Pollution in the open oceans: 2009-2013

This review of pollution in the open oceans updates a report on this topic prepared by GESAMP five years previously (Reports and Studies No. 79, GESAMP, 2009). The latter report, the first from GESAMP focusing specifically on the oceans beyond the 200 m depth contour, was prepared for purposes of the Assessment of Assessments, the preparatory phase of a regular process for assessing the state of the marine environment, led jointly by the United Nations Environment Programme (UNEP) and the Intergovernmental Oceanographic Commission (UNESCO-IOC)

Prognostic indices in stereotactic radiotherapy of brain metastases of non- small cell lung cancer

Background Our purpose was to analyze the long-term clinical outcome and to identify prognostic factors after Linac-based stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) on patients with brain metastases (BM) from non-small cell lung cancer (NSCLC). Materials and Methods We performed a retrospective analysis of survival on 90 patients who underwent SRS or FSRT of intracranial NSCLC metastases between 04/2004 and 05/2014 that had not undergone prior surgery or whole brain radiotherapy (WBRT) for BM. Follow-up data was analyzed until May 2015. Potential prognostic factors were examined in univariable and multivariable analyses. The Golden Grading System (GGS), the disease-specific graded prognostic assessment (DS-GPA), the RADES II prognostic index as well as the NSCLC-specific index proposed by Rades et al. in 2013 (NSCLC-RADES) were calculated and their predictive values were tested in univariable analysis. Results The median follow-up time of the surviving patients was 14 months. The overall survival (OS) rate was 51 % after 6 months and 29.9 % after 12 months. Statistically significant factors of better OS after univariable analysis were lower International Union Against Cancer (UICC) stage at first diagnosis, histology of adenocarcinoma, prior surgery of the primary tumor and lower total BM volume. After multivariable analysis adenocarcinoma histology remained a significant factor; higher Karnofsky Performance Score (KPS) and the presence of extracranial metastases (ECM) were also significant. The RADES II and the NSCLC-RADES indices were significant predictors of OS. However, the NSCLC-RADES failed to differentiate between intermediate- and low-risk patients. The DS-GPA and GGS were not statistically significant predictors of survival in univariable analysis. Conclusion The ideal prognostic index has not been defined yet. We believe that more specific indices will be developed in the future. Our results indicate that the histologic subtype of NSCLC could add to the prognostic value of specialized future indices. The RADES II index had the highest predictive value in the examined patient cohort

The use of HL7 as an interoperability framework in a regional healthcare system in Greece, Journal of Telecommunications and Information Technology, 2005, nr 4

The integration of information systems represents one of the most urgent priorities of a regional healthcare authority in order to meet its clinical, organizational and managerial needs. Current practice shows that the most promising approach to achieve a regional healthcare information system is to use a health level 7 (HL7) messagebased communication system implemented by an asynchronous common communication infrastructure between healthcare sites. The system is a complete and integrated information system at a regional level that comprises all types of healthcare levels, that includes interoperability issues, that covers most of the needed components, and that is able to work efficiently in a secure wide area network to ensure data privacy and confidentiality. Another important feature of the proposed solution is that it creates an interoperability framework that can be replicated from one healthcare institution to another. In that sense, common interoperability messages can be used to interconnect heterogeneous information systems. In response to this strategy, more than 10 different consortiums have submitted proposals to the Greek government and the proposed interoperability framework seems to be widely accepted as a solution to enhance information and communication technologies developments in the healthcare sector in Greece

A roadmap towards healthcare information systems interoperability in Greece, Journal of Telecommunications and Information Technology, 2006, nr 2

