segunda-feira, 29 de setembro de 2014

O tamanho do pré-sal

 

Cristovam Buarque

Cristovam Buarque

20 de Setembro de 2014 às 09:10

Não usar a riqueza do pré-sal seria uma estupidez, usá-la para iludir a nação é uma indecência

Não usar a riqueza do pré-sal seria uma estupidez, usá-la para iludir a nação é uma indecência. As estimativas para as reservas do pré-sal podem não ser exatas, mas não são mitos, são resultados de pesquisas geológicas; a exploração na sua profundidade não é um mito, a engenharia dispõe de ferramentas; a crença de que pode ser feita sem riscos para a ecologia não é um mito, embora haja exemplos de vazamentos em campos similares; a expectativa de que a demanda e os preços continuarão altos não é um mito, apesar das novas fontes.

Mito, contudo, é a afirmação de que o pré-sal mudará a realidade brasileira.

Se tudo der certo, em 2036 a receita líquida prevista do setor petrolífero corresponderá a R$ 100 bilhões, aproximadamente R$ 448 por brasileiro, quando a renda per capita será de R$ 27.800, estimando crescimento de 2% ao ano para o PIB. Apesar da dimensão da sua riqueza, o pré-sal não terá o impacto que o governo tenta passar. Explorá-lo é correto, concentrar sua receita na educação é ainda mais correto, mas é indecente usar o pré-sal como uma ilusão para enganar a nação e como mecanismo para justificar o adiamento de investimentos em educação.

O Brasil não cabe dentro de um poço de petróleo, nem deve esperar por ele.

Mito também é a afirmação de que a educação brasileira será universalizada e dará um salto de qualidade graças ao pré-sal. Em 2030, uma educação de qualidade universal custará cerca de R$ 511 bilhões, para o custo/aluno/ano de R$ 9.500. Se tudo der certo, a totalidade dos recursos do setor petrolífero destinada à educação corresponderá a R$ 37 bilhões, apenas 7,2% do necessário.

Também é um mito dizer que o atual governo teve a iniciativa da proposta de investir 75% dos royalties do petróleo em educação. A partir do momento da descoberta do pré-sal, 44 projetos de lei foram apresentados na Câmara e no Senado.

Mas foi com a aprovação do substitutivo PLC 41/2013 ao PL 323/2007, do deputado Brizola Neto, em 14/8/2013, após parecer favorável do deputado André Figueiredo (PDT-CE), que se determinou o destino de 100% dos royalties para a educação e a saúde. As atas mostram que os líderes da base de apoio ao governo tentaram impedir a aprovação, mas foram derrotados no voto.

Além de não serem destinados à educação os R$ 15 bilhões dos Bônus de Assinatura do Leilão do Campo de Libra, os recursos dos royalties não estão sendo aplicados. Até 28 de agosto, um ano depois da sanção da lei, apenas R$ 912 milhões foram efetivamente transferidos para o Ministério da Educação, ou seja, somente 13,5% do valor de R$ 4,2 bilhões previsto pela Lei de Diretrizes Orçamentárias para 2014.

Enquanto o mundo vive uma revolução no conhecimento, estamos ficando para trás, eufóricos com a promessa de mudar nossa triste realidade educacional no futuro distante, com base em um recurso ainda na profundidade de sete mil metros e que não será suficiente. E o pouco prometido não está sendo cumprido.

 

Snap 2014-09-29 at 22.07.52

World needs ‘paradigm shift’ towards sustainable agriculture, UN agency urges

 

Photo: World Bank/Maria Fleischmann

29 September 2014 – In order to move towards more sustainable agriculture, a broader approach is needed to overhaul the world’s food system, the head of the United Nations Food and Agriculture Organization (FAO) said today, as he pressed for a global reduction in the quantity of chemicals and water in contemporary agriculture.

Speaking at the opening of the 24th session of the Committee on Agriculture (COAG) in Rome, Director-General José Graziano da Silva called for a “paradigm shift” in global attitudes on agriculture, adding that only by decreasing the amounts of “inputs,” such as water and chemicals, could the sector move towards a more sustainable and productive long-term path.

“We cannot rely on an input-intensive model to increase production,” Mr. Graziano da Silva declared. “The solutions of the past have shown their limits.”

Pointing to options such as agro-ecology, climate-smart agriculture, biotechnology and the use of genetically modified organisms, the Director-General emphasized that global food production would need to grow by 60 per cent by 2050 in order to meet the expected demand from an anticipated world population of nine billion.

“We need to explore these alternatives using an inclusive approach based on science and evidence, not on ideologies,” he continued.

Established in 1971 and with over 100 members within its ranks, the COAG’s biennial meeting is currently addressing a wide range of issues, including family farming, sustainable agriculture, food safety, water governance, soil management and agricultural heritage systems.

Addressing the Committee in his keynote speech, the President of the Dominican Republic, Danilo Medina, underscored his Government’s support of the principle that food be considered a universal right and noted that his country was on the verge of passing a law establishing said right.

 

Snap 2014-09-29 at 21.56.28


News Tracker: past stories on this issue

World hunger falls, but number of undernourished remains ‘unacceptably high’ – joint UN report

In-flight sensor tests a step toward structural health monitoring for safer flights

 

"The flight test program is underway," said Dennis Roach, a senior scientist in Sandia National Laboratories' Transportation, Safeguards & Surety Program who has worked in aviation safety for 25 years. "We have moved past laboratory research and are looking for certification for actual on-board usage. Our activities are proving that the sensors work on particular applications and that it is safe and reliable to use these sensor systems for routine aircraft maintenance."

Delta Air Lines Inc. and a foreign aircraft manufacturer have partnered with Sandia researchers in two separate programs to install about 100 sensors on their commercial aircraft. These teams worked together to provide the installation procedures for technicians and now oversee monitoring of the in-flight tests.

