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Surgical management in epithelial ovarian cancer (EOC) has a significant impact in overall survival and progression-free survival. The Brazilian Society of Surgical Oncology (BSSO) supported a taskforce of experts to reach a consensus: experienced and specialised trained surgeons, in cancer centres, provide the best EOC surgery. Laparoscopic and/or radiological staging prognosticates the possibility of complete cytoreduction (CC0) and helps to reduce unnecessary laparotomies. Surgical techniques were reviewed. Multidisciplinary input is essential for treatment planning. Quality assurance criteria are proposed and require national consensus. Genetic testing is mandatory. This consensus states the final recommendations from BSSO for management of EOC.Tweetable Abstract: Brazilian Society of Surgical Oncology consensus for surgery in epithelial ovarian cancer patients. [ABSTRACT FROM AUTHOR]

Background. Internationally, the development of partnerships between institutions of higher learning and the communities they serve is stressed as a priority. The Umthombo Youth Development Foundation (UYDF) is an educational model developed in rural KwaZulu-Natal, South Africa as a response to the scarcity of medical personnel in hospitals. Community involvement in health professional education has become a key strategy in the model, and review of the model may provide lessons for other educators towards implementing community involvement in health professional education. Objective. To review the UYDF, with emphasis on aspects of community involvement. Methods. This qualitative study used a social accountability theoretical framework. Data were collected using the Appreciative Inquiry method and participants who were involved in the UYDF model were interviewed. Themes arising around community involvement were generated inductively. Results. Community involvement in health professional education grew from a funding requirement and has strengthened over time to become an integral component of the UYDF model. Community involvement occurred mainly at the student selection process, but continued during education and after graduation. Participants suggested means by which community involvement could be strengthened. Conclusion. The UYDF successfully presents a model that facilitates community involvement in health professional education. Lessons learnt could guide other models, and the UYDF model could be strengthened by further research. [ABSTRACT FROM AUTHOR]

Background. In general, the principles of palliative care suggest that, at some stage, patients should be given 'bad news' about poor illness prognosis. The information is often important for care planning, especially when it involves disclosure to children. Although there are ongoing debates about whether to tell or not to tell children bad news, these debates have largely been informed by patients who live in a developed-world context. In contrast, this paper focuses on telling bad news to children and their families from a rural, developing-world context. Objective. To analyse the experiences of providers of palliative care to children when they attempted to fulfil one of their roles as palliative caregivers, i.e. to prepare patients and families for a child's poor illness prognosis. Method. This was an exploratory study that was approached qualitatively. Five nurses and eight home-based care workers who provided palliative care for children in rural areas of South Africa formed a purposive, information-rich, self-selected sample. Data were produced through discussions with participants, using photographs taken by the caregivers to stimulate and contextualise the discussions. Results. Participants experienced four dilemmas with regard to telling bad news: when families did not want to be told any bad news; when participants felt uncomfortable about telling bad news; when participants and patients shared dissimilar values about telling bad news; and when participants were unsure about when to tell bad news. Conclusion. In the rural areas where the study was conducted, children are not usually given bad news about their illness. Disclosing poor prognosis led to the dilemmas faced by caregivers. The result was that the emotionally charged work of caring for children reaching the end of their lives became more challenging for the caregivers because they were not prepared for cultural complexities. In view of the findings of this study, there is a need for ongoing research into paediatric palliative caregiving in context. [ABSTRACT FROM AUTHOR]

