Introduction: the effects of malignant tumors of oral cavity may be reflected through mental, physical, social and emotional well-being and quality of life of patients. Those suffering from malignancies show a large degree of psychological problems (fear, anxiety, depression, panic disorders, phobias) both at the time of diagnosis and during the treatment. Aim: to determine a level of depression in patients with oral cavity cancer and to link quality of life and level of depression of patients with oral cavity cancer. Patients and methods: The study was conducted at the Clinic of Maxillofacial Surgery of the Clinical Center University of Sarajevo (CCUS) in the period from July to late October 2015, through a survey of patients with verified oral cavity cancer, questionnaire related to socio-demographic characteristics of the patients, the University of Washington Quality of Life Questionnaire (UW-QOL), and the Beck Depression Inventory (BDI). Results: Majority of patients from our study, specifically 50 (56%) of them, did not suffer from depression, 8 (9%) respondents suffered from mild depression, 14 (16%) respondents had moderate depression, whereas 17 (19%) of them had severe depression. Conclusion: quality of life and level of depression of patients with oral cavity cancer are in negative and almost linear correlation. The worse the evaluation results of one’s physical or socio-emotional health, the higher degree of depression.

– Competência Clínica. RESUMO Nas últimas duas décadas, ocorreram mudanças curriculares nos cursos de Medicina com o objetivo de formar profissionais humanizados e capazes de atender às demandas atuais. No contexto desse novo modelo, ressalta-se a importância do ensino de comunicação da má notícia na graduação, habilitando acadêmicos a atuar de maneira empática e eficiente. O conteúdo carregado de emoção reforça a necessidade de o médico se preparar adequadamente para saber lidar com as reações dos pacientes e com os próprios sentimentos. Este artigo é um estudo transversal que avaliou, por meio de checklist, a habilidade de comunicação da má notícia apresentada por acadêmicos de Medicina do ciclo pré-clínico em prova prática no modelo Objective Structured Clinical Examination (Osce). Foram avaliados 119 alunos do quarto semestre do curso de Medicina da Universidade de Fortaleza, dos quais 67% obtiveram desempenho global superior ou igual a 90%. A maior dificuldade observada foi em realizar um “anúncio breve” do problema ao transmitir a má notícia, com 35,3% de erro. Em contrapartida, os estudantes foram eficazes em não “dourar a pílula” ao comunicarem o diagnóstico, quesito que obteve índice absoluto de acertos. Além disso, foi analisada a capacidade dos alunos em identificar a influência dos sintomas na vida do paciente, por meio dos estágios do luto de Kübler-Ross e da escala de desempenho clínico Eastern Cooperative Oncology Group (Ecog), obtendo uma porcentagem de acertos de 84,1%. Embora o desempenho global tenha sido avaliado como excelente, estudantes de Medicina do ciclo pré-clínico mostram-se hesitantes em suas primeiras consultas e no primeiro contato com os pacientes, em especial naqueles de forte conteúdo emocional, fato que ficou evidente ao se identificarem as principais falhas cometidas pelos discentes durante a prova prática de comunicação da má notícia. Dessa forma, com o intuito de aprimorar essa habilidade tão importante para a prática médica, reforça-se o uso de nossas experiências de ensino-aprendizagem, como pacientes atores, treinamento entre os pares, abordagem de protocolos padronizados e reflexões acerca da importância dessas estratégias no ensino da má notícia.

The paper explores the revolutionary spirit of literary works of two Romantic poets: George Gordon Byron and Percy Bysshe Shelley. In the period of conservative early 19th century English society that held high regard for propriety, tradition, decorum, conventions and institutionalized religion, the two poets’ multi-layered rebellious and subversive writing and thinking instigated public uproar and elitist outrage, threatening to undermine traditional concepts and practices. Acting as precursors to new era notions and liberties, their opuses present literary voices of protest against 19th century social, religious, moral and literary conventions. Their revolutionary and non-conformist methods and ideas are discussed and analyzed in this paper through three works of theirs: Byron’s The Vision of Judgement and Childe Harold’s Pilgrimage and Shelley’s Prometheus Unbound.