The flight tests complement laboratory performance testing at Sandia to provide the critical step in a decade-long journey to enhance airline safety through a more comprehensive program of Structural Health Monitoring. SHM uses nondestructive inspection principles -- technologies that examine materials for damage without affecting their usefulness -- and built-in sensors that automatically and remotely assess an aircraft's structural condition in real time and signal the need for maintenance.

Roach said the goal of monitoring the sensors installed on the aircraft is to accumulate successful flight history to show that the sensors can sustain the operating environment, while providing the proper signals for flaw detection.

SHM eventually could help airlines save money by basing maintenance on the actual condition of the aircraft, rather than fixed schedules and inspection routines that might not be necessary, and thereby reduce airplanes' downtimes, Roach said.

The team said so far, sensors installed on the aircraft are working as expected.

Next year, Sandia intends to present the flight and laboratory test results to the FAA for approval and certification. Should the FAA approve the sensors, they would be available for specific applications across the entire airline industry and the process for certifying future applications should be more efficient because of the research being conducted now.

Two SHM systems reach maturity for use on regular flights

Sandia began its work in aviation safety in 1991 when the FAA, in response to a number of aviation incidents, increased its research efforts to improve inspection, maintenance and repair of commercial aircraft. Among the projects to improve aviation safety, the FAA created the AANC, operated by Sandia, to conduct research into nondestructive inspection (NDI), advanced materials, engines, structural integrity and a wide range of other airworthiness assurance areas.

The center provides a way to develop, evaluate and bring new aircraft technologies to the airline industry, Roach said. "We work to make the technology viable and often focus on that last phase of technology validation and certification."

The current SHM program is testing two sensors: Comparative Vacuum Monitoring (CVM) sensors manufactured by Structural Monitoring Systems and piezoelectric sensor arrays produced by Sunnyvale, Calif.-based Acellent Technologies Inc.

  • CVM sensors improve crack detection by monitoring "galleries," or 0.025-inch channels etched by laser into the Teflon sensor. CVM sensors are then mounted in areas of the aircraft known to experience fatigue. The sensors are bonded to the surface of the structure with an adhesive surface preparation that seals out the atmosphere, creating a vacuum inside the gallery. When a tiny crack intersects the gallery, the pressure changes, much like the pressure in a vacuum cleaner changes when the hose has a leak. The sensor records the pressure change and alerts inspectors well before the crack becomes a safety issue.
  • Piezoelectric sensors (PZT) are strategically distributed in polyimide films -- called Acellent's SMART Layers -- that adhere to an airplane's surface to monitor specific regions for damage. The array of PZT sensors communicate with one another by transmitting and receiving ultrasonic surface waves called Lamb waves. This creates a mini-communications network. Damage to the aircraft disrupts or changes the signal patterns from the baseline communication signals. Acellent's software measures and analyzes any changes, called the "damage index," and sends an alert to the inspector. Work is ongoing on the best spacing and placement for these sensors on aircraft, Sandia mechanical engineer Stephen Neidigk said.

Both of these on-board sensors must meet the same performance and reliability standards as those required for current maintenance inspections, Roach said. "The SHM systems also help eliminate some of the concerns about human factors associated with manually-deployed NDI," he said. "You have the sensor in place, you know it works and it's giving you a proper signal, whereas an inspector must manually orient the inspection probe properly each time and there are always concerns about human vigilance when inspections become time-consuming or tedious."

The sensors are custom built to fit an aircraft's parts, they are verified to be working before they are sealed inside the aircraft and the readouts provide inspectors with a "pass" or "fail" decision so the results can't be misinterpreted, the researchers said.

Sandia also is researching wide-area monitoring using piezoelectric and fiber optic strain sensors for composite materials used in today's aircraft. Impacts don't always show dents in composite materials, so SHM techniques are needed to find structural damage within what appears to be a smooth, undamaged surface, Neidigk said.

Field tests bridge gap from lab to routine use in aircraft

The field tests have helped fine tune the sensors, so they can withstand the harsh environments aircraft fly in and the environment aircraft mechanics work in, neither of which is as pristine as the laboratories where the sensors were initially tested.

For example, field testing showed that mechanics working in the cramped bowels of an aircraft couldn't see well enough to connect the sensors' tubes together by hand, Neidigk said. So the team designed snap-clip type connectors for the CVM sensors, like those used to plug a telephone landline into a wall outlet.

"With the snap-click connectors, they are able to feel them click together, which is easier than the previous method of connecting tiny tubes individually by hand," Neidigk said.

Growing realistic cracks part of Sandia performance tests

Complementing the in-flight tests, Sandia is looking at the sensors' ability to detect cracks and how well they perform in extreme environmental conditions.

In the laboratory, Sandia engineer Tom Rice breaks things for a living, but that's not as easy as it sounds. The cracks he "grows" have to represent cracks found on an airplane. So, for example, he places a pale green wing box fitting on a load frame that mimics the stress conditions the part would experience on an aircraft. After about four hours of accelerated fatigue cycles, a crack begins to show.

"We literally have to grow the crack enough to where it stays open (without the load on it), so our sensors can detect the crack when the aircraft is in an unloaded state in the maintenance hangar," Rice explained.

Once the sensors detect an array of cracks, Sandia assembles various test scenarios and collects the data to calculate the statistical probability of detection for cracks of various lengths, typically fractions of inches.

In hundreds of laboratory tests, the sensors have never issued a false call, Rice said.

Future of SHM can reduce costs, enhance safety for airline industry

If flight tests verify that the sensors can be used to help monitor airliners' structural health, the Sandia researchers hope to see a more comprehensive SHM program follow.

In addition to safety enhancement, SHM would save the airline industry time and money, particularly if sensors are mounted in hard-to-reach areas and used widely throughout an aircraft, Roach said.

