Trends and outcome of neoadjuvant treatment for rectal cancer: A retrospective analysis and critical assessment of a 10-year prospective national registry on behalf of the Spanish Rectal Cancer Project

Introduction: Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons. Method: This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006–2009; II)2010–2013; III)2014–2017. Survival analyses were run for 3-year survival in timeframes I-II. Results: Out of 14, 391 patients, 8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%, p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59–0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers. Conclusion: There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most

Análise da atividade e gasto fisiológico dos catadores de resíduos sólidos: a percepção da terapia ocupacional

The world’s transformation in the market has been causing changes in the working class. As those changes have come, the market calls for a high capacity from the workers. Due to that, the unemployment rate has increased and induced a new type of class worker: the Recyclable Material Collectors. In this job, the role of the collector is to return the materials to their commodity chain, and to accomplish this, two methods of collecting are used: one with a truck and the other with a manual collector car. This is one type of occupation which has an extenuating work time, where the worker is exposed to a high ergonomic risk. This study, which was labored from a quantitative and qualitative approach to exploratory method and field research, is intended to compare which collecting technique can be less weariness to the worker. To the purpose of comparison of the physiological work weight, the participants used the Polar FT7 frequency counter, which generated, in graphic form, the performance of the collector in both methods. According to the values presented, was concluded that three of the four participants had a higher physiological weariness by using the manual car collecting approach, concluding that this method is the one that brings most effort to the worker. Considering the results obtained in this research, it was possible to observe that the use of the manual car causes a higher damage to the health of the recyclable material collector.A transformação no mundo do trabalho tem causado mudanças no perfil da classe trabalhadora. Cada vez mais, o mercado de trabalho requer exigências e, como decorrência disso, a taxa de desemprego aumentou e fez surgir uma nova profissão, a de Catadores de Materiais Recicláveis. A função do catador é a de devolver os materiais à sua cadeia produtiva e, para isso, existem dois métodos de coleta: com o caminhão e com o carro manual de coleta. Essa é uma profissão que possui jornadas de trabalho extenuantes, nas quais o trabalhador está exposto a riscos ergonômicos. Esse estudo foi elaborado a partir de uma abordagem quantitativa e qualitativa de método explorátorio e pesquisa de campo; pretende comparar qual método de coleta causa menos desgaste ao trabalhador. Para fins de comparação da carga fisiológica do trabalho, os participantes utilizaram o frequencímetro Polar FT7 que gerou, em forma de gráfico, o desempenho do catador em ambos os métodos de coleta. De acordo com os valores expostos, avaliou-se que, dos 4 participantes, 3 apresentaram um maior desgaste fisiológico no método de coleta com o carro manual, sendo esta a forma pela qual o trabalhador realiza mais esforços. Considerando os resultados obtidos nessa pesquisa, foi possível observar que o uso do carro manual de coleta causa um maior prejuízo à saúde do catador de materiais recicláveis

Modelling the potential impacts of climate change on the hydrology of the Aipe river basin in Huila, Colombia

[EN] The dynamics of a global world, and humans performing as a new geological force, require that an effort is undertaken to make robust decisions in order to devise strategies for the management and adaptation to climate change. This study aims to investigate the potential impact of climate change on the hydrology of the Aipe river basin in Huila, Colombia. The abcd Thomas model (four parameters) was calibrated and validated for the stream flows of the Aipe catchment (1992¿2012). The sensitivity and identifiability of the parameters were evaluated using the Monte Carlo Analysis Toolbox (MCAT). The results show the ability of the model to simulate the monthly stream flow (Nash¿Sutcliffe efficiency coefficient of 0,89). The most influential parameters are: a (water storage in the soil) and c (contribution to the aquifer). From the simulated scenarios, the baseline (1992¿2012) was estimated to be an average flow of 15,44 m3s¿1; the trend extrapolation scenario estimated a rate 13,79 m3s¿1 (¿10,64%); while for the multi-model assembly scenario it was 9,34 m3s¿1 (¿39,47%) and for the A2 scenario it was 5,74 m3s¿1 (¿62,60%). Lastly, we propose a set of strategies for adaptation to climate change that are committed to the integral management of water resources.[ES] La dinámica de un mundo global y el hombre como nueva fuerza geológica plantean la necesidad de tomar decisiones robustas, diseñar estrategias de manejo y de adaptarse al cambio climático. Este estudio investiga la respuesta hidrológica de la cuenca hidrográfica del río Aipe (688.9 km2 ), en Huila, Colombia, en acorde con los escenarios de cambio climático desde 2011 a 2040. El modelo hidrológico abcd de Thomas (4 parámetros) fue calibrado y validado comparando el caudal simulado y lo observado en el punto de cierre de la cuenca (en la estación Puente Carretera), usando series históricas mensuales (1992¿2012). Realizamos la evaluación de la sensibilidad e identificabilidad de los parámetros con la herramienta `Monte Carlo Analysis Toolbox¿ (MCAT). Los resultados muestran que el modelo es capaz de representar adecuadamente los caudales mensuales observados en el punto de desagüe de la cuenca, al encontrarse un índice de eficiencia de Nash¿Sutcliffe (NSE) de 0,89. Los parámetros más influyentes son a (almacenamiento del agua en el suelo) y c (aporte al acuífero). Con respecto a la simulación de los escenarios, la línea base (1992¿2012) estimó un caudal medio de 15,44 m3 s ¿1 ; el escenario de extrapolación de tendencias estimó un caudal de 13,79 m3 s ¿1 (¿10,64%); el escenario de ensamble multi-modelo de 9,34 m3 s ¿1 (¿39,47%) y el escenario A2 de 5,74 m3 s ¿1 (¿62,60%). Proponemos una batería de medidas de adaptación al cambio climático que buscan la gestión integral del recurso hídrico.Romero-Cuellar, J.; Buitrago-Vargas, A.; Quintero-Ruiz, T.; Francés, F. (2018). Simulación hidrológica de los impactos potenciales del cambio climático en la cuenca hidrográfica del río Aipe, en Huila, Colombia. RIBAGUA - Revista Iberoamericana del Agua. 5(1):63-78. https://doi.org/10.1080/23863781.2018.1454574S63785