Most, if not all, existing studies on power line communication (PLC) systems as well as industrial PLC standards are based on orthogonal multiple access schemes, such as orthogonal frequency-division multiplexing and code-division multiple access. In this paper, we propose non-orthogonal multiple access (NOMA) for decode-and-forward cooperative relaying PLC systems to achieve higher throughput and improve user fairness. To quantitatively characterize the proposed system performance, we also study conventional cooperative relaying (CCR) PLC systems. We evaluate the performance of the two systems in terms of the average capacity. In this respect, accurate analytical expressions for the average capacity are derived and validated with Monte Carlo simulations. The impact of several system parameters, such as the branching, impulsive noise probability, cable lengths, the power allocation coefficients, and input signal-to-noise ratio, is investigated. The results reveal that the performance of the proposed NOMA-PLC scheme is superior compared with that of the CCR-PLC system. It is also shown that the NOMA-PLC system can be more effective in reducing electromagnetic compatibility associated with PLC and that increasing the network branches can considerably degrade the performance. Moreover, optimizing the power allocation coefficients is found to be of utmost importance to maximize the performance of the proposed system.

The EU Water Framework Directive aims to ensure restoration of Europe’s water bodies to “good ecological status” by 2027. Many Member States will struggle to meet this target, with around half of EU river catchments currently reporting below standard water quality. Diffuse pollution from agriculture represents a major pressure, affecting over 90% of river basins. Accumulating evidence shows that recent improvements to agricultural practices are benefiting water quality but in many cases will be insufficient to achieve WFD objectives. There is growing support for land use change to help bridge the gap, with a particular focus on targeted tree planting to intercept and reduce the delivery of diffuse pollutants to water. This form of integrated catchment management offers multiple benefits to society but a significant cost to landowners and managers. New economic instruments, in combination with spatial targeting, need to be developed to ensure cost effective solutions – including tree planting for water benefits - are realised. Payments for Ecosystem Services (PES) are flexible, incentive-based mechanisms that could play an important role in promoting land use change to deliver water quality targets. The PESFOR-W COST Action will consolidate learning from existing woodlands for water PES schemes in Europe and help standardize approaches to evaluating the environmental effectiveness and cost-effectiveness of woodland measures. It will also create a European network through which PES schemes can be facilitated, extended and improved, for example by incorporating other ecosystem services linking with aims of the wider forests-carbon policy nexus.

P381 Transient periosteal hyperostosis with dysproteinemia (Goldbloom syndrome): two cases report Riccardo Papa, Alessandro Consolaro, Francesca Minoia, Roberta Caorsi, Gianmichele Magnano, Marco Gattorno, Angelo Ravelli, Paolo Picco Pediatria II, Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Radiologia, Istituto Giannina Gaslini, Genoa, Italy Presenting author: Riccardo Papa Pediatric Rheumatology 2017, 15(Suppl 1):P381

PURPOSE Veliparib, a poly (ADP ribose) polymerase inhibitor, potentiated standard chemotherapy against small-cell lung cancer (SCLC) in preclinical studies. We evaluated the combination of veliparib with cisplatin and etoposide (CE; CE+V) doublet in untreated, extensive-stage SCLC (ES-SCLC). MATERIALS AND METHODS Patients with ES-SCLC, stratified by sex and serum lactate dehydrogenase levels, were randomly assigned to receive four 3-week cycles of CE (75 mg/m2 intravenously on day 1 and 100 mg/m2 on days 1 through 3) along with veliparib (100 mg orally twice per day on days 1 through 7) or placebo (CE+P). The primary end point was progression-free survival (PFS). Using an overall one-sided 0.10-level log-rank test, the study had 88% power to demonstrate a 37.5% reduction in the PFS hazard rate. RESULTS A total of 128 eligible patients received treatment on protocol. The median age was 66 years, 52% of patients were men, and Eastern Cooperative Oncology Group performance status was 0 for 29% of patients and 1 for 71%. The respective median PFS for the CE+V arm versus the CE+P arm was 6.1 versus 5.5 months (unstratified hazard ratio [HR], 0.75 [one-sided P = .06]; stratified HR, 0.63 [one-sided P = .01]), favoring CE+V. The median overall survival was 10.3 versus 8.9 months (stratified HR, 0.83; 80% CI, 0.64 to 1.07; one-sided P = .17) for the CE+V and CE+P arms, respectively. The overall response rate was 71.9% versus 65.6% (two-sided P = .57) for CE+V and CE+P, respectively. There was a significant treatment-by-strata interaction in PFS: Male patients with high lactate dehydrogenase levels derived significant benefit (PFS HR, 0.34; 80% CI, 0.22 to 0.51) but there was no evidence of benefit among patients in other strata (PFS HR, 0.81; 80% CI, 0.60 to 1.09). The following grade ≥ 3 hematology toxicities were more frequent in the CE+V arm than the CE+P arm: CD4 lymphopenia (8% v 0%; P = .06) and neutropenia (49% v 32%; P = .08), but treatment delivery was comparable. CONCLUSION The addition of veliparib to frontline chemotherapy showed signal of efficacy in patients with ES-SCLC and the study met its prespecified end point.