With today's routine maintenance, inspectors often need to remove a cabin's interior seats or galleys to conduct inspections. But with the on-board sensors mounted in place, the mechanics can plug in from a convenient location to acquire the sensor data without the time and cost of removing items, Roach said. Such part removal also introduces the possibility of damaging the structure during disassembly.

Researchers hope SHM eventually will permit the real-time condition of the aircraft to dictate maintenance. "The ultimate goal is to monitor it in-flight and have it tell you 'I need some attention, I've got a problem here.' So you do condition-based maintenance rather than time-based maintenance," Roach said. "That's downstream a ways, but these are all building blocks working toward that."

Rice adds that with SHM, abnormal problems that show up prior to scheduled maintenance would be detected with real-time sensors. "With condition-based maintenance, you could find damage earlier than normal," he said. "It's rare that it happens, but it could."

Such early damage detection and repairs provided by SHM also are cost-effective because they reduce the need for subsequent major repairs, Roach said.

Talk therapy_not medication _ best for social anxiety disorder, large study finds

 


While antidepressants are the most commonly used treatment for social anxiety disorder, new research suggests that cognitive behavioral therapy (CBT) is more effective and, unlike medication, can have lasting effects long after treatment has stopped.

Social anxiety disorder is a psychiatric condition characterized by intense fear and avoidance of social situations and affects up to 13 percent of Americans and Europeans. Most people never receive treatment for the disorder. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists.

The findings of the study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, are published online Sept. 26 in The Lancet Psychiatry.

"Social anxiety is more than just shyness," says study leader Evan Mayo-Wilson, DPhil, a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

The research was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.

For the study, Mayo-Wilson and his colleagues analyzed data from 13,164 participants in 101 clinical trials. The participants all had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo pill, and more than 4,000 received a psychological intervention. Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone.

The data compared several different types of talk therapy and found individual CBT was the most effective. CBT is a form of treatment that focuses on relationships between thoughts, feelings and behaviors. It helps people challenge irrational fears and overcome their avoidance of social situations, Mayo-Wilson says.

For people who don't want talk therapy, or who lack access to CBT, the most commonly used antidepressants -- selective serotonin reuptake inhibitors (SSRIs) -- are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn't work at all for many people, and that improvements in symptoms do not last after people stop taking the pills.

The researchers acknowledge that medication remains important but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy. The group's analysis has already led to new treatment guidelines guidance in the U.K. and, Mayo-Wilson says, it could have a significant impact on policymaking and the organization of care in the U.S.

Social anxiety disorder typically begins in adolescence or early adulthood, and it can severely impair a person's daily functioning by impeding the formation of relationships, by negatively affecting performance at work or school, and by reducing overall quality of life. Because it strikes people at critical times in their social and educational development, social anxiety disorder can have important and lasting consequences.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs," Mayo-Wilson says. "The healthcare system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."


Story Source:

The above story is based on materials provided by Johns Hopkins Bloomberg School of Public Health. Note: Materials may be edited for content and length.


Journal Reference:

  1. Evan Mayo-Wilson et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis. The Lancet Psychiatry, September 2014 DOI: 10.1016/S2215-0366(14)70329-3

 

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Chemotherapy: Rolapitant reduces nausea and vomiting in phase III trial

 


Rolapitant reduces nausea and vomiting in patients receiving cisplatin-based chemotherapy, according to the results of a phase III trial presented for the first time today at the ESMO 2014 Congress in Madrid, Spain.

Dr Martin Chasen, lead author and medical director, Palliative Care, Ottawa Hospital Cancer Centre, Canada, said: "This agent makes a significant difference in the way people tolerate their chemotherapy. Patients experienced no loss in quality of life and, in fact, many saw meaningful improvements. One of the patients in the rolapitant cohort reported that he had just finished 18 holes of golf one week after receiving chemotherapy. This is in sharp contrast to many patients on current standard anti-emetics that are too ill to get out of bed within a week after each cycle of cisplatin."

"We must treat nausea and vomiting, not just the cancer," added Chasen, emphasising that some patients are extremely sensitive to cisplatin effects and recalling that he had one or two patients with curable cancers who refused treatment after one round of cisplatin. "They preferred to die," he said.

The phase III trial investigated rolapitant, a novel antagonist of the NK-1 receptor, for the prevention of severe nausea and vomiting often experienced by patients receiving cisplatin-based chemotherapy, which may cause dose reductions and treatment discontinuation. The multicentre trial randomised 532 patients 1:1 to receive rolapitant plus granisetron/dexamethasone or placebo plus granisetron/dexamethasone prior to cisplatin-based chemotherapy.

The primary endpoint was complete response (defined as the patient having no emesis and not requiring any rescue medication) in the delayed phase (>24-120 hours) post-chemotherapy. Key secondary endpoints included complete response during the acute (0-24 hours) and overall (0-120 hours) phases.

The trial met its primary endpoint, with 72.7% of patients receiving rolapitant achieving complete response in the delayed phase compared to 58.4% of those receiving placebo (p<0.001). Rolapitant also improved the complete response rate compared to placebo in the acute (83.7% vs 73.7%, p=0.005) and overall (70.1% vs 56.5%, p=0.001) phases. Patients receiving rolapitant tended to report that chemotherapy had less of an impact on their daily quality of life (72.8% vs 67.8%, p=0.231).

Chasen said: "Rolapitant demonstrated a significant effect in both the acute and delayed phases. Our primary endpoint was achieved in the delayed phase, an incredible result. We know that the NK-1 receptor in the brain must be blocked to control nausea and vomiting --there are other agents that block this for a short time; rolapitant is an exceptionally long term receptor blocker that binds to the receptor and remains in place for up to 120 hours, therefore not allowing the chemotherapy to induce nausea and vomiting."