Dinamización de la clase magistral en medicina: diez ejemplos de minicasos utilizados en la docencia de la farmacología Improving lectures in Medicine: ten examples of mini-cases to be used in the teaching of pharmacology

Las clases magistrales constituyen un método pedagógico muy utilizado en las facultades de medicina. Sin embargo, tiene diversas limitaciones entre las que se encuentran la pasividad y la pérdida de la atención de los alumnos. A fin de estimular la atención y revigorizar su empleo, se han empleado textos cortos que plantean preguntas que pueden resolverse con la información proporcionada en la clase magistral (minicasos). El presente artículo describe una experiencia de su uso en la docencia de la farmacología y ofrece diez ejemplos para ilustrar sobre su empleo. La mayoría de ellos están ambientados en el mundo real, permiten contextualizar los conocimientos básicos de farmacología y estimulan la comprensión de los conceptos claves.Lectures are the preferred method of teaching in many schools of Medicine. However, this method has several limitations, such as the passive role assumed by students and the loss of their attention. In order to improve the use of lectures, some authors have suggested the use of minicases. These are short texts that include several questions, which are related with the contents of the lecture and students are asked to answer them at its end. The present paper describes an experience of using minicases in the teaching of pharmacology. It offers ten examples to illustrate how they are built. Most of them are related with the real world, they permit to put knowledge of basic sciences in context of clinical problems and stimulate the understanding of key concepts of the discipline

La transversalidad en la enseñanza de la medicina: el ejemplo de la Oncología Cross-sectional approach in medical education: the example of Oncology

Introducción. El desarrollo de la medicina durante el siglo XIX conllevó la aparición de las especialidades médicas y quirúrgicas, configurando un nuevo escenario asistencial con la fragmentación de los tradicionales servicios de medicina y cirugía. Estos cambios también acontecieron en el campo de la docencia de la medicina, originando algunos conflictos en la definición de competencias que aún persisten. La patología médica debería actuar como punto de encuentro y eje vertebrador del resto de las especialidades médicas, pero hasta hace relativamente poco tiempo ha existido un excesivo esfuerzo en delimitar el campo de cada disciplina, aspecto que no ha facilitado una comunicación fluida entre los diferentes especialistas. La atención a los pacientes con cáncer necesita de la implicación y colaboración de los diferentes profesionales que participan en el diagnóstico y tratamiento y, por ello, precisa de un diálogo fluido entre todos ellos. La oportunidad de poder desarrollar en el pregrado una formación multidisciplinar que englobe aspectos referentes a la integración de los diferentes especialistas en beneficio del paciente facilitará una mejora en la optimización de los recursos sanitarios. La enseñanza de la Oncología en el pregrado ha estado compartida con otras especialidades, pero hasta el momento actual no ha tenido la adecuada consideración. La Oncología constituye un claro ejemplo de que el trabajo en equipo permite mejorar la eficiencia y conducción de los procesos asistenciales. Es de esperar que en las futuras promociones de estudiantes existan menos resistencias para establecer puntos de encuentro y de sinergia y que ello redunde en la adquisición de una visión más amplia y posibilista, y que pueda aplicarse en beneficio de los futuros enfermos.<br>The development of Medicine throughout the 19th century led to the appearance of medical and surgical specialties, which thus gave rise to a new health care scenario in which the traditional services of medicine and surgery became fragmented. These changes also came about within the field of the teaching of medicine and gave rise to a number of conflicts over the definition of competencies that still exist today. Medical pathology should act as a point of contact and backbone for the other medical specialities, but up until a relatively short time ago too much effort was being made to define the limits of each discipline, something that has not encouraged very fluent communication among the different specialists. Health care for cancer patients requires the commitment and collaboration of the different professionals who are involved in the diagnosis and treatment of the disease, and this in turn calls for fluent dialogue among all of them. The chance to be able to carry out multidisciplinary training for under-graduates that covers aspects related with the integration of the different specialists in order to benefit patients will make it easier to optimise health care resources. The teaching of Oncology at undergraduate level has been shared with other specialties, but up until now it has been paid too little attention. Oncology is a clear example of how teamwork makes it possible to improve the efficiency of health care processes and the way they are implemented. It is to be expected that in the future students will meet less resistance to establishing points of contact and synergy, and that this will result in their acquiring a broader and more positive vision, which they will be able to apply to help their patients