Impact of the COVID-19 pandemic on tuberculosis national reference laboratory services in the WHO European Region, March to November 2020.

We assessed the impact of COVID-19 on diagnostic services for tuberculosis (TB) by national reference laboratories in the WHO European Region. Of 35 laboratories, 30 reported declines in TB sample numbers, amounting up to > 50% of the pre-COVID-19 volumes. Sixteen reported reagent or consumable shortages. Nineteen reallocated ressources to SARS-CoV-2 testing, resulting in an overall increase in workload, largely without a concomitant increase in personnel (n = 14). This poses a risk to meeting the 2025 milestones of the End TB Strategy

The Greek Connection(s): The Social Organization of the Cigarette-Smuggling Business in Greece

Despite the fact that cigarette smuggling has a long history in specific contexts, it has only relatively recently received some media attention in Greece. It is now suggested that contraband cigarettes represent 8 percent of total cigarette consumption in the country and that the cigarette-smuggling business deprives the Greek state of millions in taxes. The purpose of this article, which draws on a variety of data sources and builds on a previous study of a cigarette-smuggling network in Greece, is to provide an account of the social organization of the cigarette black market in Greece

Hepatic arterial chemotherapy for primary and metastatic liver cancers

Hepatic arterial chemotherapy represents a means of selectively exposing hepatic tumor to cytotoxic agents. Although 5-fluoro-2′-deoxyuridine has been shown to generate a higher response rate in the treatment of colorectal liver metastases than that achieved by intravenous infusion, responses are largely incomplete and rarely of long duration. This review describes the rationale for the use of the thymidine analogs 5-bromo-2′-deoxyuridine and 5-iodo-2′-deoxyuridine in hepatic arterial infusions and indicates how combination therapy adding radiotherapy, specifically with hepatic arterially administered yttrium-90 microspheres, might generate a new, more efficient and effective therapeutic approach.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/46919/1/280_2004_Article_BF00647244.pd

Percutaneous transhepatic vs. endoscopic retrograde biliary drainage for suspected malignant hilar obstruction: study protocol for a randomized controlled trial

Abstract Background The optimal approach to the drainage of malignant obstruction at the liver hilum remains uncertain. We aim to compare percutaneous transhepatic biliary drainage (PTBD) to endoscopic retrograde cholangiography (ERC) as the first intervention in patients with cholestasis due to suspected malignant hilar obstruction (MHO). Methods The INTERCPT trial is a multi-center, comparative effectiveness, randomized, superiority trial of PTBD vs. ERC for decompression of suspected MHO. One hundred and eighty-four eligible patients across medical centers in the United States, who provide informed consent, will be randomly assigned in 1:1 fashion via a web-based electronic randomization system to either ERC or PTBD as the initial drainage and, if indicated, diagnostic procedure. All subsequent clinical interventions, including crossover to the alternative procedure, will be dictated by treating physicians per usual clinical care. Enrolled subjects will be assessed for successful biliary drainage (primary outcome measure), adequate tissue diagnosis, adverse events, the need for additional procedures, hospitalizations, and oncological outcomes over a 6-month follow-up period. Subjects, treating clinicians and outcome assessors will not be blinded. Discussion The INTERCPT trial is designed to determine whether PTBD or ERC is the better initial approach when managing a patient with suspected MHO, a common clinical dilemma that has never been investigated in a randomized trial. Trial registration ClinicalTrials.gov, Identifier: NCT03172832 . Registered on 1 June 2017.https://deepblue.lib.umich.edu/bitstream/2027.42/142379/1/13063_2018_Article_2473.pd

Taxing Services under the EU VAT and Japanese Consumption Tax: A Comparative Assessment of New EU Place of Taxation Rules for Services and Intangibles

Place of taxation rules are the seminal cross-jurisdictional provisions of any consumption tax regime. They determine where among competing jurisdictions a particular service is taxed. They are not important for transactions that are restricted to a single jurisdiction and to businesses or individuals belonging to that jurisdiction. However, when two or more jurisdictions are involved, these are the essential tools for revenue allocation and avoidance of double taxation. It is therefore of considerable importance to Japanese businesses and consumers when the European Union (EU) undertakes a wholesale revision of the place of supply rules for services and intangibles. The European Commission has advanced two sets of proposals for reform of these rules. If adopted, these changes will be comprehensive, covering business-to-business (B2B) as well as business-to-consumer (B2C) transactions, effective July 1, 2006. The importance of these proposed changes is amplified by the Organization for Economic Cooperation and Development\u27s (OECD\u27s) recent assessment of global place of taxation rules. Examining the taxation of services and intangibles in the world\u27s consumption tax regimes the Committee of Fiscal Affairs (CFA) concluded that these rules exhibit a general lack of international consistency and coherence. According to the OECD, this lack of consistency and coherence has erected global trade barriers (double taxation), and provided opportunities for global tax avoidance. This article first considers the proposed changes in the EU place of taxation rules for services and intangibles from the historical context of their development. It then takes up the companion rules under the Japanese Consumption Tax (CT). Less historical context is presented because these rules have a more limited history. A final section offers a comparative assessment that seeks to answer two questions. First, is there a lack of consistency and coherence between the Japanese and EU rules as currently constituted? Secondly, have the proposed changes in the EU place of taxation rules minimized or exacerbated differences? Although the EU Commission is contemplating major changes in the place of taxation rules for services and intangibles, at least with respect to transactions between the EU and Japan these changes will do nothing to eliminate the double taxation or double non-taxation in B2B transactions that currently exist. These reforms do however reinforce earlier efforts of the EU to impose the VAT on sales to EU final consumers from businesses not established in the EU. This area has been problematical for Japan. If Japan wishes to impose its CT on similar B2C transaction it should consider reforming its place of taxation rules for these transactions in a manner similar to that of the EU. However, the EU experience is that this change should not be just one of changing the place of taxation. In conjunction with this change Japan should consider adopting the electronic filing and reporting procedures adopted by the EU in its one-stop shop efforts under Article 26c and proposed Article 22b. Moving in this direction would also be in harmony with OECD recommendations