The investigators tested the agent in patients receiving cisplatin, possibly the strongest inducer of emesis. "Without a doubt this drug can be evaluated in other less emetogenic cancer treatments," said Chasen.

He pointed out that rolapitant may also save costs. For example, in Ottawa patients can have a visit from a nurse following their chemotherapy who administers intravascular hydration and nutrients. Chasen said: "Patients receiving rolapitant may not require this service. They are able to eat and drink as they should." -END-


Story Source:

The above story is based on materials provided by European Society for Medical Oncology (ESMO). Note: Materials may be edited for content and length.


 

French studies measure benefits of colorectal cancer screening

 

Dr Vanessa Cottet from INSERM Unité 866 in Dijon, France, and colleagues studied the region of Côte-d'Or, where a registry has been collecting data on adenomas since 1976. They wanted to evaluate the rate of diagnosis of adenomas before and after the initiation of a screening program using fecal occult blood testing that began in 2003.

The study included all residents aged between 50 and 74 years of age who had a first adenoma identified between January 1997 and December 2008. The researchers showed that 38.7% of these people had high-risk adenomas --meaning they were larger than 1 centimetre in diameter, involved the finger-like projections called villi in the intestinal lining, or exhibited a high grade of dysplasia.

For such high-risk adenomas, age-standardized diagnosis rates were 136 per 100,000 people before screening program and 257 per 100,000 after, which correlates to a percentage increase of 89%. The corresponding rates for non-advanced adenomas were 235 and 392 diagnoses per 100,000, with a percentage increase of 68%.

These results reinforce the value of extending organised mass screening programs for colorectal cancer, the authors say. "It is very important that public follows recommendations and participates in colorectal cancer screening campaigns," Cottet says. "Participation rate is a major issue for the success of such programs."

The authors also found that the rate of detection did not continue increasing between the 2005 and 2007 rounds of screening. However, they suggest that shifting the methodology used in the screening programs from the more common guaiac test to immunochemical testing will improve results in the future.

"Immunochemical fecal occult blood tests outperform guaiac tests for the detection of colorectal cancer and advanced adenoma," Cottet says. "They have doubled the detection rate of invasive colorectal cancer, mostly at early stages, and led to a fourfold increase in the detection rate of non-invasive colorectal cancer and advanced adenomas."

"Given the superior performance of immunochemical tests, it is reasonable to assume that an organized screening program using such tests would led to a greater reduction of colorectal cancer death and probably to a reduction in colorectal cancer incidence."

Caption: Dr Vanessa Cottet and colleagues report that biennial colorectal cancer screening in France's Cote-D'Or region increased detection of high-risk polyps, but that the improvement recently plateaued

Commenting on the study, Professor Hans-Joachim Schmoll, former Head of the Division of Hematology and Oncology and Director of the Center for Cell and Gene Therapy, Martin Luther University, Halle, Germany and Professor of Medicine at Martin Luther University, Germany, said that many retrospective and prospective studies have clearly demonstrated the value of screening for adenoma, polyps and manifest colorectal cancer with respect to early diagnosis and treatment of precursor lesions and manifest tumours, and with regard to improving survival.

"However, the question is which method is most appropriate with respect to accessing the target population, maximising participation in these programs, and efficacy, as well as costs," Schmoll said.

"The French trial reproduces the positive outcome from other studies by looking on the sequential period before and after 2003 when screening programs started in the Côte-d'Or region. They have shown that the stool test for occult blood (guaiac test) was effective by doubling the rate and therefore these data further support the value of screening programs in the general population with a given standard risk, as in this group of people aged 50-75 years."

"It can definitively be expected that the new FOBT-test could have produced even better results," Schmoll said. "Further strong improvement can be expected by the recent new combined test of FOBT together with a molecular test for specific mutations. These third-generation tests are going to be implemented in US and other countries."

However, the optimal method for increasing the detection rate is colonoscopy, or at least sigmoidoscopy, which is implemented as standard in Germany and in the US, at least for a high risk population, Schmoll said. These approaches can be called the 'gold standard', despite several drawbacks including risks from the procedure itself and potential false positive or negative results, he said.

Colonoscopy evaluated in patients at high risk of colorectal cancer For people who have been identified as being at higher risk of developing colorectal cancer, a screening program that uses colonoscopy appears to be less efficient than using fecal occult blood tests, French researchers report.

Dr Sylvain Manfredi from CHU Pontchaillou in Rennes, France, and colleagues conducted their study in a region of the country where fecal occult blood test (FOBT) screening for people with average risk of colorectal cancer has been implemented for long time.

As part of the screening program, a pre-screening procedure is undertaken by a general practitioner or gastroenterologist to identify patients who are at higher than average risk of colorectal cancer based on their family history. Those patients were invited to undergo colonoscopy rather than FOBT.

The aim of the study was to estimate the positive predictive value of colorectal neoplasia in this high-risk group. Positive predictive value is a statistical measure that is defined as the ratio of true positive results to the number of times the test shows a positive result (which can include true positive results and 'false positives' where the test indicates a positive result but the patient does not actually have colorectal cancer).

Of 1179 patients studied, 889 underwent colonoscopy, the researchers report. Overall, 253 colorectal neoplasias were diagnosed including 35 cancers, and adenomas (polyps) in 219 patients. A total of 209 advanced adenomas were diagnosed.

The authors calculated that the positive predictive value of colonoscopy was 3.9% for cancer, 12.9% for advanced adenoma and 25% for adenoma overall.

This compared poorly to the positive predictive value in the average risk population selected by a positive FOBT, they say. In this population, the positive predictive value of the coloscopy done after positive test in their administrative area ranges from 7.5% to 10% for cancer, from 15% to 27% for advanced adenoma and between 32% and 37% for adenoma.

