Register-based studies on childhood cancer : relapsed childhood acute lymphoblastic leukemia and skeletal adverse events in childhood cancer survivors in the Nordic countries

Background: Although cancer is a rare disease in children, it is the leading disease-related cause of death in children and adolescents in developed countries. Currently 80% of patients become long-time survivors but if a relapse occurs the outcome for most patients is still poor. Childhood cancer survivors are also at increased risk of chronic health conditions caused by the cancer treatment. The skeletal system is vulnerable to the toxic effects of cancer treatment during childhood and adolescence. Skeletal adverse events are not life- threatening events but may have a large impact on the quality of life and daily functions of childhood cancer survivors. Aims: The overall aim of this thesis is to explore the use of the unique Nordic registry data to find ways to improve outcomes in childhood cancer. In studies I and II we identified a cohort of patients with relapsed acute lymphoblastic leukemia (ALL) within the NOPHO ALL registry and searched for factors associated with overall survival and treatment-related mortality (TRM). In studies III and IV, we used both the Nordic public health data registries and arthroplasty quality registries to explore the life-time pattern of skeletal late adverse events in a large cohort of childhood cancer survivors and to identify vulnerable subgroups. Results: In study I, we observed an improvement in the 5-year overall survival after relapse of ALL between 1992-2001 and 2002-2011. We identified risk factors independently associated with death: short duration in first remission, bone marrow relapse, age ≥10 years at primary diagnosis, unfavorable cytogenetics and Down syndrome. Our findings indicate that the currently used risk stratification underestimates the risk of second relapses in patients with combined B-precursor relapses. In study II, we identified 52 patients who met criteria for TRM but we did not observe a reduction of TRM over time. Infections, predominantly bacterial infections, were the most common cause of death. Factors associated with TRM were high-risk stratification at relapse, unfavorable cytogenetics and allogeneic HSCT. In study III, we observed a 35% increased hospitalization risk for skeletal adverse events among childhood cancer survivors compared to population comparison subjects. For most of the skeletal adverse events the risk was highest in the years close to the treatment, but an excess risk extended for decades for some of the events. The relative risk was particularly high for osteonecrosis, especially among patients with hematological malignancies and patients diagnosed with cancer between 10-19 years of age. In study IV, we observed an increased risk for hip arthroplasties among survivors of leukemia and lymphoma and for knee arthroplasties among survivors of malignant bone tumors. The rate of arthroplasty operations was highest in early adulthood. Conclusions: Finding ways to balance the treatment intention of inducing and maintaining long-term remission against the potential risk of life-threatening or long-term treatment complications is becoming more difficult. Individualized treatment approaches and novel strategies are therefore needed both to increase survival and improve health in patients with childhood cancer. Despite different study designs and end-points, studies I-IV provide evidence that the Nordic registry data can be used as excellent research tools to increase our knowledge on childhood cancer. The Nordic countries are in a unique position to conduct registry studies on childhood cancer by combining data from public health registries and different quality registries. The design of the registries and the regulatory framework should aim to facilitate research using this valuable source of information

Deliverable DJRA1.3: Tool prototype for creating and stitching multiple network resources for virtual infrastructures

This document describes the prototype FEDERICA Slice Tool developed for the virtualization of network elements in FEDERICA and for creating and stitching network resources over this virtual infrastructure. An SNMP-based resource discovery prototype is also introduced as a new functionality to be integrated in the tool.The deliverable also presents aviability study for the use of traffic prioritization in the FEDERICA infrastructure and some network performance measurements on a real slice within FEDERICA.This document reports the final results of JRA1.2 Activity in the development of a tool prototype for creating sets ofvirtual resourcesinFEDERICA.The prototype goal is to simplify and automate part of the work for NOC.The tool may also serve,with different privileges, a FEDERICA user to operate on his/her slice. The tool described here was designed with the objective of providing an interactive application with a graphical interface to operate on resources for the NOC and the end users (researchers). The tool simplify the creation and configuration of resources in a slice and it is a mandatory step to ensure scalability of the NOC effort. It offers an interactive Graphical User Interface that translates the users’ actions to commands in the substrate (networknodesandV-nodes)andslice elements(VirtualMachines).User accounts may be created for the NOC and for researchers, each with specific privileges to enable different sets of capabilities. The NOC account has full access to all the resources in the substrate, while each user’account has full access only to the virtual resources in his/her slice. The tool has been developed using the Java programming language as Open Source code and relies on the open source Globus® Toolkit. Testing has been performed in a laboratory environment and on some FEDERICA substrate equipment (1switch, 2VMwareServers) in their standard configuration. For testing the router, web services and GUI an additional computer was used, using a public IP address.Postprint (published version

