suggests from model estimation and calibration that entrepreneurial inputs and possibly human capital externalities help understand the data.

Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer.

To complement the existing treatment guidelines for all tumour types, ESMO organises consensus conferences to focus on specific issues in each type of tumour. The Second ESMO Consensus Conference on Lung Cancer was held on 11-12 May 2013 in Lugano. A total of 35 experts met to address several questions on management of patients with non-small-cell lung cancer (NSCLC) in each of four areas: pathology and molecular biomarkers, early stage disease, locally advanced disease and advanced (metastatic) disease. For each question, recommendations were made including reference to the grade of recommendation and level of evidence. This consensus paper focuses on recommendations for pathology and molecular biomarkers in relation to the diagnosis of lung cancer, primarily non-small-cell carcinomas.

Assessment of needs, health-related quality of life, and satisfaction with care in breast cancer patients to better target supportive care.

BACKGROUND: This study assessed whether breast cancer (BC) patients express similar levels of needs for equivalent severity of symptoms, functioning difficulties, or degrees of satisfaction with care aspects. BC patients who did (or not) report needs in spite of similar difficulties were identified among their sociodemographic or clinical characteristics. PATIENTS AND METHODS: Three hundred and eighty-four (73% response rate) BC patients recruited in ambulatory or surgery hospital services completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ)-C30 quality of life [health-related quality of life (HRQOL)], the EORTC IN-PATSAT32 (in-patient) or OUT-PATSAT35 (out-patient) satisfaction with care, and the supportive care needs survey short form 34-item (SCNS-SF34) measures. RESULTS: HRQOL or satisfaction with care scale scores explained 41%, 45%, 40% and 22% of variance in, respectively, psychological, physical/daily living needs, information/health system, and care/support needs (P < 0.001). BC patients' education level, having children, hospital service attendance, and anxiety/depression levels significantly predicted differences in psychological needs relative to corresponding difficulties (adjusted R(2) = 0.11). Medical history and anxiety/depression levels significantly predicted differences in information/health system needs relative to degrees of satisfaction with doctors, nurses, or radiotherapy technicians and general satisfaction (adjusted R(2) = 0.12). Unmet needs were most prevalent in the psychological domains across hospital services. CONCLUSIONS: Assessment of needs, HRQOL, and satisfaction with care highlights the subgroups of BC patients requiring better supportive care targeting.