"The take-home message is that the positive predictive value for colorectal neoplasia in high risk patients screened by colonoscopy is lower than it is for average risk patients screened by FOBT."

"As a result, we believe this population may benefit from fecal occult blood or immunochemical blood testing to select the best candidates for colonoscopy." Further studies are required to understand how best this could be achieved, Manfredi said.

"In the study from Manfredi, it was shown that a prediction for screening colonoscopy using high risk features --based on family history-- revealed a less positive predictive value than pre-screening by FOBT with follow-up of those who have a positive result," Schmoll said.

"These data favour the widely used standard approach of routine use of FOBT followed by colonoscopy only when the FOBT test is positive, rather than colonoscopy first. Those patients with prior FOBT are at higher risk for having cancer or precursor lesion compared to those who are only identified by family history," Schmoll said.

"However, if colonoscopy is restricted only to those patients who have positive FOBT, there is a high chance that adenoma or even cancer can be not identified. FOBT can be negative in a number of patients despite the presence of adenoma, precursor lesions or even in early cancer. Therefore the optimal method remains the colonoscopy in all patients," Schmoll said.

"The data support the use of both options as part of a large national screening program which is adapted to several different groups, to optimize the outcome and increase the rate of cure," Schmoll noted.

Customizing chemotherapy in lung cancer: New phase II data reported

 

September 27, 2014

European Society for Medical Oncology (ESMO)

Measuring the expression levels of an enzyme involved in DNA synthesis can help predict the response of lung cancers to certain treatments, a Korean study has shown. In a randomized phase II study, researchers showed that patients whose lung cancers expressed low levels of an enzyme called thymidylate synthase experienced a greater benefit from treatment with the combination of pemetrexed and cisplatin than those whose tumors expressed high levels.


Measuring the expression levels of an enzyme involved in DNA synthesis can help predict the response of lung cancers to certain treatments, a Korean study has shown at the ESMO 2014 Congress in Madrid.

In a randomized phase II study, researchers showed that patients whose lung cancers expressed low levels of an enzyme called thymidylate synthase experienced a greater benefit from treatment with the combination of pemetrexed and cisplatin than those whose tumours expressed high levels.

"Thymidylate synthase is one of the proteins that is targeted by pemetrexed which is the most widely used chemotherapeutic regimen in the treatment of non-squamous NSCLC," explains study author Professor Myung-Ju Ahn, from the Section of Hematology-Oncology at Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

"In this study, we tried to evaluate whether expression of thymidylate synthase is a predictive factor for response to pemetrexed plus cisplatin chemotherapy compared with gemcitabine plus cisplatin in non-squamous cell lung cancer patients."

In terms of response rate and progression-free survival, the clinical benefits of the pemetrexed combination compared to other regimen were more prominent in those patients who expressed low levels of the molecule, Ahn said.

"This suggests that thymidylate synthase can be used as a predictive biomarker. Furthermore, we also found that low thymidylate synthase expression was associated with prolonged overall survival irrespective of which chemotherapeutic regimen the patients received, suggesting that its expression can also serve as a prognostic biomarker."

In the study, patients with more than 10% of tumour cells expressing thymidylate synthase were grouped as 'TS-positive' and those with 10% or less were grouped as a 'TS-negative'. Among 315 patients, the response rate of pemetrexed and gemcitabine were 47.0% and 21.1% in TS- patients, and 40.3% and 39.2% in the TS+ group. The median progression-free survival of pemetrexed and gemcitabine combinations were 6.4 and 5.5 months in the TS- group and 5.9 and 5.3 months in the TS+ group.

The median overall survival in response to treatment with the pemetrexed combination and the gemcitabine combination were not different in the TS- group or in the TS+ group, however those with TS-negative tumours tended to survive for longer.

The take-home message is that thymidylate synthase could be a useful biomarker in this setting, Ahn says.

"In non-squamous cell NSCLC, thymidylate synthase-negative patients get more clinical benefit from pemetrexed/cisplatin combination therapy. Furthermore, multivariate analysis of the present study showed that TS negative expression was significantly associated with longer survival, along with younger age and EGFR mutation, suggesting it is a good independent prognostic marker."

"This study opens the gates for thymidylate synthase (TS)-customized chemotherapy in advanced NSCLC," commented Dr Rafael Rosell, director of the Cancer Biology and Precision Medicine Program at the Catalan Institute of Oncology, Spain.

"They focus their research on patients with non-squamous NSCLC and show that low-TS expressing patients have a significantly better response and outcome, either with pemetrexed or gemcitabine, in combination with cisplatin."

"Over-expression of TS could behave as an oncogene and therefore TS could be not only a predictive marker of response to antimetabolite drugs, but also a prognostic marker," Rosell said. "Therefore, it could be of interest to see what the relevance of using TS as an overall biomarker could be for predicting chemotherapy outcome. It would be of great interest to gain further insights on the mechanisms of TS up-regulation since a master oncogene, astrocyte elevated gene-1 (AEG-1) has been shown to induce the transcription factor LSF (late SV40 factor) that directly up-regulates TS." (Cancer Res 2009; 69:8529).

Scan may identify lung cancer patients who will benefit from folate-targeted drug A non-invasive method for measuring the expression folate receptors on tumour cells can identify which patients with advanced lung cancer are likely to derive greater benefit from combination chemotherapy with the investigational drug vintafolide, researchers report at ESMO 2014.

At the meeting, medical oncologist Dr Rohit Lal from Guy's & St Thomas' NHS Foundation Trust in London, reported results from the phase II TARGET trial, which included 199 patients with non-small cell lung cancer who had already been treated with other drugs, and whose tumours all expressed the folate receptor.

