Quality of Life and Colorectal Cancer: a Review

Objectives: To describe what is known of quality of life for colorectal cancer patients, to review what has been done in the Australian setting and to identify emerging directions for future research to address current gaps in knowledge. Method: A literature search (using Medline, PsychInfo, CINAHL and Sociological Abstracts) was conducted and 41 articles identified for review. Results: Three key areas relating to quality of life in colorectal cancer patients emerged from the literature review: the definition and measurement of quality of life; predictors of quality of life; and the relationship of quality of life to survival. Results of existing studies are inconsistent in relation to quality of life over time and its relationship to survival. Small sample sizes and methodological limitations make interpretation difficult. Conclusions: There is a need for large-scale, longitudinal, population-based studies describing the quality of life experienced by colorectal cancer patients and its determinants. Measurement and simultaneous adjustment for potential confounding factors would productively advance knowledge in this area, as would an analysis of the economic cost of morbidity to the community and an assessment of the cost effectiveness of proposed interventions. Implications: As the Australian population ages, the prevalence of colorectal cancer within the community will increase. This burden of disease presents as a priority area for public health research. An improved understanding of quality of life and its predictors will inform the development and design of supportive interventions for those affected by the disease.

Epizootic activity of Murray Valley encephalitis and Kunjin viruses in an aboriginal community in the Southeast Kimberley region of Western Australia: Results of mosquito fauna and virus isolation studies

We undertook annual surveys of flavivirus virus activity in the community of Billiluna of Western Australia in the southeast Kimberley region between 1989 and 2001. Culex annulirostris was the dominant mosquito species, particularly in years of above average rains and flooding. Murray Valley encephalitis (MVE) virus was isolated in 8 of the 13 years of the study from seven mosquito species, but more than 90% of the isolates were from Cx. annulirostris. The results suggest that MVE virus is epizootic in the region, with activity only apparent in years with average or above average rainfall and increased numbers of Cx. annulirostris. High levels of MVE virus activity and associated human cases were detected only once (in 1993) during the survey period. Activity of MVE virus could only be partially correlated with wet season rainfall and flooding, suggesting that a number of other factors must also be considered to accurately predict MVE virus activity at such communities.

Theoretical and experimental studies of unbraced tubular trusses allowing for torsional stiffness

This paper describes the buckling phenomenon of a tubular truss with unsupported length through a full-scale test and presents a practical computational method for the design of the trusses allowing for the contribution of torsional stiffness against buckling, of which the effect has never been considered previously by others. The current practice for the design of a planar truss has largely been based on the linear elastic approach which cannot allow for the contribution of torsional stiffness and tension members in a structural system against buckling. The over-simplified analytical technique is unable to provide a realistic and an economical design to a structure. In this paper the stability theory is applied to the second-order analysis and design of the structural form, with detailed allowance for the instability and second-order effects in compliance with design code requirements. Finally, the paper demonstrates the application of the proposed method to the stability design of a commonly adopted truss system used in support of glass panels in which lateral bracing members are highly undesirable for economical and aesthetic reasons.

Graduate entry to medical studies: thoughts from 'down under' (editorial)

This invited editorial, reflecting on expectations of changing to graduate entry, eg enhanced maturity in the student cohort with greater self-sufficiency and taking of responsibility for learning in the context of adoption of a problem-based learning model, examines experiences of early post-change years and raises questions for contemplation by medical schools considering graduate entry.

Online titrimetric and off-gas analysis for examining nitrification processes in wastewater treatment

The two steps of nitrification, namely the oxidation of ammonia to nitrite and nitrite to nitrate, often need to be considered separately in process studies. For a detailed examination, it is desirable to monitor the two-step sequence using online measurements. In this paper, the use of online titrimetric and off-gas analysis (TOGA) methods for the examination of the process is presented. Using the known reaction stoichiometry, combination of the measured signals (rates of hydrogen ion production, oxygen uptake and carbon dioxide transfer) allows the determination of the three key process rates, namely the ammonia consumption rate, the nitrite accumulation rate and the nitrate production rate. Individual reaction rates determined with the TOGA sensor under a number of operation conditions are presented. The rates calculated directly from the measured signals are compared with those obtained from offline liquid sample analysis. Statistical analysis confirms that the results from the two approaches match well. This result could not have been guaranteed using alternative online methods. As a case study, the influences of pH and dissolved oxygen (DO) on nitrite accumulation are tested using the proposed method. It is shown that nitrite accumulation decreased with increasing DO and pH. Possible reasons for these observations are discussed. (C) 2003 Elsevier Science Ltd. All rights reserved.