Objectives: There are challenges when it is considered that a main role of a rural clinical attachment for medical students is to encourage students to return after graduation to practise in rural areas. This view may lead to the relative neglect of other potential valuable roles with regard to rural exposure. This paper draws on the Force Field Model of teacher development to describe medical students' experiences, illustrate the complexity of interacting factors during rural exposure, caution that experiences cannot be predicted and highlight the positive incentives of a rural clinical attachment. Design: The design was explorative, descriptive and qualitative. Setting: The study setting was a district hospital in rural KwaZulu-Natal. Subjects: The participants were four final-year medical students who had completed a compulsory attachment during their Family Medicine rotation. Outcome measures: Data were collected using photo elicitation and analysed using the Force Field Model. Results: The participants felt that overall the experience was positive. The effect of biography and contextual forces were not as strong as expected. Institutional forces were important and programmatic forces tended to have a negative effect on experiences. The participants particularly enjoyed being acknowledged and felt empathy for the difficult tasks of doctors. Conclusion: The potential role of a clinical attachment may go beyond attracting students to practise in rural areas. The experience can be beneficial, irrespective of where the student decides to practise after graduation. There is a need for a review of the rural attachment curriculum and paedagogy. Caution should be used when screening medical students for suitability to work in rural areas prior to rural exposure. [ABSTRACT FROM AUTHOR]

We examined factors and pathways involved in the transfer of mercury (Hg) to the food web in St. Lawrence River embayments near Cornwall, Ontario, where natural remediation of contaminated sediments (eventual burial by settling of cleaner sediments) has been adopted as a management strategy. Yellow perch ( Perca flavescens) from one of the study zones (Zone 1) along the river by Cornwall contained significantly higher total mercury (THg) concentrations than perch from other equally contaminated zones. While THg concentrations in benthic invertebrates did not vary among contaminated zones, THg concentrations in yellow perch and invertebrate prey recovered from the perch stomachs were 1.5–2.5 times higher in Zone 1 than those from other zones, suggesting that prey selection affects THg accumulation more than habitat location. No significant differences were found in THg concentrations among different prey species within Zone 1, although there were significant differences in THg concentrations in the same prey species within Zone 1. In contrast, THg concentrations among different prey species increased significantly with trophic level in other contaminated and reference zones. The lack of correspondence between trophic position and THg accumulation in Zone 1 suggests two possibilities: (1) yellow perch in Zone 1 are highly mobile and are assimilating THg from a wide range of prey across Zone 1 with variable THg concentrations and (2) there may be an important non-dietary source of THg to the Zone 1 food web. Potential waterborne Hg sources to Zone 1 were investigated. Whereas THg and MeHg values in discharges from a disused canal were similar to Zone 1 surface water values (0.97 and 0.04 ng l−1, respectively), concentrations in storm sewer and combined sewer overflows discharging in the vicinity of Zone 1 were 19–45-fold (THg) and 2–4-fold (MeHg) higher than upstream river water. Contributions of Hg to the water column from sediment–water diffusion, estimated using a simple, well-mixed reactor model, ranged 0.05–0.1% of the surface water THg concentration and 1–2% of the MeHg concentration measured in summer months in Zone 1. Although not investigated in the other zones, a strong correlation ( r2 = 0.82) was found between MeHg in porewater and amphipod concentrations in Zone 1, indicating that the sediment porewater is bioavailable and likely an important pathway for transfer of sediment Hg to the foodweb. Large areas of Zone 1 contain bark deposits and produce high rates of gas ebullition, and may not provide favourable conditions for progressive burial with clean sediments and attenuation of Hg transfer to biota through natural remediation. Careful monitoring of surface sediment concentrations and biota is required in these areas. Failure to reduce concentrations of Hg in these media would indicate alternative or additional management measures are required. [ABSTRACT FROM AUTHOR]

The article discusses issues related to domestic legislation and the requirements of multilateral agreements in the Caribbean region. There is a growing concern regarding the effects of the utilization on the conservation status of the marine turtle species. This species have been placed on the most protective annexes of certain multilateral environmental agreements.