Folic acid and folates are key to the synthesis of DNA and RNA, and abnormalities in folate pathways and folate receptors are involved in many cancers including lung cancer, Lal explains. Vintafolide is a drug targeted to the folate receptor, and is being developed together with an imaging agent that enables non-invasive imaging of folate receptor expression in tumours.

"Our results show a statistical improvement in overall survival and a promising progression-free survival signal with vintafolide and docetaxel for advanced lung adenocarcinoma patients selected by an imaging biomarker for the folate receptor. These patients also had a higher rate of radiological disease control. More patients treated in the vintafolide combination arm required dose adjustment. The results warrant confirmation in a phase III study," Lal said.

"In this phase II trial, adenocarcinoma patients treated with the vintafolide combination were half as likely to have succumbed from their disease than patients in the docetaxel group. These results will need to be validated in a phase III trial," Lal said.

"Choosing treatments based on tumour biopsy tests is well established. The TARGET trial results show a positive outcome for 2nd-line advanced lung adenocarcinoma patients and may show that by using a scan we can select advanced stage lung cancer patients that may derive a greater benefit from combination chemotherapy."

"This group reports the results of a revolutionary study employing a non-invasive method to detect folate receptor expression in NSCLC cells and the relation to treatment with vintafolide, targeting the folate receptor," Rosell noted. "The preliminary results are promising, indicating that the combination of vintafolide and docetaxel could be effective in advanced lung adenocarcinoma patients selected by imaging tracer for the folate receptor."


Story Source:

The above story is based on materials provided by European Society for Medical Oncology (ESMO). Note: Materials may be edited for content and length.


 

Óleo de coco auxilia na perda de peso?

 

Publicado em 25/09/2014 às 00:00:00 - Atualizado em 24/09/2014 às 21:21:51

Geralmente quando alguém resolve fazer uma dieta de emagrecimento o primeiro pensamento é eliminar alimentos ricos em gordura do seu dia a dia, porém, um produto que vem recebendo destaque no auxílio ao emagrecimento é justamente uma gordura - o óleo de coco.
Será que o consumo de óleo de coco realmente emagrece?
Em levantamento bibliográfico não foi possível identificar estudos suficientes ligando a perda de peso com o consumo de óleo de coco, no entanto, parte dos estudos encontrados relacionava o seu uso do mesmo com a prevenção de doenças cardiovasculares. Sendo assim, não há como afirmar que o óleo de coco leve ao emagrecimento, uma vez que não existem pesquisas suficientes que avaliaram esta possibilidade.
Porque o óleo de coco?
O coco (Cocos nucifera) é uma fruta das regiões tropical e subtropical que há milhares de anos tem sido aplicado popularmente na Índia para tratar diversas doenças, incluindo as cardíacas. Análises indicam que ácidos graxos saturados encontrados no coco podem melhorar a saúde por diminuírem o mau colesterol sanguíneo, o que explicaria o fato dos países com alto consumo de óleos tropicais possuírem baixas taxas de doenças cardiovasculares, no entanto, este benefício não ocorre devido a perda de peso.
Ainda por responder
Mesmo que as aplicações do óleo de coco recebam ampla publicidade não se sabe se há riscos que podem estar envolvidos no consumo deste produto. Desta forma são necessárias mais pesquisas para explorar sua utilidade terapêutica, seja no emagrecimento ou no combate a doenças. Se houver comprovação de sua eficácia, é preciso identificar quais seriam as doses diárias, se há limitações para uso em populações vulneráveis como crianças e gestantes, se há efeitos colaterais e, se realmente o óleo de coco pode resultar em perda de peso, pois por enquanto, não há estudos científicos suficientes comprovando sua eficácia como “emagrecedor”.
Dica de nutricionista
Conclui-se que o uso de suplementos a base de óleo de coco está longe de ser um método para emagrecer. Emagrecimento e saúde dependem de várias ações e bons hábitos os quais compreendem ter uma alimentação equilibrada e saudável. O nutricionista é o profissional habilitado para avaliar as necessidades nutricionais e orientar a alimentação com alimentos que proporcionem ao organismo todos os elementos necessários para uma vida saudável e longe de modismos.

Snap 2014-09-29 at 09.49.15

 

Crizotinib treatment effective against ROS1-positive lung cancer, study suggests

 


Treatment with the targeted therapy drug crizotinib effectively halts the growth of lung tumors driven by rearrangements of the ROS1 gene. In an article receiving Online First publication in the New England Journal of Medicine to coincide with a presentation at the European Society for Medical Oncology meeting, an international research team reports that crizotinib treatment led to significant tumor shrinkage in 36 of 50 study participants and suppressed tumor growth in another 9.

"Prior to this study, there were a handful of reports describing marked responses to crizotinib in individual patients with ROS1-positive lung tumors," says Alice Shaw, MD, PhD, of the Massachusetts General Hospital (MGH) Cancer Center, lead author of the NEJM report. "This is the first definitive study to establish crizotinib's activity in a large group of patients with ROS1-positive lung cancer and to confirm that ROS1 is a bona fide therapeutic target in those patients."

Crizotinib currently is FDA-approved to treat non-small-cell lung cancers (NSCLC) driven by rearrangments in the ALK gene, which make up around 4 percent of cases. An MGH Cancer Center report published in 2012 reported that 1 to 2 percent of NSCLCs are driven by rearrangements in ROS1, which encodes a protein with significant structural similarities to that encoded by the ALK gene.

The current study, an expansion of the original phase 1 crizotinib trial, enrolled 50 patients with ROS1-positive NSCLC, beginning in late 2010. Patients received twice daily doses of crizotinib. As noted above, tumor size was significantly reduced in 72 percent of patients and tumor growth was halted in an additional 18 percent. The average duration of response was over 17 months. At the end of the study, 25 of the 50 patients were still receiving crizotinib with no evidence of tumor progression.

