Nonopioid drugs in the treatment of cancer pain

The WHO analgesic ladder for the treatment of cancer pain provides a three-step sequential approach for analgesic administration based on pain severity that has global applicability. Nonopioids were recommended for mild pain, with the addition of mild opioids for moderate pain and strong opioids for severe pain. Here, we review the evidence for the use of nonopioid analgesic agents in patients with cancer and describe the mode of action of the main drug classes. Evidence supports the use of anti-inflammatory drugs such as acetaminophen/paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) for mild cancer pain. Adding an NSAID to an opioid for stronger cancer pain is efficacious, but the risk of long-term adverse effects has not been quantified. There is limited evidence to support using acetaminophen with stronger opioids. Corticosteroids have a specific role in spinal cord compression and brain metastases, where improved analgesia is a secondary benefit. There is limited evidence for adding corticosteroids to stronger opioids when pain control is the primary objective. Systematic reviews suggest a role for antidepressant and anticonvulsant medications for neuropathic pain, but there are methodologic issues with the available studies. Bisphosphonates improve pain in patients with bony metastases in some tumor types. Denosumab may delay worsening of pain compared with bisphosphonates. Larger studies of longer duration are required to address outstanding questions concerning the use of nonopioid analgesia for stronger cancer pain. © 2014 by American Society of Clinical Oncology

Obligation de l'État d'aider financièrement les personnes atteintes du VIH par suite d'une transfusion de sang ou de dérivé sanguin

L'État fédéral a récemment approuvé la mise sur pied d'un Régime d'aide extraordinaire destiné aux hémophiles et aux personnes infectées par le V.l.H. à cause d'une transfusion de sang ou de dérivé sanguin (concentré de facteurs de coagulation) infecté. Les auteurs saluent cette initiative et se penchent sur les arguments d'ordre juridique et moral qui obligent les pouvoirs publics provinciaux, en particulier le Québec, à prévoir eux aussi des régimes d'indemnisation ou d'aide financière destinés à ces personnes. Le présent article fait d'abord l'historique du sida puis examine le processus de transmission du V.l.H. lors d'une transfusion de sang ou de dérivé sanguin. Les auteurs se penchent ensuite sur la possibilité pour les hémophiles et les receveurs de transfusion sanguine infectés par le V.l.H. de toucher une indemnité s'ils intentent les recours légaux habituels contre les hôpitaux, les fabricants et les distributeurs en cause, de même que contre l'État fédéral ou provincial. Il est également fait mention des principes de droit international et des chartes canadienne et québécoise, de même que des régimes d'indemnisation mis sur pied au Canada, aux paliers fédéral et provincial, et à l'étranger. Puisque les pouvoirs publics, tant au palier fédéral que provincial, et leurs fonctionnaires ont tardé à prendre les mesures qui s'imposaient pour prévenir la transmission du V.l.H. par voie sanguine, ils ont une obligation morale, voire juridique, envers les personnes qui ont contracté la maladie de cette façon. En effet, leur inaction équivaut à une violation des droits humains les plus fondamentaux, soit le droit à la vie et à la santé et le droit à la protection de ces derniers. L'État fédéral a maintenant reconnu les besoins des hémophiles et des receveurs de transfusion sanguine infectés par le V.l.H. et leur fournit une aide financière. À cause des obligations d'ordre constitutionnel et législatif qui leur incombent, les pouvoirs publics provinciaux sont également tenus de reconnaître leur responsabilité envers ces personnes et de suivre l'exemple du fédéral quant à la création d'un régime d'indemnisation ou d'aide financière à leur intention.The Federal Government recently approved an Extraordinary Assistance Plan for hemophiliacs and blood-transfusion recipients who became H.I.V.-infected through contaminated blood and blood products (clotting factor concentrates). The authors welcome the response of the Federal Government to the needs of such individuals and examine the legal and moral arguments which compel the Provincial Governments, in particular that of Quebec, to provide similar compensation or financial aid to such individuals. The early history of aids and the process of H.I.V.-transmission through blood and blood products is first considered. The authors then assess the potential for H.I.V.-infected hemophiliacs and blood-transfusion recipients to obtain redress through normal legal channels against responsible hospitals, manufacturers and distributors, as well as either level of government. Reference is also made to international legal principles and the Canadian and Quebec Charters. Compensation schemes in other countries for such individuals are described and other types of Provincial and Federal compensation schemes which exist in Canada are considered. Since the Provincial Governments, as well as the Federal Government, and their bureaucracies responded too slowly at the outset to warnings of H.I.V.-transmission through blood, they have a moral, if not a legal duty to those unsuspecting individuals who contracted the disease from contaminated blood. Through their inaction, they breached the most elementary responsibility in the field of human rights; the right to life and to health and to the protection thereof. The Federal Government has since acknowledged the needs of H.I.V.-infected hemophiliacs and blood-transfusion recipients and has provided them with financial assistance. Due to their specific constitutional and legislative duties, the Provinces too must now recognize their responsibility towards these same individuals and follow the lead of the Federal Government in setting up an appropriate compensation or financial assistance scheme for their benefit

