Surveillance of cirrhosis for hepatocellular carcinoma: a cost-utility analysis.

Using a decision-analytic model, we evaluated the effectiveness and cost-effectiveness of surveillance for hepatocellular carcinoma (HCC) in individuals with cirrhosis. Separate cohorts with cirrhosis due to alcoholic liver disease, hepatitis B and hepatitis C were simulated. Results were also combined to approximate a mixed aetiology population. Comparisons were made between a variety of surveillance algorithms using alpha-foetoprotein (AFP) assay and/or ultrasound at 6- and 12-monthly intervals. Parameter estimates were obtained from comprehensive literature reviews. Uncertainty was explored using one-way and probabilistic sensitivity analyses. In the mixed aetiology cohort, 6-monthly AFP+ultrasound was predicted to be the most effective strategy. The model estimates that, compared with no surveillance, this strategy may triple the number of people with operable tumours at diagnosis and almost halve the number of people who die from HCC. The cheapest strategy employed triage with annual AFP (incremental cost-effectiveness ratio (ICER): 20,700 pounds per quality-adjusted life-year (QALY) gained). At a willingness-to-pay threshold of 30,000 pounds per QALY the most cost-effective strategy used triage with 6-monthly AFP (ICER: 27,600 pounds per QALY gained). The addition of ultrasound to this strategy increased the ICER to 60,100 pounds per QALY gained. Surveillance appears most cost-effective in individuals with hepatitis B-related cirrhosis, potentially due to younger age at diagnosis of cirrhosis. Our results suggest that, in a UK NHS context, surveillance of individuals with cirrhosis for HCC should be considered effective and cost-effective. The economic efficiency of different surveillance strategies is predicted to vary markedly according to cirrhosis aetiology

Opportunities for Environmental Noise Mapping in Saudi Arabia: A Case of Traffic Noise Annoyance in an Urban Area in Jeddah City

As the traffic and other environmental noise generating activities are growing in The Kingdom of Saudi Arabia (KSA), adverse health and other impacts are expected to develop. The management of such problem involves many actions, of which noise mapping has been proven to be a helpful approach. The objective of the current study was to test the adequacy of the available data in KSA municipalities for generating urban noise maps and to verify the applicability of available environmental noise mapping and noise annoyance models for KSA. Therefore, noise maps were produced for Al-Fayha District in Jeddah City, KSA using commercially available noise mapping software and applying the French national computation method “NMPB” for traffic noise. Most of the data required for traffic noise prediction and annoyance analysis were available, either in the Municipality GIS department or in other governmental authorities. The predicted noise levels during the three time periods, i.e., daytime, evening, and nighttime, were found higher than the maximum recommended levels established in KSA environmental noise standards. Annoyance analysis revealed that high percentages of the District inhabitants were highly annoyed, depending on the type of planning zone and period of interest. These results reflect the urgent need to consider environmental noise reduction in KSA national plans. The accuracy of the predicted noise levels and the availability of most of the necessary data should encourage further studies on the use of noise mapping as part of noise reduction plans

Occupational Safety and Health Conditions Aboard Small- and Medium-Size Fishing Vessels: Differences among Age Groups

Although marine fishing is one of the most hazardous occupations, research on the occupational safety and health (OSH) conditions aboard marine fishing vessels is scarce. For instance, little is known about the working conditions of vulnerable groups such as young and aging fishermen. The objective of the current paper is to study the OSH conditions of young and aging fishermen compared to middle-aged fishermen in the small- and medium-size (SM) marine fishing sector. A cross-sectional study was designed, and 686 fishermen working aboard SM fishing vessels were interviewed to collect information about their safety and health. The associations of physical and psychosocial work conditions with safety and health outcomes, e.g., injuries, illnesses and job satisfaction, are presented. The results of the current study can be utilized in the design of effective accident prevention and OSH training programs for the three age groups and in the regulation of working conditions aboard fishing vessels

Diagnostic interplay of proton magnetic resonance spectroscopy and diffusion weighted images with apparent diffusion coefficient values in suspicious breast lesions

Aim of the work: To study the diagnostic performance of combined single voxel 1H-MRS and DW-MRI with ADC values as a non-contrast diagnostic tool, compared to the DCE-MRI, in suspicious breast lesions. Materials and methods: 113 female patients (mean age 45.8 years) with suspicious breast lesions, categorized as BI-RADS 3 or 4 by sono-mammographic examinations, were subjected to bilateral breast imaging with non-contrast MRI including conventional MRI, DW-MRI with quantitative ADC values, and single voxel 1H-MRS, in addition to DCE-MRI. They had 132 pathologically proved lesions (74 benign and 58 malignant). Results: DW-MRI with ADC values was 96.97% accurate with 94.92% sensitivity and 98.63% specificity, while DCE-MRI was 97.73% accurate with 98.29% sensitivity but with 97.29% specificity, and 1H-MRS was 98.48% accurate with the highest sensitivity (100%) and 97.33% specificity. Furthermore, the combined use of DW-MRI with ADC values and 1H-MRS improved the diagnostic capability than utilization of each sequence alone with the highest accuracy of 99.24%, 100% sensitivity and 98.65% specificity. Conclusion: The combined use of DW-MRI with quantitative ADC data and single-voxel 1H-MRS is a reliable non-contrast tool that provides higher accuracy in characterizing suspicious breast, and can efficiently be used in the absence of DCE-MRI

Biological treatment of hydrogen sulfide in an airlift bioreactor with direct gas injection

Bioconversion of H2S into elemental sulfur has been investigated using an airlift bioreactor with direct injection of the gas into the bioreactor. Almost complete removal of H2S has been achieved at its inlet concentrations lower than 25 000 ppm. Maximum bioconversion capacity of ca 111.3 g/(m3·h) and up to 93.5% conversion of the inlet sulfide to elemental sulfur was obtained. To further improve the bioreactor performance, factors influencing mass transfer and biological activity should be investigated in future studies

Characterization of the impact to PET quantification and image quality of an anterior array surface coil for PET/MR imaging

OBJECT: The aim of this study was to determine the impact to PET quantification, image quality and possible diagnostic impact of an anterior surface array used in a combined PET/MR imaging system. MATERIALS AND METHODS: An extended oval phantom and 15 whole-body FDG PET/CT subjects were re-imaged for one bed position following placement of an anterior array coil at a clinically realistic position. The CT scan, used for PET attenuation correction, did not include the coil. Comparison, including liver SUVmean, was performed between the coil present and absent images using two methods of PET reconstruction. Due to the time delay between PET scans, a model was used to account for average physiologic time change of SUV. RESULTS: On phantom data, neglecting the coil caused a mean bias of -8.2 % for non-TOF/PSF reconstruction, and -7.3 % with TOF/PSF. On clinical data, the liver SUV neglecting the coil presence fell by -6.1 % (±6.5 %) for non-TOF/PSF reconstruction; respectively -5.2 % (±5.3 %) with TOF/PSF. All FDG-avid features seen with TOF/PSF were also seen with non-TOF/PSF reconstruction. CONCLUSION: Neglecting coil attenuation for this anterior array coil results in a small but significant reduction in liver SUVmean but was not found to change the clinical interpretation of the PET images