As with other targeted cancer therapy drugs, treatment resistance developed in a number of participants, but the effectiveness of crizotinib appeared to last longer in ROS1-positive patients than in patients with ALK-positive tumors. "Almost all patients treated with targeted therapies eventually develop resistance," explains Shaw, an associate professor of Medicine at Harvard Medical School (HMS). "Fortunately, the remissions induced by crizotinib in ROS1-positive patients are quite prolonged, and resistance appears to emerge much later, on average, than what we have seen with other targeted therapies for lung cancer and melanoma."

The authors note that development of efficient laboratory diagnostics has been critical to identification of ROS1 rearrangements and of other genetic alterations that drive tumor growth. John Iafrate, MD, PhD, medical director of the MGH Center for Integrated Diagnostics and associate professor of Pathology at HMS, who is senior author of the study comments, "This is a great example of success in personalized medicine. While NSCLC patients with ROS1 fusions are rare, if you devote the diagnostic laboratory resources to find that 1 to 2 percent of patients, you will make a real difference."

While crizotinib's FDA approval currently covers only ALK-positive NSCLC, Shaw notes that National Comprehensive Cancer Network guidelines recommend that patients with advanced lung cancer be considered for ROS1 testing and that crizotinib should be used to treat ROS1-positive patients.


Story Source:

The above story is based on materials provided by Massachusetts General Hospital. Note: Materials may be edited for content and length.


 

How neuroscience can teach children about mental health

 

At a recent talk I gave as a Sheffield NeuroGirl, a group of three female PhD students who aim to bring interesting and exciting research on the brain to the public, I carried out a little experiment…

Author

Rebecca Slack is one of the Sheffield NeuroGirls @Shef_NeuroGirls

Provides funding as a Founding Partner of The Conversation. sheffield.ac.uk/

Brain on the whiteboard. Brain by Shutterstock

At a recent talk I gave as a Sheffield NeuroGirl, a group of three female PhD students who aim to bring interesting and exciting research on the brain to the public, I carried out a little experiment. I asked everyone to get to their feet and then for everyone who either had, or knew someone with a mental illness to sit back down again. Amazingly, only two people were left standing.

This is by no means an unusual state of affairs. One in four people will experience some kind of mental health problem, including 10% of all children. Suicide is the second leading cause of death among 15 to 29-year-olds across the globe, with depression a major risk factor. And a breakdown in a healthy brain is indiscriminate in who it targets: rich, poor, all races and both sexes.

Yet negative attitudes from the stigma of mental health problems are still very prevalent, and the perception of those that seek help for mental ill health is that they are “crazy”, “weak”, “flawed” or “dangerous”.

A 2007 study found that anticipated negative attitudes – from peers, family members and even school staff – were crucial to whether they sought help for mental health problems. So why is there still so little education on the brain and how it works in schools? Lessons could teach children what our brains do and why they might go wrong. If mental health will likely touch us all at some point throughout our lives, can we not begin to understand it earlier?

If a child breaks their arm, everyone talks about it; from how it was broken, why it hurts, how it will mend, potential complications. No-one bats an eyelid about seeing a cast. However, if a child becomes depressed, there is usually no frank discussion about what might be wrong with their brain and why they could be feeling down. Although there are treatments available, there may be a big gap in explaining the processes happening in the brain.

Neuroscience, which investigates how the central nervous system and the brain functions in health and in disease, can inform education and reduce stigma. Those of us who study or work in neuroscience are aware of the many problems the brain can face throughout its lifetime.

We know for, example, that you can’t just “snap out” of deep depression, because many brain imaging studies have shown there are abnormalities in the way that the depressed brain works. A study by Andrew Leuchter and colleagues at UCLA used EEG to measure brain signals and found that the limbic region, an area involved in processing emotion, and cortical brain regions such as the dorsolateral prefrontal cortex, which is involved in the regulation of thinking and action, sent many more messages back and forth in participants suffering from major depressive disorder compared to those with healthy brains.

Neuroscience can also convey to a child the underlying issue beneath their problem. For example, the role of an area buried deep in the brain called the caudate putamen, which helps to control voluntary movement but is also believed to play a role in Obsessive Compulsive Disorder (OCD). In people with OCD, problems with the caudate putamen can mean an inability to stop worrying or stop having anxious thoughts.

Although environment and life circumstances play their part in depression, it is also a physical manifestation. And understanding this can help move a narrative from blaming the sufferer for being crazy, or weak, to acknowledging that part of the brain is no longer healthy. Just as you can become sick with a cold, your brain can also become sick. This is an important message that we could teach much more.

Ignorance about mental health can lead to bullying, prejudice, fear and heartache. It can lead to resistance in those suffering to seek the help and support for those around them, unnecessary fear and worry. For children especially, not understanding mental illness could potentially also lead to guilt that they have somehow caused it.

A simple programme of education in schools could help to bring about a real change in society. It could help to provide a long-term solution to the problem of ignorance about mental health and bring more discussion about mental illness into the open. While some of this work could be done by people going into schools, a better solution would be to add the brain itself into the national curriculum.

Snap 2014-09-29 at 09.37.21

Early sign of pancreatic cancer identified by researchers

 

September 28, 2014

Dana-Farber Cancer Institute

A sign of the early development of pancreatic cancer - an upsurge in certain amino acids that occurs before the disease is diagnosed and symptoms appear has been identified by a team of researchers. Although the increase isn’t large enough to be the basis of a new test for early detection of the disease, the findings will help researchers better understand how pancreatic cancer affects the rest of the body.


Scientists at Dana-Farber Cancer Institute, the Massachusetts Institute of Technology, and other institutions have discovered a sign of the early development of pancreatic cancer – an upsurge in certain amino acids that occurs before the disease is diagnosed and symptoms appear. The research is being published online today by the journal Nature Medicine.