Hvernig gengur í skólanum?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkin

Deliverable DJRA1.2. Solutions and protocols proposal for the network control, management and monitoring in a virtualized network context

This deliverable presents several research proposals for the FEDERICA network, in different subjects, such as monitoring, routing, signalling, resource discovery, and isolation. For each topic one or more possible solutions are elaborated, explaining the background, functioning and the implications of the proposed solutions.This deliverable goes further on the research aspects within FEDERICA. First of all the architecture of the control plane for the FEDERICA infrastructure will be defined. Several possibilities could be implemented, using the basic FEDERICA infrastructure as a starting point. The focus on this document is the intra-domain aspects of the control plane and their properties. Also some inter-domain aspects are addressed. The main objective of this deliverable is to lay great stress on creating and implementing the prototype/tool for the FEDERICA slice-oriented control system using the appropriate framework. This deliverable goes deeply into the definition of the containers between entities and their syntax, preparing this tool for the future implementation of any kind of algorithm related to the control plane, for both to apply UPB policies or to configure it by hand. We opt for an open solution despite the real time limitations that we could have (for instance, opening web services connexions or applying fast recovering mechanisms). The application being developed is the central element in the control plane, and additional features must be added to this application. This control plane, from the functionality point of view, is composed by several procedures that provide a reliable application and that include some mechanisms or algorithms to be able to discover and assign resources to the user. To achieve this, several topics must be researched in order to propose new protocols for the virtual infrastructure. The topics and necessary features covered in this document include resource discovery, resource allocation, signalling, routing, isolation and monitoring. All these topics must be researched in order to find a good solution for the FEDERICA network. Some of these algorithms have started to be analyzed and will be expanded in the next deliverable. Current standardization and existing solutions have been investigated in order to find a good solution for FEDERICA. Resource discovery is an important issue within the FEDERICA network, as manual resource discovery is no option, due to scalability requirement. Furthermore, no standardization exists, so knowledge must be obtained from related work. Ideally, the proposed solutions for these topics should not only be adequate specifically for this infrastructure, but could also be applied to other virtualized networks.Postprint (published version

Marketing communication towards cruise ship passengers: the implications of market segmentation

Tourism in Iceland has been growing incredibly fast during the past years; for example, the cruise industry has grown at a rapid rate, as Iceland continues to gain popularity as a cruise destination. Although a certain amount of research has been conducted in this sphere, it does not cover all of the important issues, including a better insight into clustering of cruise ship passengers, who differ from other tourists in a number of ways, and marketing communication towards them regarding product and services offered at the point of destination. The main objective of this research is to examine factors that have an impact on potential segmentation of cruise ship passengers coming to Iceland and learn about marketing communication practices used by local companies offering them products and services. Qualitative research was used as an approach and personal interviews chosen as a means of collecting information. Interviews were taken with 10 people from different companies who interact with cruise passengers on a regular basis at their workplace. The main findings reveal that participants note the strongest difference between cruise passengers of different nationalities, passengers coming on different ships (size and type), and passengers arriving at different times of the year. Concerning marketing communication towards cruise passengers, the results indicate that it is almost exclusively carried out through the Internet; a reliable website, search engine optimization and word-of-mouth. This research provides a contribution by deepening understanding of approaches that may be effective in market segmentation in this particular section of the tourism industry and identifying effective ways to reach potential customers. This research thus provides a significant addition to marketing knowledge for an increasingly important sector of the tourist industry.Peer Reviewe

