The Role of Occupational Therapy in the Transition Process for Young Adults with Developmental Disabilities

This critically appraised topic (CAT) focuses on occupational therapy’s role and best practice in assisting families with young adults that have developmental disabilities in making the transition out of the home into the community, secondary education, or supported independent living. The transition experience is unique to each individual, as there are both supports and barriers to the process

Resectable rectal cancer: which patient does not need preoperative radiotherapy?

It is well known that some patients with resectable rectal cancer benefit from preoperative radiotherapy in combination with or without chemotherapy. In order to reduce local recurrence and improve long-term survival, current guidelines advocate such neoadjuvant treatment in UICC (Union for International Cancer Control) stage II and III patients. However, the vast majority of patients may be adequately treated by rectal resection with total mesorectal excision (TME) alone. Recent evidence suggests an overtreatment of patients leading to unnecessary exposure to acute and long-term toxicity of radiation therapy. The question which consequently arises is which patient does not need preoperative radiotherapy. Improvements in MRI combined with better understanding of prognostic indicators suggest that patients with UICC stage I tumors, with tumors more than 12 cm proximal the anal verge can and patients with a circumferential resection margin 6 > 2 mm as assessed by preoperative MRI might be managed by radical surgery with adequate TME alone. Copyright © 2012 S. Karger AG, Base

Relative survival is an adequate estimate of cancer-specific survival: baseline mortality-adjusted 10-year survival of 771 rectal cancer patients.

BACKGROUND The objective of the present investigation is to assess the baseline mortality-adjusted 10-year survival of rectal cancer patients. METHODS Ten-year survival was analyzed in 771 consecutive American Joint Committee on Cancer (AJCC) stage I-IV rectal cancer patients undergoing open resection between 1991 and 2008 using risk-adjusted Cox proportional hazard regression models adjusting for population-based baseline mortality. RESULTS The median follow-up of patients alive was 8.8 years. The 10-year relative, overall, and cancer-specific survival were 66.5% [95% confidence interval (CI) 61.3-72.1], 48.7% (95% CI 44.9-52.8), and 66.4% (95% CI 62.5-70.5), respectively. In the entire patient sample (stage I-IV) 47.3% and in patients with stage I-III 33.6 % of all deaths were related to rectal cancer during the 10-year period. For patients with AJCC stage I rectal cancer, the 10-year overall survival was 96% and did not significantly differ from an average population after matching for gender, age, and calendar year (p = 0.151). For the more advanced tumor stages, however, survival was significantly impaired (p < 0.001). CONCLUSIONS Retrospective investigations of survival after rectal cancer resection should adjust for baseline mortality because a large fraction of deaths is not cancer related. Stage I rectal cancer patients, compared to patients with more advanced disease stages, have a relative survival close to 100% and can thus be considered cured. Using this relative-survival approach, the real public health burden caused by rectal cancer can reliably be analyzed and reported

Hurricanes affect diversification among individual life courses of a primate population

1. Extreme climatic events may influence individual- level variability in phenotypes, survival and reproduction, and thereby drive the pace of evolution. Climate mod -els predict increases in the frequency of intense hurricanes, but no study has measured their impact on individual life courses within animal populations. 2. We used 45 years of demographic data of rhesus macaques to quantify the influ- ence of major hurricanes on reproductive life courses using multiple metrics of dynamic heterogeneity accounting for life course variability and life-history trait variances. 3. To reduce intraspecific competition, individuals may explore new reproductive stages during years of major hurricanes, resulting in higher temporal variation in reproductive trajectories. Alternatively, individuals may opt for a single optimal life-history strategy due to trade- offs between survival and reproduction. 4. Our results show that heterogeneity in reproductive life courses increased by 4% during years of major hurricanes, despite a 2% reduction in the asymptotic growth rate due to an average decrease in mean fertility and survival by that is, shortened life courses and reduced reproductive output. In agreement with this, the population is expected to achieve stable population dynamics faster after being perturbed by a hurricane (p = 1.512 ; 95% CI: 1.488, 1.538), relative to ordi- nary years (p = 1.482; 1.475, 1.490). 5. Our work suggests that natural disasters force individuals into new demographic roles to potentially reduce competition during unfavourable environments where mean reproduction and survival are compromised. Variance in lifetime reproduc- tive success and longevity are differently affected by hurricanes, and such vari- ability is mostly driven by survival

Integrated CO2 refrigeration and heat pump systems for dairies

Production facilities in the food industry are large consumers of electricity and thermal energy due to energyintensive processes such as steam production, cleaning, sanitising, refrigeration and drying. Furthermore, there is often a considerable thermal demand for heating the building and for air‐conditioning purposes. Dairy plants require both heating and cooling at various temperature levels to process the different dairy products. The thermal demands in these plants have traditionally been covered by separate systems, such as fossil fuel burners or electric boilers for the heating processes and various refrigeration systems for the cooling processes. In recent years, there has been an increased focus on integrated energy systems for dairies as a measure to reduce the overall energy consumption of the plant. This strategy involves integrating all functions to serve the thermal demands into one centralised energy system. This paper describes the energy system for a dairy plant in central Norway. A CO2 refrigeration system serves the various cooling loads in the production process. The energy system in the dairy is mapped and the thermal loads have been identified. Based on the current configuration of the cold side of the CO2 refrigeration units, proposals for improvements are made. Using thermodynamic calculations, the modifications are evaluated in terms of COP improvement and the annual reduction in energy consumption. The calculations show that the energy consumption can be reduced by 12 % to 21.2 % depending on the alteration of the system.Integrated CO2 refrigeration and heat pump systems for dairiesacceptedVersio