The Broughton Formation, the basal part of the lower Upper Permian (ca 264–263 Ma) Gerringong Volcanics of the Kiama area of the southern Sydney Basin, comprises intercalated shoshonitic lava flows and shallow-marine, predominantly volcaniclastic, sediments emplaced under periglacial climatic conditions at high palaeolatitude. Four lower members of the Gerringong Volcanics (the Westley Park Sandstone, Blow Hole Latite, Kiama Sandstone and Bumbo Latite Members) were examined to elucidate the lava-flow directions and coeval palaeophysiography. Field evidence indicates that the individual flows that comprise the compound-flow-units of the Blow Hole and Bumbo Latites advanced toward the north-northwest and north, respectively, from an emergent island volcano or volcanic archipelago that developed offshore of the present-day coastline, some tens of kilometres south-southeast of Kiama. The field evidence incorporates descriptions and interpretations of features including vesicles and amygdales, lava tubes, pillow lavas and contact relationships between coherent lavas and sediments and brecciated lava. The similarity of the coherent lavas and volcaniclastic components in the intercalated sediments and in the underlying uppermost Berry Siltstone indicate that the lavas and the volcaniclastic material shared a common source. Lava flows and epiclastic deposits contributed to the formation of the volcanic edifice, as probably did hyaloclastic and pyroclastic and reworked pyroclastic deposits. Much fragmental volcanic material was dispersed into the local shallow-marine environment by mass flows that were generated by a variety of mechanisms on the volcano’s subaerial and subaqueous slopes. Redistribution of the volcanogenic sediment and erosion of the lava flows was influenced by longshore marine currents that flowed predominantly northwards across the basin floor. The Gerringong Volcanics constitute the oldest onshore-preserved record of the regional onset... [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in which the authors cite the need to have a balance between communitarianism and individualism and how community consideration is important in South Africa as the concept of Ubuntu may be an important part of societal norms.

Treatment with angiotensin-converting enzyme (ACE) inhibitors is frequently associated with persistent dry cough. This side effect is thought to be due to the non-specific action of ACE inhibitors, which, in addition to suppressing the renin-angiotensin system (RAS), leads to the accumulation of kinins, encephalins and other biologically active peptides. Candesartan cilexetil is a new, long-acting angiotensin II type 1 (AT1) receptor blocker, which offers a more specific means of suppressing the RAS than can be achieved with ACE inhibitors. In this study, we compared the incidence and severity of cough during treatment with candesartan cilexetil, enalapril and placebo in patients with hypertension and enalapril-induced cough. Men and women, aged 20-80 years, with a history of medically treated primary hypertension and ACE-inhibitor-related cough were enrolled. The presence of cough was confirmed during a 4-week challenge period with enalapril, 10 mg, which abated during a subsequent 4-week washout period with placebo. Patients with confirmed ACE-inhibitor-related cough were then randomized to double-blind treatment with candesartan cilexetil, 8 mg once daily (n = 62), enalapril, 10 mg once daily (n = 66), or placebo (n = 26). Baseline blood pressure was similar in all groups. Although blood pressure was recorded during the study, this was for safety monitoring, and the measurements were not standardized in relation to study drug intake or time of day. The frequency of dry cough was recorded on a visual analogue scale (VAS). For each assessment, patients marked a cross on a straight horizontal 100 mm line, rating cough frequency from “none of the time” at one end of the line to “all of the time” at the other end. The impact of treatment on quality of life was also studied, using the Symptom Assessment (SA) questionnaire and the Minor Symptom Evaluation (MSE) profile. The SA questionnaire assessed the severity of nine symptoms, including dry cough, by means of a five-graded Likert scale (not at all, a little, moderately, quite a bit, extremely). Changes in the three dimensions of the MSE profile - contentment, vitality and sleep - were recorded using a VAS. Candesartan cilexetil was superior to enalapril regarding the change in frequency (p = 0.001) and severity (p < 0.001) of dry cough. After 8 weeks of treatment, the proportions of patients with cough were 26.9% for placebo, 35.5% for candesartan cilexetil and 68.2% for enalapril (p < 0.001, candesartan cilexetil versus enalapril; p > 0.20, candesartan cilexetil versus placebo). Treatment with candesartan cilexetil did not compromise patients' well-being. Compared with placebo, candesartan cilexetil was superior in terms of its effect on contentment; similar trends were noted for vitality and sleep, although the differences were not significant. When all adverse events were considered, candesartan cilexetil was very well tolerated. No serious adverse events occurred in the candesartan cilexetil or placebo groups, while three patients in the enalapril group reported serious adverse events (chest pain, agranulocytosis, accidental fracture). No treatment-related changes of clinical relevance could be found with regard to laboratory variables, ECG or vital signs/physical findings, except the anticipated blood pressure reduction in the active treatment groups. In conclusion, candesartan cilexetil is not associated with cough in hypertensive patients with previous ACE-inhibitor-induced cough. The incidence of dry cough in patients treated with candesartan cilexetil was similar to that of placebo and lower than that of enalapril. [ABSTRACT FROM AUTHOR]