The Reykjavik Medical Society at 100 years. Doctors and Society

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenEitt hundrað ár eru ekki langur tími í sögu læknisfræðinnar almennt, enda nær sú saga örugglega langt aftur fyrir elstu skrifuðu heimildir. Mannskepnan hefur örugglega reynt að bæta heilsu sína og græða sár sín frá því hún fór að ganga um á þessari jörð. Í sögu lækninga á Íslandi eru eitt hundrað ár ekki heldur svo langur tími. Skráðar heimildir um lækningar á Íslandi er að finna í Íslendingasögum og í annálum. Óhætt er að fullyrða að frá næstsíðustu aldamótum hafi framfarir í læknisfræði orðið hvað stórstígastar; sama hvort litið er til rannsókna á uppruna og eðli sjúkdóma, greiningar þeirra eða meðferðar. Bætt heilsa, auknar lífslíkur og lífslengd, eru vissulega ekki aðeins afrakstur þessa heldur ráða hér miklu almennir hollustuhættir, mataræði og betri félagslegur aðbúnaður borgaranna. Það er því ánægjulegt að hugsa til þess að allt frá stofnun Læknafélags Reykjavíkur á haustmánuðum 1909 og á fyrstu áratugunum í sögu þess var félaginu ekki aðeins beitt til þess að bæta alla starfsaðstöðu lækna og þjónustu við sjúklinga, heldur lagði það einnig mikla áherslu á almenningsfræðslu um heilbrigði og hollustu, á sóttvarnir almennt og varnir gegn kynsjúkdómum. Læknafélag Reykjavíkur tók líka frumkvæði í eða hvatti til stofnunar félaga eins og Berklavarnafélags Íslands og Rauðakrossdeildar Alþjóða Rauða krossins á Íslandi, svo að fátt eitt sé nefnt

The use of embryonic stem cells for medical-therapeutical purposes: ethical issues

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenThe capacity of self-renewal and differentiation renders stem cells an appealing option for cell replacement therapy. Although stem cells are known to exist in fully differentiated tissues, those derived from embryos have generated greater scientific interest due to their capacity for differentiation. The use of embryos as a source of stem cells raises, however, difficult ethical questions, since removing stem cells from an embryo terminates further development of the embryo. The ethics debate on the use of embryonic stem cells focuses on the biological and ethical status of the embryo and the sanctity of life. This paper reviews various ethical issues pertinent to the use of embryonic stem cells for medical purposes.Þar sem stofnfrumur geta fjölgað sér endalaust og sérhæfst í aðrar frumutegundir þykja þær sérlega athyglisverðar frá sjónarhóli læknavísindanna. Hefur athygli vísindamanna sérstaklega beinst að stofnfrumum fósturvísa þar sem sérhæfingargeta þeirra er öðrum stofnfrumum meiri. Við að nálgast þessar stofnfrumur stöðvast þroski fósturvísisins og því hafa slíkar framkvæmdir vakið upp margar áleitnar siðferðisspurningar. Umræðan um siðferðilegt réttmæti þess að nota stofnfrumur fósturvísa til lækninga snýst því í reynd um siðferðisstöðu fósturvísisins, upphaf lífsins og helgi þess. Í þessari yfirlitsgrein er varpað ljósi á þau sjónarmið sem hæst ber í umræðunni um réttmæti þess að nota stofnfrumur úr fósturvísum til lækninga

An evaluation of diagnosis and treatment of acute sinusitis at three health care centers