Aspects Clinique Et Paraclinique Des Paralysies Bilatérales Des Cordes Vocales

L’immobilité bilatérale des cordes vocales peut mettre en jeu le pronostic vital du patient. L’objectif de l’étude a été d’analyser les éléments diagnostiques à évaluer avant la prise en charge. Il s’est agi d’une étude transversale et descriptive portant sur les cas d’immobilité bilatérale des cordes vocales reçus entre 1 er Janvier 2008 et le 1 er Mars 2018. Les données socio-démographiques, cliniques, paracliniques et les étiologies ont été recueillies. En dix ans 56 patients ont été reçus et examinés. L’âge moyen a été de 56 ans avec une sex-ratio de 1,07. Les principaux signes répertoriés étaient la dyspnée (44 cas ; 78,6%), la dysphonie (8 cas ; 14,3%) et les fausses routes (2 cas ; 3,6%). Les cordes vocales étaient immobiles en adduction paramédiane (29 cas ; 51,79%), en adduction médiane (25 cas ; 44,64%) ou en abduction (2 cas ; 3,6%). Les deux principales causes retrouvées ont été l’intubation prolongée et la thyroïdectomie totale. La paralysie des cordes vocales est peu fréquente. La nasofibroscopie est la clé du diagnostic. L’intubation prolongée et la chirurgie thyroïdienne en sont les causes les plus fréquentes. Bilateral immobility of the vocal cords can be life-threatening. The aim of the study was to analyze the diagnostic elements to be assessed before treatment. This was a cross-sectional and descriptive study on the cases of bilateral immobility of the vocal cords received between January 1, 2008 and March 1, 2018. Socio-demographic, clinical, paraclinical and etiology data were collected. In ten years 56 patients have been received and examined. The average age was 56 with a sex ratio of 1.07. The main signs listed were dyspnea (44 cases; 78.6%), dysphonia (8 cases; 14.3%) and false routes (2 cases; 3.6%). The vocal cords were immobile in paramedian adduction (29 cases; 51.79%), in median adduction (25 cases; 44.64%) or in abduction (2 cases; 3.6%). The two main causes found were prolonged intubation and total thyroidectomy. Vocal cord paralysis is uncommon. Nasofibroscopy is the key to diagnosis. Prolonged intubation and thyroid surgery are the most common causes

Radiolitid rudists: An underestimated archive for cretaceous climate reconstruction?

Rudist shells are important archives for palaeoenvironmental reconstructions in the greenhouse world of the Cretaceous. Radiolitids, a family of rudists became very abundant dwellers of the shallow marine carbonate platforms during the Cretaceous. Still, due to the complex structure of their low-Mg calcite outer shell layer, radiolitids are often deemed unsuitable for palaeoenvironmental reconstructions. The aim of this study is to present a combination of petrographic (transmitted light microscopy and cathodoluminescence microscopy) and elemental analyses (high-resolution μXRF and stable isotope) to investigate radiolitid shells for diagenetic alteration and to make them accessible as an archive for environmental conditions during the mid-Cretaceous. Four Eoradiolitites shells were analysed in detail: two right valves (RV), a left valve (LV) with an articulated RV and an isolated LV. Three shell structure types have been identified, including a non-compact, compact and celluloprismatic types. The compact structure type was identified in the LVs while the other two types were observed exclusively in the RVs. Radiolitid shell material composed of the non-compact and the compact structure types can be used as palaeoenvironmental archives as it preserved seasonal signals in both, shell growth structure and isotopic records, while celluloprismatic shell structures are less suitable for reconstructions due to diagenetic alteration. The alternation of dark and light lamellae in both valves, RV and LV, provide information on the intertidal living habitat of the shell-producing organism and its life span. Cretaceous; radiolitid rudists; petrographic and rlemental analyses; right and left valves; palaeoenvironmental reconstructio

Addition of platinum derivatives to neoadjuvant single-agent fluoropyrimidine chemoradiotherapy in patients with stage II/III rectal cancer: protocol for a systematic review and meta-analysis (PROSPERO CRD42017073064)

Background Neoadjuvant (chemo-)radiation has proven to improve local control compared to surgery alone, but this improvement did not translate into better overall or disease-specific survival. The addition of oxaliplatin to fluoropyrimidine-based neoadjuvant chemoradiotherapy holds the potential of positively affecting survival in this context since it has been proven effective in the palliative and adjuvant setting of colorectal cancer. Thus, the objective of this systematic review is to assess the efficacy, safety, and quality of life resulting from adding a platinum derivative to neoadjuvant single-agent fluoropyrimidine-based chemoradiotherapy in patients with Union for International Cancer Control stage II and III rectal cancer. Methods: MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials will be systematically searched to identify all randomized controlled trials comparing single-agent fluoropyrimidine-based chemoradiotherapy to combined neoadjuvant therapy including a platinum derivative. Predefined data on trial design, quality, patient characteristics, and endpoints will be extracted. Quality of included trials will be assessed according to the Cochrane Risk of Bias Tool, and the GRADE recommendations will be applied to judge the quality of the resulting evidence. The main outcome parameter will be survival, but also treatment toxicity, perioperative morbidity, and quality of life will be assessed. Discussion: The findings of this systematic review and meta-analysis will provide novel insights into the efficacy and safety of combined neoadjuvant chemoradiotherapy including a platinum derivative and may form a basis for future clinical decision-making, guideline evaluation, and research prioritization. Systematic review registration PROSPERO CRD4201707306