Treatment with angiotensin-converting enzyme (ACE) inhibitors is frequently associated with persistent dry cough. This side effect is thought to be due to the non-specific action of ACE inhibitors, which, in addition to suppressing the renin-angiotensin system (RAS), leads to the accumulation of kinins, encephalins and other biologically active peptides. Candesartan cilexetil is a new, long-acting angiotensin II type 1 (AT 1 ) receptor blocker, which offers a more specific means of suppressing the RAS than can be achieved with ACE inhibitors. In this study, we compared the incidence and severity of cough during treatment with candesartan cilexetil, enalapril and placebo in patients with hypertension and enalapril-induced cough. Men and women, aged 20-80 years, with a history of medically treated primary hypertension and ACE-inhibitor-related cough were enrolled. The presence of cough was confirmed during a 4-week challenge period with enalapril, 10 mg, which abated during a subsequent 4-week washout period with placebo. Patients with confirmed ACE-inhibitor-related cough were then randomized to double-blind treatment with candesartan cilexetil, 8 mg once daily ( n = 62), enalapril, 10 mg once daily ( n = 66), or placebo ( n = 26). Baseline blood pressure was similar in all groups. Although blood pressure was recorded during the study, this was for safety monitoring, and the measurements were not standardized in relation to study drug intake or time of day. The frequency of dry cough was recorded on a visual analogue scale (VAS). For each assessment, patients marked a cross on a straight horizontal 100 mm line, rating cough frequency from 'none of the time( at one end of the line to 'all of the time( at the other end. The impact of treatment on quality of life was also studied, using the Symptom Assessment (SA) questionnaire and the Minor Symptom Evaluation (MSE) profile. The SA questionnaire assessed the severity of nine symptoms, including dry cough, by means of a five-graded Likert scale (not at all, a little, moderately, quite a bit, extremely). Changes in the three dimensions of the MSE profile - contentment, vitality and sleep - were recorded using a VAS. Candesartan cilexetil was superior to enalapril regarding the change in frequency ( p = 0.001) and severity ( p < 0.001) of dry cough. After 8 weeks of treatment, the proportions of patients with cough were 26.9% for placebo, 35.5% for candesartan cilexetil and 68.2% for enalapril ( p < 0.001, candesartan cilexetil versus enalapril; p > 0.20, candesartan cilexetil versus placebo). Treatment with candesartan cilexetil did not compromise patients' well-being. Compared with placebo, candesartan cilexetil was superior in terms of its effect on contentment; similar trends were noted for vitality and sleep, although the differences were not significant. When all adverse events were considered, candesartan cilexetil was very well tolerated. No serious adverse events occurred in the candesartan cilexetil or placebo groups, while three patients in the enalapril group reported serious adverse events (chest pain, agranulocytosis, accidental fracture). No treatment-related changes of clinical relevance could be found with regard to laboratory variables, ECG or vital signs/physical findings, except the anticipated blood pressure reduction in the active treatment groups. In conclusion, candesartan cilexetil is not associated with cough in hypertensive patients with previous ACE-inhibitor-induced cough. The incidence of dry cough in patients treated with candesartan cilexetil was similar to that of placebo and lower than that of enalapril. [ABSTRACT FROM AUTHOR]