Optimization of diacylglycerol production by glycerolysis of fish oil catalyzed by Lipozyme TL IM with Tween 65.

The diacylglycerols (DAG) are emulsifiers with high added value used as functional additives in food, medicine, and cosmetic industries. In glycerolysis of oils for the production of DAG, the immiscibility between the substrates (glycerol and oil phases) has to be overcome, for example, by the addition of a food grade surfactant like Tween 65. The main objective of this work was to optimize the process conditions for obtaining diacylglycerols rich in the omega-3 eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, through the enzymatic glycerolysis of fish oil, in systems with Tween 65 and without this surfactant, using Lipozyme TL(®) IM as biocatalyst. The experiments were performed according to predetermined conditions varying the temperature, enzyme load, the oil to glycerol molar ratio and, when added, the surfactant load. After 6 h of reaction, it was possible to produce up to 20.76 and 13.76% of diacylglycerols from fish oil in the reactions with and without Tween 65, respectively.

Cancer screening in primary care: strategies for your office. A program of the Connecticut Division of the American Cancer Society.

Primary-care physicians' compliance with cancer screening guidelines has been in general unsatisfactory. Mailings have not had the desired effect upon these busy physicians who are preoccupied with many other issues. The Ohio Division of the American Cancer Society developed a program of in-office cancer screening education of primary-care physicians which resulted in a significant improvement in compliance to cancer screening guidelines. The Connecticut Division of the American Cancer Society has pursued this concept with their own program of visits targeted at physicians and their office staffs. A description of this program, which is still in its initial phases, is presented. The impact will be evaluated in due time, however additional volunteers to conduct these visits are needed.

Contradictions in case management: client-centered theory and directive practice with frail elderly.

New long-term care legislation and managed care legitimate case management for gatekeeping and advocacy for frail elderly. Qualitative in-depth interviews with case managers who are social workers and nurses were used to address the question: To what extent is client-centered theory reflected in case management practice? Differences between reported client-centered theory and directive practice were identified by five themes: (a) client wishes versus system constraints; (b) the paradox of working to keep clients home versus the perceived inevitability of nursing home placement; (c) client centeredness versus the case manager's care plan; (d) client self-determination versus strategies of persuasion; (e) informing the client about case management versus the reality of practice. Ethical implications, competing demands, and environmental constraints are discussed. Suggestions are made to better integrate client-centered theory with directive practice.

Case managers and physicians: communication and perceived problems.

OBJECTIVE: To describe case managers' perceptions of the physician-case manager relationship. DESIGN: A qualitative field study using in-depth open-ended interviews was used to elicit case managers' experiences and practices. A multidisciplinary team analyzed transcripts using an adaptation of the "grounded theory" approach of Glaser and Strauss. PARTICIPANTS/SETTING: Case managers were selected for interview using a maximum variation sampling strategy within an established state-wide case management agency. MAIN OUTCOME MEASURES: Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses. RESULTS: Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home-bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda. CONCLUSIONS: From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals.

The effect of advanced age on the efficacy of radiation therapy for early breast cancer, local prostate cancer and grade III-IV gliomas.

PURPOSE: This study was undertaken to determine the effect of advanced age on radiation therapy outcomes for early breast cancer, local prostate cancer and Grade 3-4 gliomas of the brain. METHODS AND MATERIALS: Radiation therapy outcomes for three malignancies (N = 1,401) were determined for a geriatric cancer population defined as 70 years of age or older and compared to a non-geriatric cancer population defined as less than 70 years of age. The three patient groups studied were: (a) primary breast cancer patients with clinical Stage I or II disease treated with lumpectomy and radiation therapy (N = 994), (b) local prostate cancer patients with Stage A2, B, or C disease treated with radical radiation therapy (N = 294), and (c) patients with Grade 3-4 gliomas of the brain treated with high dose radiation therapy (N = 113). RESULTS: For Stage I and II breast cancer, there was no statistically significant difference in the overall 10-year survival rates (63% vs. 73%), 10-year cause-specific disease-free survival rates (70% vs. 63%), and 10-year local breast recurrence free survival rates (76% vs. 79%) comparing the geriatric cancer population to the non-geriatric cancer population. For local prostate cancer, there was no statistically significant difference in the 10-year survival rates (38% vs. 41%) or in the 10-year cause-specific disease-free survival rates (58% vs. 52%) in the geriatric population compared with the non-geriatric population. On the other hand, the use of high dose radiation therapy for malignant gliomas resulted in statistically significant inferior 1-year (18% vs. 38%) and 2-year (0% vs. 10%) survival rates for the geriatric population versus the non-geriatric population. CONCLUSION: This study strongly supports the use of standard radiation therapy programs for early breast and prostate cancer patients age 70 years or more. However, our study raises questions about the efficacy of radiation therapy in patients over the age of 70 years with Grade 3-4 gliomas.

Needle placement of myelography.

Proper placement of the entire bevel of the spinal needle within the subarachnoid space at myelography is necessary to prevent partial extra-arachnoid deposition of the contrast medium. A Cuatico aspiration cannula passed through the spinal needle at the time of spinal puncture serves to indicate the depth of the needle tip within the subarachnoid space.