Although the increase isn’t large enough to be the basis of a new test for early detection of the disease, the findings will help researchers better understand how pancreatic cancer affects the rest of the body, particularly how it can trigger the sometimes deadly muscle-wasting disease known as cachexia.

“Most people with pancreatic ductal adenocarcinoma (PDAC) [by far the most common form of pancreatic cancer] are diagnosed after the disease has reached an advanced stage, and many die within a year of diagnosis,” said Brian Wolpin, MD, MPH, of Dana-Farber, co-senior author of the new study with Matthew Vander Heiden, MD, PhD, of MIT and Dana-Farber. “Detecting the disease earlier in its development may improve our ability to treat it successfully. In this study, we asked whether PDAC produces metabolic changes – changes in the way the body uses energy and nutrients – that can be detected before the disease is diagnosed.”

The researchers utilized blood samples collected years earlier from 1,500 people participating in large health-tracking studies. They analyzed the samples for more than 100 different metabolites – substances produced by the metabolic process – and compared the results from participants who had gone on to develop pancreatic cancer and those who had not.

“We found that higher levels of branched chain amino acids were present in people who went on to develop pancreatic cancer compared to those who did not develop the disease,” Wolpin said. (Branched chain amino acids are one family of amino acids, the building blocks of proteins.) The amount of time that would elapse before those individuals were diagnosed with pancreatic cancer ranged from two to 25 years, although the highest risk was in the several years before diagnosis, the researchers found.

“These findings led us to hypothesize that the increase in branched chain amino acids is due to the presence of an early pancreatic tumor,” Wolpin remarked. This theory was confirmed in laboratory experiments performed by Vander Heiden’s group at the Koch Institute for Integrative Cancer Research at MIT. Their experiments showed that mice with newly formed pancreatic tumors had above-normal blood levels of these amino acids.

The researchers found the increase was due to a breakdown of muscle tissue, which caused branched amino acids to be released into the bloodstream. This process is similar to what occurs in patients with cancer cachexia. “What was surprising about our results was that it appears the breakdown of muscle protein begins much earlier in the disease process than previously appreciated,” noted Vander Heiden.

The findings provide an important lead to scientists studying how pancreatic tumors interact with patients’ normal tissues, the authors say. According to Vander Heiden, this work provides a glimpse into how pancreatic cancer changes the way the rest of the body handles nutrients. “This work has the potential to spur progress in detecting pancreatic tumors earlier and identifying new treatment strategies for those with the disease,” he remarks.


Story Source:

The above story is based on materials provided by Dana-Farber Cancer Institute. Note: Materials may be edited for content and length.


Journal Reference:

  1. Jared R Mayers, Chen Wu, Clary B Clish, Peter Kraft, Margaret E Torrence, Brian P Fiske, Chen Yuan, Ying Bao, Mary K Townsend, Shelley S Tworoger, Shawn M Davidson, Thales Papagiannakopoulos, Annan Yang, Talya L Dayton, Shuji Ogino, Meir J Stampfer, Edward L Giovannucci, Zhi Rong Qian, Douglas A Rubinson, Jing Ma, Howard D Sesso, John M Gaziano, Barbara B Cochrane, Simin Liu, Jean Wactawski-Wende, JoAnn E Manson, Michael N Pollak, Alec C Kimmelman, Amanda Souza, Kerry Pierce, Thomas J Wang, Robert E Gerszten, Charles S Fuchs, Matthew G Vander Heiden, Brian M Wolpin. Elevation of circulating branched-chain amino acids is an early event in human pancreatic adenocarcinoma development. Nature Medicine, 2014; DOI: 10.1038/nm.3686

 

Students all over the world need best possible nutrition

 

11:52 p.m. CDT September 28, 2014

MUR NEWS SchoolLunch 05.jpg

A student takes a free sample of a new sloppy joe recipe being tested at Riverdale High School. (Photo: John A. Gillis/DNJ )

Although the details often are a matter of debate, the general consensus is that good health requires at least two things— good nutrition and exercise.

What precisely constitutes good nutrition is a matter of ongoing research, but most of developed and developing countries have a problem with effects of poor nutrition including high rates of obesity, particularly among children.

The Centers for Disease Control and Prevention reported this year that while the rate of childhood obesity has declined in most states, it has increased in three states — Colorado, Pennsylvania and Tennessee. Tennessee has ranked as high as fourth in the nation in childhood obesity.

Efforts are underway in the state and the nation to reduce rates of childhood obesity.

State government has launched its Eat Well, Play More initiative to try to reduce childhood obesity by a 2015 target date.

The U.S. Department of Agriculture is implementing the Healthy, Hunger-Free Kids Act through public school systems that participate in the national school lunch program.

Among the provisions of the act are increased consumption of fruits and vegetables, reduced consumption of salt and trans fats and fewer calories in meals.

Implementation of these new requirements has not been easy, but we commend the efforts of the Murfreesboro and Rutherford County school systems to implement these new requirements.

The Murfreesboro system is providing free breakfast and lunches to all students in its schools this year, and that is a major undertaking in itself.

Among the criticisms of the new guidelines is that they waste food because students do not want to eat healthier meals, so we commend efforts of the food-service programs to provide not only healthy but also tasty food.

Unfortunately some criticism of the new nutritional requirements has its basis in ideology rather than concern about the health of children now and in the long term.

Students in public schools still have the option to bring their meals with them, and if parents think they can provide healthier food options for their children, they have every opportunity to do so.

City and county school officials have recognized through participation in the national school lunch program that the systems need to assist many parents in providing nutritional meals for their children.

Such nutritious meals help students to be receptive to instruction throughout the day, and if students also learn about what constitutes good nutrition, then so much the better.

Snap 2014-09-29 at 05.14.54