LiDAR mapping of tidal marshes for ecogeomorphological modelling in the TIDE project

The European research project TIDE (Tidal Inlets Dynamics and Environment) is developing and validating coupled models describing the morphological, biological and ecological evolution of tidal environments. The interactions between the physical and biological processes occurring in these regions requires that the system be studied as a whole rather than as separate parts. Extensive use of remote sensing including LiDAR is being made to provide validation data for the modelling. This paper describes the different uses of LiDAR within the project and their relevance to the TIDE science objectives. LiDAR data have been acquired from three different environments, the Venice Lagoon in Italy, Morecambe Bay in England, and the Eden estuary in Scotland. LiDAR accuracy at each site has been evaluated using ground reference data acquired with differential GPS. A semi-automatic technique has been developed to extract tidal channel networks from LiDAR data either used alone or fused with aerial photography. While the resulting networks may require some correction, the procedure does allow network extraction over large areas using objective criteria and reduces fieldwork requirements. The networks extracted may subsequently be used in geomorphological analyses, for example to describe the drainage patterns induced by networks and to examine the rate of change of networks. Estimation of the heights of the low and sparse vegetation on marshes is being investigated by analysis of the statistical distribution of the measured LiDAR heights. Species having different mean heights may be separated using the first-order moments of the height distribution

Perforated tunnel exit regions and micro-pressure waves:geometrical influence

ACKNOWLEDGEMENTS The authors are grateful to the following bodies that provided financial support for the project: (i) China Scholarship Council, (ii) National Natural Science Foundation of China (Grant No. U1334201 and (iii) UK Engineering and Physical Sciences Research Council (Grant No. EP/G069441/1).Peer reviewedPublisher PD

Gas migration pathways, controlling mechanisms and changes in sediment acoustic properties observed in a controlled sub-seabed CO2 release experiment

Carbon capture and storage (CCS) is a key technology to potentially mitigate global warming by reducing carbon dioxide (CO2) emissions from industrial facilities and power generation that escape into the atmosphere. To broaden the usage of geological storage as a viable climate mitigation option, it is vital to understand CO2 behaviour after its injection within a storage reservoir, including its potential migration through overlying sediments, as well as biogeochemical and ecological impacts in the event of leakage. The impacts of a CO2 release were investigated by a controlled release experiment that injected CO2 at a known flux into shallow, under-consolidated marine sediments for 37 days. Repeated high-resolution 2D seismic reflection surveying, both pre-release and syn-release, allows the detection of CO2-related anomalies, including: seismic chimneys; enhanced reflectors within the subsurface; and bubbles within the water column. In addition, reflection coefficient and seismic attenuation values calculated for each repeat survey, allow the impact of CO2 flux on sediment acoustic properties to be comparatively monitored throughout the gas release. CO2 migration is interpreted as being predominantly controlled by sediment stratigraphy in the early stages of the experiment. However, either the increasing flow rate, or the total injected volume become the dominant factors determining CO2 migration later in the experiment

