Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes

Effetti della somministrazione di buprenorfina transdermica in pazienti oncologici : Risultati di uno studio di outcome

Nonostante il dolore affligga la maggior parte dei pazienti oncologici, soprattutto nelle fasi metastatiche della malattia, spesso il trattamento non \ue8 proporzionato all\u2019intensit\ue0 del dolore. Le preparazioni transdermiche hanno alcuni vantaggi rispetto a quelle orali e parenterali, ma le evidenze fornite da studi comparativi sono ancora scarse. Nel contesto di una iniziativa pi\uf9 ampia, nel 2006 \ue8 stato avviato in Italia uno studio di Outcome Research per studiare gli effetti di diverse terapie analgesiche, in particolare Buprenorfina TDS. Nonostante i limiti legati alla natura osservazionale dello studio, i risultati ottenuti forniscono informazioni ai medici per comprendere meglio gli effetti della somministrazione di Buprenorfina transdermica in una casistica ampia e ben caratterizzata e possono essere utili per disegnare ulteriori studi comparativ

A survey of kinetic data of compounds containing flourine

Chlorofluoromethanes may have a significant effect on the level of ozone in the atmosphere. However, the role of fluroine-containing compounds has not been examined fully. A tabulation of a search of the chemical kinetic literature published between 1953 and July 1975, is presented. The data are then evaluated with respect to acceptability and importance to the overall reaction balance in the atmosphere. Possible future research to elucidate important reaction processes is discussed

Gaussian-3 studies of the structures, bonding, and energetics of selected chemical systems.

Law Chi-Kin.Thesis (M.Phil.)--Chinese University of Hong Kong, 2002.Includes bibliographical references.Abstracts in English and Chinese.Abstract --- p.iAcknowledgements --- p.iiiTable of Contents --- p.ivList of Tables --- p.viList of Figures --- p.viiiChapter Chapter 1 --- Introduction --- p.1Chapter 1.1 --- The Gaussian´ؤ3 Method --- p.1Chapter 1.2 --- The G3 Method with Reduced Mφller-Plesset Order and Basis Set --- p.2Chapter 1.3 --- The Gaussian-3X Method --- p.2Chapter 1.4 --- Calculation of Thermodynamical Data --- p.3Chapter 1.5 --- Remark on the Location of Equilibrium and Transition Structures --- p.3Chapter 1.6 --- Natural Bond Orbital (NBO) Analysis --- p.4Chapter 1.7 --- Scope of the Thesis --- p.4Chapter 1.8 --- References --- p.5Chapter Chapter 2 --- Gaussian´ؤ3 Heats of Formation for (CH)6 Isomers --- p.6Chapter 2.1 --- Introduction --- p.6Chapter 2.2 --- Methods of Calculation and Results --- p.7Chapter 2.3 --- Discussion --- p.9Chapter 2.4 --- Conclusion --- p.11Chapter 2.5 --- Publication Note --- p.12Chapter 2.6 --- References --- p.12Chapter Chapter 3 --- A Gaussian-3 Investigation of N7 Isomers --- p.14Chapter 3.1 --- Introduction --- p.14Chapter 3.2 --- Computational Method and Results --- p.16Chapter 3.3 --- Discussion --- p.16Chapter 3.4 --- Conclusion --- p.24Chapter 3.5 --- Publication Note --- p.24Chapter 3.6 --- References --- p.24Chapter Chapter 4 --- A Gaussian-3 Study of N7+ and N7- Isomers --- p.27Chapter 4.1 --- Introduction --- p.27Chapter 4.2 --- Computational Method and Results --- p.29Chapter 4.3 --- Discussion --- p.30Chapter 4.3.1 --- The N7+ isomers --- p.30Chapter 4.3.2 --- The N7- isomers --- p.37Chapter 4.4 --- Conclusion --- p.41Chapter 4.5 --- Publication Note --- p.41Chapter 4.6 --- References --- p.41Chapter Chapter 5 --- "Thermochemistry of Chlorine Fluorides ClFn, n = 1-7, and Their Singly Charged Cations and Anions: A Gaussian-3 and Gaussian-3X Study" --- p.45Chapter 5.1 --- Introduction --- p.45Chapter 5.2 --- Methods of Calculations --- p.47Chapter 5.3 --- Results and Discussion --- p.48Chapter 5.3.1 --- Comparison of the G3 and G3X methods --- p.48Chapter 5.3.2 --- Assessments of the experimental results --- p.54Chapter 5.3.3 --- "Bond dissociation energies of ClFn, ClFn+, and ClFn-" --- p.57Chapter 5.3.4 --- Summary of the thermochemical data --- p.58Chapter 5.4 --- Conclusion --- p.59Chapter 5.5 --- Publication Note --- p.60Chapter 5.6 --- References --- p.60Chapter Chapter 6 --- A Gaussian-3 Study of the Photoionization and Dissociative Photoionization Channels of Dimethyl Sulfide --- p.63Chapter 6.1 --- Introduction --- p.63Chapter 6.2 --- Methods of Calculations --- p.64Chapter 6.3 --- Results and Discussion --- p.64Chapter 6.3.1 --- Bond cleavage reactions --- p.67Chapter 6.3.2 --- Dissociation channels involving transition structures --- p.68Chapter 6.4 --- Conclusion --- p.70Chapter 6.5 --- Publication Note --- p.70Chapter 6.6 --- References --- p.70Chapter Chapter 7 --- "Theoretical Study of the Electronic Structures of Carbon and Silicon Nanotubes, Carbon and Silicon Nanowires" --- p.72Chapter 7.1 --- Introduction --- p.72Chapter 7.2 --- Models and Computational Methods --- p.74Chapter 7.3 --- Results and Discussion --- p.75Chapter 7.4 --- Conclusion --- p.87Chapter 7.5 --- Publication Note --- p.87Chapter 7.6 --- References --- p.87Chapter Chapter 8 --- Conclusion --- p.90Appendix A --- p.91Appendix