Model studies on the role of citrate, malate and pectin esterification on the enzymatic degradation of Al- and Ca-pectate gels: possible implications for Al-tolerance

Aluminium (At) tolerance in plants may be conferred by reduced binding of Al in the cell wall through low root cation exchange capacity (CEC) or by organic acid exudation. Root CEC is related to the degree of esterification (DE) of pectin in the cell wall, and pectin hydrolysis plays a role in cell expansion. Therefore, it was hypothesised that Al-tolerant plants with a low root CEC maintain pectin hydrolysis in the presence of Al, allowing cell expansion to continue. Irrespective of the DE, binding of Al to pectin reduced the enzymatic hydrolysis of Al-pectin gels by polygalacturonase (E.C. 3.2.1.15). Pectin gels with calcium (Ca) were slightly hydrolysed by polygalacturonase. It was concluded, therefore, that Al tolerance conferred by low root CEC is not mediated by the ability to maintain pectin hydrolysis. Citrate and malate, but not acetate, effectively dissolved Al-pectate gel and led to hydrolysis of the dissolved pectin by polygalacturonase. The organic acids did not dissolve Ca-pectate, nor did they increase pectin hydrolysis by polygalacturonase. It was concluded that exudation of some organic acids can remove Al bound to pectin and this could alleviate toxicity, constituting a tolerance mechanism. (C) 2003 Editions scientitiques et medicales Elsevier SAS. All rights reserved.

Simulation supplements field studies to determine no-till dryland corn population recommendations for semiarid western Nebraska

In a 2-yr multiple-site field study conducted in western Nebraska during 1999 and 2000, optimum dryland corn (Zea mays L.) population varied from less than 1.7 to more than 5.6 plants m(-2), depending largely on available water resources. The objective of this study was to use a modeling approach to investigate corn population recommendations for a wide range of seasonal variation. A corn growth simulation model (APSIM-maize) was coupled to long-term sequences of historical climatic data from western Nebraska to provide probabilistic estimates of dryland yield for a range of corn populations. Simulated populations ranged from 2 to 5 plants m(-2). Simulations began with one of three levels of available soil water at planting, either 80, 160, or 240 mm in the surface 1.5 m of a loam soil. Gross margins were maximized at 3 plants m(-2) when starting available water was 160 or 240 mm, and the expected probability of a financial loss at this population was reduced from about 10% at 160 mm to 0% at 240 mm. When starting available water was 80 mm, average gross margins were less than $15 ha(-1), and risk of financial loss exceeded 40%. Median yields were greatest when starting available soil water was 240 mm. However, perhaps the greater benefit of additional soil water at planting was reduction in the risk of making a financial loss. Dryland corn growers in western Nebraska are advised to use a population of 3 plants m(-2) as a base recommendation.

Gene flow in great bustard populations across the Strait of Gibraltar as elucidated from excremental PCR and mtDNA sequencing

Recent advances in molecular biology have made it possible to use the trace amounts of DNA in faeces to non-invasively sample endangered species for genetic studies. Here we use faeces as a source of DNA and mtDNA sequence data to elucidate the relationship among Spanish and Moroccan populations of great bustards. 834 bp of combined control region and cytochrome-b mtDNA fragments revealed four variable sites that defined seven closely related haplotypes in 54 individuals. Morocco was fixed for a single mtDNA haplotype that occurs at moderate frequency (28%) in Spain. We could not differentiate among the sampled Spanish populations of Caceres and Andalucia but these combined populations were differentiated from the Moroccan population. Estimates of gene flow (Nm = 0.82) are consistent with extensive observations on the southern Iberian peninsular indicating that few individuals fly across the Strait of Gibraltar. We demonstrate that both this sea barrier and mountain barriers in Spain limit dispersal among adjacent great bustard populations to a similar extent. The Moroccan population is of high ornithological significance as it holds the only population of great bustards in Africa. This population is critically small and genetic and observational data indicate that it is unlikely to be recolonised via immigration from Spain should it be extirpated. In light of the evidence presented here it deserves the maximum level of protection.

Emergence of joint attention: Relationships between gaze following, social referencing, imitation, and naming in infancy

The authors investigated the extent to which the joint-attention behaviors of gaze following, social referencing, and object-directed imitation were related to each other and to infants vocabulary development in a sample of 60 infants between the ages of 8 and 14 months. Joint-attention skills and vocabulary development were assessed in a laboratory setting. Split-half reliability analyses on the joint-attention measures indicated that the tasks reliably assessed infants' capabilities. In the main analysis, no significant correlations were found among the joint-attention behaviors except for a significant relationship between gaze following and the number of names in infants' productive vocabularies. The overall pattern of results did not replicate results of previous studies (e.g., M. Carpenter, K. Nagell, & M. Tomasello, 1998) that found relationships between various emerging joint-attention behaviors.

