Extemporaneous compounding of dabrafenib and trametinib for cancer patients with feeding tubes.

INTRODUCTION: Dabrafenib and trametinib are oral targeted agents indicated for BRAF mutated non-small cell lung cancer and melanoma. There is little data to support the administration of these two agents via enteral feeding tube. This case series describes three patients who received compounded dabrafenib and trametinib suspensions through enteral feeding tubes. CASE REPORT: We present three patients who required dabrafenib and trametinib to be prepared as a non-standard compound for the medications to be administered via feeding tube. The patients were diagnosed with with BRAF mutated cancers including melanoma, non-small-cell lung carcinoma, and anaplastic thyroid cancer. In all three cases, there was evidence of initial disease response on imaging, and there were no unexpected toxicities secondary to dabrafenib and trametinib. DISCUSSION: There are patients that are unable to tolerate medications by mouth due to dysphagia, anatomical malfunctions, or other digestive disorders. There is limited literature that describes preparation of trametinib and dabrafenib into an enteral suspension. Identifying a safe and efficacious method of administering these two medications via feeding tube ensures that these patients continue to be able to receive them as part of their anti-cancer therapy. CONCLUSION: Despite the lack of available data, compounding of dabrafenib and trametinib may be clinically appropriate when benefits outweigh the risk of unconventional administration. Further studies are warranted to assess for the pharmacokinetics, pharmacodynamics, stability, and storage for these liquid medications.

Rice land protection in a transitional economy: The case of Vietnam.

Agricultural land protection (ALP) is a standard policy response to a desire for food security. However, ALP may result in a misallocation of resources. Examining rice land policy in Vietnam, we determine the optimal level of rice land protected against other crops using a stochastic optimization model built on top of a general equilibrium framework, combined with sequential micro-simulations on household data. We find that converting part of protected rice land enhances economic efficiency. Nonetheless, the policy is relatively pro-rich, implying a trade-off between poverty reduction and economic efficiency, making some households in already poor areas worse off. Our approach can be applied to land-use planning generally, highlighting the relevant tradeoffs and the search for needed optimal land-use policies.

Behaviors of printed circuit boards due to microwave supported curing process of coating materials.

The Application of a microwave supported curing process for coatings in the field of electronic industry poses a challenge. Here the implementation of this technology is represented. Within the scope of the investigation special PCB Test Layouts were designed and the polymer curing process examined by the method of dielectric analysis. Furthermore the coupling of microwave radiation with conductive PCB structures was analyzed experimentally by means of special test boards. The formation of standing waves and regular heating distribution along the conductive wires on the PCB could be observed. The experimental results were compared with numerical simulation. In this context the numerical analysis of microwave PCB interaction led to important findings concerning wave propagation on wired PCB. The final valuation demonstrated a substantial similarity between numerical simulations and experimental results.

Pain and palliative medicine.

Severe pain is highly prevalent, with rates of 40% to 70% in patients with advanced cancer, liver disease, heart failure, human immunodeficiency virus, and renal failure. Wide variations in pain assessment and reporting methods and the measurement of multiple symptoms should be addressed in future studies. Regarding psychological approaches, determining whether hypnotherapy or other individual psychotherapeutic interventions reduce pain and/or psychological distress in a palliative care population is difficult. Interest is increasing in the concept of demoralization syndromes and the role of posttraumatic stress disorder in modulating responses to pain at the end of life. We review evidence from multiple studies that the use of rehabilitative therapy improves functional status and pain control among patients with advanced cancer, and we raise the possibility that rehabilitation therapy will be helpful in patients with other advanced diseases. We summarize ongoing clinical trials of electronic order sets, clinical care pathways, and care management pathways to improve pain management in palliative care. Wagner's Chronic Illness Model provides a way of analyzing how healthcare systems can be changed to provide adequate and continuing pain management in palliative care. Much work remains to ensure that pain is recognized, treated, and monitored effectively.