LA RILEVANZA PENALE DELL\u2019ABUSO DEL DIRITTO

La Tesi si pone l\u2019obiettivo di indagare la rilevanza dell'abuso del diritto nel diritto penale. L'abuso del diritto \ue8 la categoria del diritto civile che esprime la violazione dei limiti interni previsti all'esercizio dei diritti soggettivi. Secondo la dottrina dell\u2019abuso del diritto, i titolari dei diritti non possono esercitare i poteri e le facolt\ue0, che ne formano il contenuto, per scopi diversi dalla tutela degli interessi per cui i diritti sono stati riconosciuti. Negli ultimi anni, la categoria dell\u2019abuso del diritto ha avuto un forte sviluppo ed \ue8 stata oggetto di numerose applicazioni giurisprudenziali in diversi campi del diritto extra-penale (ad esempio, nel tradizionale ambito degli atti emulativi, nelle relazioni contrattuali o nei rapporti famigliari). Anche se la logica dell'abuso di diritto presenta un'atipicit\ue0 apparentemente lontana dal rispetto dei principi del diritto penale italiano, l\u2019elemento dell\u2019abuso di poteri giuridici privati caratterizza esplicitamente o implicitamente diversi istituti della parte generale e pi\uf9 fattispecie di reato. Tanto suscita l\u2019esigenza di un confronto tra il funzionamento atipico dell\u2019abuso del diritto e i principi generali del diritto penale, con riferimento in primis a quello di tipicit\ue0 e a quello di nullum crimen, nulla poena sine lege previa, scripta, stricta. Posto che l'abuso \ue8 un concetto "atipico", caratterizzato dalla violazione di norme di principio, piuttosto che di regole, occorre domandarsi cosa succeda quando questa contrariet\ue0 al diritto qualifichi un elemento della norma penale (per esempio, un abuso di potere, un abuso di informazioni, una condotta tenuta "abusivamente"). Cos\uec, la ricerca opera una ricognizione, nei diversi campi del diritto penale, dei problemi che possono essere messi in relazione con l\u2019abuso del diritto, tra i quali, possiamo ricordare inter alios, il superamento dei limiti di operativit\ue0 delle cause di giustificazione (art. 51, 55 c.p.), alcune fattispecie di parte speciale, come l'arbitrario esercizio delle proprie ragioni (artt. 392 e 393 c.p.), considerato da certa dottrina una forma di "abuso" diritto, o l'estorsione in caso di minaccia di far uso di un diritto (art. 629 c.p.); la relazione tra abuso di diritto e violazione di un obbligo di fedelt\ue0; la resistenza della funzione critica del bene giuridico, la cui offesa \ue8 una condizione necessaria \u2013 ma non sufficiente \u2013per giustificare la criminalizzazione di un fatto in accordo con il principio di "ultima ratio" nel diritto penale; la funzione tipizzante dello scopo dell\u2019agente. Con riferimento ai settori analizzati, la Tesi prende in considerazione la problematica dell\u2019abuso del diritto nel diritto penale tributario, con attenzione al dibattito che, prima degli interventi legislativi del 2015, ha interessato la materia a seguito della giurisprudenza della Corte di Cassazione, ritenendo punibile un comportamento elusivo di delocalizzazione (Cassazione penale n. 7739/2012), e riconducendolo al reato di dichiarazione infedele previsto dall\u2019art. 4 del decreto legislativo n. 74/2000, nella veste precedente alla riforma dei reati tributari. Ulteriore campo di indagine, nel diritto penale complementare, \ue8 quello degli abusi di mercato e del c.d. negazionismo

Gemcitabine and oxaliplatin: a safe and active regimen in poor prognosis advanced non-small cell lung cancer patients.

Most patients with non-small cell lung cancer (NSCLC) cannot tolerate a cisplatin-based chemotherapy because of old age, general conditions, and/or multiorgan metastatic sites. Oxaliplatin is active in NSCLC, offers advantage in terms of toxicity, and shows synergism with gemcitabine. The aims of this phase II study were to evaluate the response rate and toxicity of the gemcitabine-oxaliplatin combination in patients with advanced NSCLC and poor prognosis.Patients were given a gemcitabine infusion (1000 mg/m(2) over 30 min on days 1 and 8) followed by oxaliplatin (65 mg/m(2) over 120 min on days 1 and 8) every 21 days for six cycles.Thirty-two patients with poor-prognosis advanced NSCLC received 136 cycles. There were 25 males and seven females, and the median age was 65 years (range 29-76). Fifty-six percent of patients had adenocarcinoma, and 31\% had squamous cell carcinoma. Sixty-six percent of patients had stage IV disease, and 34\% had stage IIIB disease. Eastern cooperative oncology group (ECOG) performance status was 2-3 in 50\%, 1 in 44\%, and 0 in 6\% of patients. Eight patients (25\%) had been previously treated with cisplatin or carboplatin. All patients were symptomatic. Of the 32 patients who received study drug, five (16\%) achieved partial response, six (19\%) had minor response, three (9\%) had stable disease, and 15 (47\%) progressed. The median overall survival was 27 weeks. Thirty-one patients were evaluable for toxicity: seven patients (23\%) had grade 3-4 thrombocytopenia with no bleeding; four patients (13\%) had grade 3-4 neutropenia with no febrile neutropenia, and three patients (10\%) had grade 3 anemia. Two patients (6\%) had grade 3, and six patients (19\%) had grade 1-2 neurotoxicity.The combination of gemcitabine and oxaliplatin seems to be well tolerated and active in patients with poor prognosis advanced NSCLC and deserves further evaluation in phase II clinical trials