Gerenciamento proteano de carreira entre universitários

A partir da segunda metade do século XX, mudanças no modo de produção capitalista começaram a afetar a relação que as empresas estabeleciam com o trabalhador. Diante de um mercado imprevisível, a carreira tradicional, marcada, entre outros aspectos, por empregos duradouros e com possibilidade de ascensão na hierarquia da organização, tornou-se menos recorrente. Paralelamente, começaram a despontar novas concepções sobre carreira, tendo a maioria um enfoque individualista. Dentre as novas proposições, o presente estudo tomou como referência a concepção de carreira proteana. Esse modelo, de origem norte-americana, tem como ideia central a noção de uma carreira que é gerida pelo indivíduo, e tem como meta o alcance do sucesso psicológico. Desta forma, ancora-se em duas principais dimensões: autogerenciamento e direcionamento para valores. Considerando os diversos estudos que descrevem as dificuldades enfrentadas por estudantes na transição da universidade para o mercado de trabalho, esta pesquisa objetivou compreender aspectos do gerenciamento proteano de carreira entre universitários brasileiros que já tinham concluído, pelo menos, a primeira metade do curso de graduação. Para tanto, o estudo foi dividido em dois artigos. O primeiro foi destinado ao desenvolvimento e validação da Escala de Atitudes de Carreira Proteana para universitários, tendo sido realizado com uma amostra de 1016 estudantes de 37 cursos diferentes, com idade variando entre 18 e 65 anos, e média de 24,52 (DP = 6,69 anos). O instrumento, denominado neste estudo de Escala de Gerenciamento Proteano de Carreira para Universitários (EGPC-U) atestou a estrutura de duas dimensões, evidenciada também na versão original da medida. Os índices de confiabilidade foram satisfatórios e superiores a 12 0,61, tendo o instrumento a possibilidade de ser utilizado em serviços de orientação profissional ou de carreira. O segundo artigo objetivou compreender como as dimensões do modelo proteano se relacionam com variáveis sóciodemográficas e com construtos psicossociais: personalidade, lócus de controle, saúde e satisfação com a vida, e envolveu alunos de duas áreas de conhecimento: humanas e exatas. A amostra foi composta por 525 alunos, sendo 245 da área de humanas e 280 de exatas, sendo 52% do sexo masculino. A idade dos participantes variou entre 18 e 30 anos e média de 22,59 anos (DP = 2,66 anos). A partir dos resultados do estudo 2, constatou-se que alunos da área de humanas, quando comparados a estudantes de exatas, tendem a apresentar média superior na dimensão de direcionamento para valores. Verificou-se ainda que os aspectos de conscienciosidade e lócus de controle interno são preditores significativos do autogerenciamento tanto entre alunos de humanas como de exatas e que a adoção de atitudes proteanas tende a impactar positivamente aspectos da saúde e da satisfação com a vida do indivíduo. O estudo, de um modo geral, permitiu verificar a existência de características proteanas entre universitários, como também possibilitou conhecer variáveis relacionadas às atitudes de autogerenciamento e direcionamento para valores. Destaca-se, porém, a necessidade de pesquisas complementares com a exploração de outras variáveis psicossociais que possam estar relacionadas ao gerenciamento proteano entre graduandos.

Prevalência e fatores associados à infecção pelo M. tuberculosis entre agentes comunitários de saúde

Introdução: A tuberculose é uma doença milenar e que, ainda hoje, constitui grave problema de saúde pública em todo o mundo. Objetivo: Estimar a prevalência e os fatores associados à infecção latente pelo MTB entre Agentes Comunitários de Saúde atuantes na rede básica de saúde de Municípios prioritários para o controle de TB – Cuiabá/MT, Manaus/AM, Salvador/BA e Vitória/ES. Métodos: Estudo de corte transversal no qual os dados foram coletados através de questionário, composto de questões abertas e fechadas sobre características pessoais; informações a respeito da tuberculose; utilização de medidas preventivas, etc. Aplicou-se prova tuberculínica, com leitura após 48-72h por enfermeiros treinados, considerando como ponte de corte positivo 5 e 10 mm de enduração. A análise múltipla foi feita por meio de regressão logística hierarquica. Foram incluídas no modelo as variáveis que mostraram associação com desfecho com p<0,1. Permaneceram no modelo as variáveis independentes que mantiveram associação com desfecho após ajuste (p<0,05). Este estudo obteve aprovação do Comitê de Ética em Pesquisa com seres humanos do Centro de Ciências da Saúde da Universidade Federal do Espírito Santo, n° de registro CEP-07/2010 e das Secretarias Municipais de Saúde, por meio de uma Carta de Apresentação. Resultados: 322 Agentes Comunitários de Saúde (ACS) aceitaram participar voluntariamente do estudo por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Destes, 10 não compareceram para leitura, sendo estes considerados como perdas, além do que um indivíduo foi excluído pelo fato do teste rápido para HIV ter resultado positivo, perfazendo uma amostra final de 311 participantes. Ainda em relação aos ACS triados, a positividade a Prova Tuberculínica, levando-se em consideração o ponto de corte ao teste de 10 mm e de 5 mm de enduração, foi de 37,30% (IC95%: 0,31-0,42) e de 57,88% (IC95%: 0,52-0,63), respectivamente.Conclusões: Faz-se necessário um programa de realização de Prova Tuberculínica, de rotina, combinado com intervenções para reduzir o risco de transmissão nosocomial, bem como a realização de outros estudos para avaliar a eficácia de novos testes para detecção de tuberculose latente.