Positive Scores on the 4AT Delirium Assessment Tool at Hospital Admission are Linked to Mortality, Length of Stay, and Home Time:Two-Centre Study of 82,770 Emergency Admissions

BACKGROUND: Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). METHODS: The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of [Formula: see text] 3 years were analysed using logistic regression models adjusted for age and sex. RESULTS: 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with 4AT scores of 1–3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001). CONCLUSIONS: Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment

The effects of clam fishing on the properties of surface sediments in the lagoon of Venice, Italy

International audienceHarvesting of clams(Tapes philippinarum) has important socio-economic and environmental implications for the Venice lagoon area, Italy. Clam harvesting disrupts the structure of benthic communities but the effects upon sediment stability and surface structure remain unclear. The effect of clam fishing on the sediment properties of the lagoon bed was investigated at two different sites, a heavily fished site (San Angelo) and an infrequently fished site (San Giaccomo). Both sites were assessed for immediate impacts of fishing, using indicators of biogenic sediment stabilisation. Samples were taken at three points along three 100 m linear transects at each site prior to and post fishing. Paired samples were also taken parallel to each transect at a distance of 5m, to allow for temporal variation. Sediment stability, measured with a cohesive strength meter (CSM), was significantly higher at the less impacted site (F1,34 = 6.23, p a (chl a), colloidal-S carbohydrate and dry bulk density were observed on the transect after fishing but not adjacent to the fishing path. At the heavily impacted site, clam fishing by trawling had, in general, no significant effect on the biological and physical properties (although chl a did decrease significantly after fishing). The lack of a significant impact from fishing at the impacted site was attributed to the higher frequency of fishing occurring in this area. Hence, frequent fishing of the lagoon prevents establishment of biotic communities, preventing biostabilisation and thus reduces the stability of the surface sediment. Keywords: clam harvesting, erosion threshold, microphytobenthos, sediment, stabilit

3D seismic imaging of buried Younger Dryas mass movement flows: Lake Windermere, UK

Windermere is a glacially overdeepened lake located in the southeastern Lake District, UK. Using the threedimensional(3D) Chirp subbottom profiler, we image mass movement deposits related to the Younger Dryas(YD) within a decimetre-resolution 3D seismic volume, documenting their internal structure and interactionwith preexisting deposits in unprecedented detail. Three distinct flow events are identified and mappedthroughout the 3D survey area. Package structures and seismic attributes classify them as: a small (totalvolume of c. 1500 m3) debris flow containing deformed translated blocks; a large (inferred total volume ofc. 500,000 m3), homogeneous fine-grained mass flow deposit; and a debris flow (inferred total volume ofc. 60,000 m3) containing small (c. 8.0×2.0 m) deformed translated blocks. Geomorphological mapping oftheir distribution and interaction with preexisting sediments permit the reconstruction of a depositionalhistory for the stratigraphic units identified in the seismic volume.<br/

Temporal acceleration of a turbulent channel flow

We report new laboratory experiments of a flow accelerating from an initially turbulent state following the opening of a valve, together with large eddy simulations of the experiments and extended Stokes first problem solutions for the early stages of the flow. The results show that the transient flow closely resembles an accelerating laminar flow superimposed on the original steady turbulent flow. The primary consequence of the acceleration is the temporal growth of a boundary layer from the wall, gradually leading to a strong instability causing transition. This extends the findings of previous direct numerical simulations of transient flow following a near-step increase in flow rate. In this interpretation, the initial turbulence is not the primary characteristic of the resulting transient flow, but can be regarded as noise, the evolution of which is strongly influenced by the development of the boundary layer. We observe the spontaneous appearance of turbulent spots and discontinuities in the velocity signals in time and space, revealing rich detail of the transition process, including a striking contrast between streamwise and wall-normal fluctuating velocities