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland. MATERIAL AND METHODS: Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month). RESULTS: The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin. CONCLUSIONS: The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.Tilgangur: Tilgangur rannsóknarinnar var að meta greiningu og meðferð bráðrar skútabólgu á þremur heilsugæslustöðvum á Norður- og Austurlandi, með áherslu á sýklalyfjanotkun. Aðferðir og efniviður: Gerð var leit í SÖGU að þeim sem greindust með bráða skútabólgu (ICD 10 J01.0, J01.9) á heilsugæslustöðvunum á Akureyri, Egilsstöðum og Húsavík árið 2004. Síðan voru allir viðkomandi samskiptaseðlar skoðaðir og lykilatriði við greiningu og meðferð skráð. Til að fá sem jafnasta dreifingu á fjölda var einungis þriðjungur tilfella á Akureyri tekinn með í reikninginn (fyrstu tíu dagar hvers mánaðar). Upplýsingasöfnun fór fram í febrúar 2006. Niðurstöður: Heildarfjöldi tilfella var 468. Nýgengi bráðrar skútabólgu mældist 3,4 á hverja 100 íbúa á ári. Fylgni við greiningarskilmerki bakteríuskútabólgu samkvæmt erlendum klínískum leiðbeiningum var lítil. Mikill munur kom í ljós milli staða í notkun myndgreiningar (Húsavík 24%, Akureyri 6%, Egilsstaðir 3%). Sjúkdómurinn var greindur í gegnum síma í 28% tilvika (Húsavík 38%, Akureyri 32%, Egilsstaðir 10%). Yfir 90% greindra voru meðhöndluð með sýklalyfjum, óháð tímalengd einkenna. Oftast voru notuð sýklalyfin doxýcýklín (36,7%) og amoxicillín (36,7%). Ályktanir: Nýgengi bráðrar skútabólgu virðist sambærilegt því sem gerist í öðrum vestrænum löndum. Bráð skútabólga af völdum baktería er sennilega ofgreind, og notkun sýklalyfja er úr öllu samhengi við klínískar leiðbeiningar. Niðurstöðurnar styðja þá tilgátu að læknar hneigist til að líta á bráða skútabólgu sem bakteríusýkingu og meðhöndli hana í samræmi við það

The regulatory environment of entrepreneurs in Iceland: Analysis of current situation and opportunities for improvements

Þar sem helstu atvinnugreinar Íslands eru bundnar stækkunartakmörkunum gegna aðrar atvinnugreinar auknu mikilvægi í íslenskum efnahag. Í þessu samhengi sinna frumkvöðlafyrirtæki þýðingarmiklu hlutverki, en til að þau geti dafnað og staðist samkeppni á erlendum mörkuðum þarf sá reglugerðargrunnur sem fyrirtækin eru stofnuð á að vera nútímalegur, hagkvæmur og skilvirkur. Markmið þessarar greinar er að varpa ljósi á reglugerðarumhverfi frumkvöðla og greina hvort og þá hvar helstu tækifæri til úrbóta gætu legið. Rannsóknin byggir annars vegar á djúpviðtölum við sex frumkvöðla sem hafa stofnað og rekið nokkur þekkt frumkvöðlafyrirtæki og náð árangri á alþjóðlegum mörkuðum, eða fyrirtæki sem eru skemmra á veg komin og eru að fóta sig í umhverfi íslenskra frumkvöðlafyrirtækja. Hins vegar byggir rannsóknin á samanburði reglugerðarumhverfis á Íslandi við önnur lönd þar sem slíkt umhverfi hefur verið skoðað í alþjóðlegum greiningum. Niðurstöðurnar sýna að reglugerðarumhverfi íslenskra frumkvöðla er að mörgu leyti hagkvæmara en í samanburðarlöndunum, en þó eru enn tækifæri til úrbóta.Peer Reviewe

A new compilation of stomach content data for commercially-important pelagic fish species in the Northeast Atlantic

There is increasing demand for information on predator–prey interactions in the ocean as a result of legislative commitments aimed at achieving sustainable exploitation. However, comprehensive data sets are lacking for many fish species and this has hampered development of multispecies fisheries models and the formulation of effective food-web indicators. This work describes a new compilation of stomach content data for five pelagic fish species (herring, blue whiting, mackerel, albacore and bluefin tuna) sampled across the northeast Atlantic and submitted to the PANGAEA open-access data portal (www.pangaea.de). We provide detailed descriptions of sample origin and of the corresponding database structures. We describe the main results in terms of diet composition and predator–prey relationships. The feeding preferences of small pelagic fish (herring, blue whiting, mackerel) were sampled over a very broad geographic area within the North Atlantic basin, from Greenland in the west, to the Lofoten Islands in the east and from the Bay of Biscay northwards to the Arctic. This analysis revealed significant differences in the prey items selected in different parts of the region at different times of year. Tunas (albacore and bluefin) were sampled in the Bay of Biscay and Celtic Sea. Dominant prey items for these species varied by location, year and season. This data compilation exercise represents one of the largest and most wide-ranging ever attempted for pelagic fish in the North Atlantic. The earliest data included in the database were collected in 1864, whereas the most recent were collected in 2012. Data sets are available at doi:10.1594/PANGAEA.820041 and doi:10.1594/PANGAEA.826992