The advantages of the introduction of information and communication technologies (ICT) in the complex healthcare sector are already well known and well stated in the past. It is common knowledge that in order to install any type of information system in healthcare, six main groups of issues have to be dealt with: organizational and cultural matters related to healthcare, technological gap between healthcare professionals and information science experts, legal requirements on the confidentiality of personal data, of patient related data and on data privacy, industrial and market position of healthcare informatics and interoperability complexity, lack of vision and leadership of the health care managers and health authorities and user acceptability and usability of the proposed information systems. In order to meet these issues stated above, a special focus group (Z3) performed an assessment of the situation of healthcare informatics in Greece and of the main key points that would lead to success. In that sense it is now common knowledge that Greece is lagging information and communication technology progress in healthcare because almost none of the above mentioned issues were dealt with. This assessment is the result of the interaction of more than 150 decision makers, medical informaticians, healthcare practitioners and other individual involved in healthcare. As a conclusion, this focus group resulted in 4 major propositions that will lead to healthcare informatics introduction with better success chances: focus on terminologies and standards, focus on interoperability and information systems sustainability, focus on clear goals and system metrics that can create a healthcare performance management cockpit, and focus on people and what they have to say, by creating a e-health forum. These conclusions were taken into consideration by the Greek government and are incorporated the IASYS project, the national healthcare informatics framework for the next ten years

Concepts of price fairness: Empirical research into the Dutch coffee market

This paper researches perceptions of the concept of price fairness in the Dutch coffee market. We distinguish four alternative standards of fair prices based on egalitarian, basic rights, capitalistic and libertarian approaches. We investigate which standards are guiding the perceptions of price fairness of citizens and coffee trade organizations. We find there is a divergence in views between citizens and key players in the coffee market. Whereas citizens support the concept of fairness derived from the basic rights approach, holding that the price should provide coffee farmers with a minimum level of subsistence, representatives of Dutch coffee traders hold the capitalistic view that the free world market price is fair

SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues.

There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus clade 2 (SARS-CoV-2), which causes the disease COVID-19. SARS-CoV-2 spike (S) protein binds angiotensin-converting enzyme 2 (ACE2), and in concert with host proteases, principally transmembrane serine protease 2 (TMPRSS2), promotes cellular entry. The cell subsets targeted by SARS-CoV-2 in host tissues and the factors that regulate ACE2 expression remain unknown. Here, we leverage human, non-human primate, and mouse single-cell RNA-sequencing (scRNA-seq) datasets across health and disease to uncover putative targets of SARS-CoV-2 among tissue-resident cell subsets. We identify ACE2 and TMPRSS2 co-expressing cells within lung type II pneumocytes, ileal absorptive enterocytes, and nasal goblet secretory cells. Strikingly, we discovered that ACE2 is a human interferon-stimulated gene (ISG) in vitro using airway epithelial cells and extend our findings to in vivo viral infections. Our data suggest that SARS-CoV-2 could exploit species-specific interferon-driven upregulation of ACE2, a tissue-protective mediator during lung injury, to enhance infection

The role of high frequency intra-daily data, daily range and implied volatility in multi-period Value-at-Risk forecasting

In this paper, we assess the informational content of daily range, realized variance, realized bipower variation, two time scale realized variance, realized range and implied volatility in daily, weekly, biweekly and monthly out-of-sample Value-at-Risk (VaR) predictions. We use the recently proposed Realized GARCH model combined with the skewed student distribution for the innovations process and a Monte Carlo simulation approach in order to produce the multi-period VaR estimates. The VaR forecasts are evaluated in terms of statistical and regulatory accuracy as well as capital efficiency. Our empirical findings, based on the S&P 500 stock index, indicate that almost all realized and implied volatility measures can produce statistically and regulatory precise VaR forecasts across forecasting horizons, with the implied volatility being especially accurate in monthly VaR forecasts. The daily range produces inferior forecasting results in terms of regulatory accuracy and Basel II compliance. However, robust realized volatility measures such as the adjusted realized range and the realized bipower variation, which are immune against microstructure noise bias and price jumps respectively, generate superior VaR estimates in terms of capital efficiency, as they minimize the opportunity cost of capital and the Basel II regulatory capital. Our results highlight the importance of robust high frequency intra-daily data based volatility estimators in a multi-step VaR forecasting context as they balance between statistical or regulatory accuracy and capital efficiency

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prognostic factors and indices in stereotactic radiotherapy of brain metastases of non-small cell lung cancer

Abstrakt Hintergrund: Ziel dieser Arbeit war die Analyse von potentiellen Prognosefaktoren und Prognose-Bewertungsziffern in Hinblick auf die Überlebenszeit von Patienten mit Hirnmetastasen des nicht-kleinzelligen Lungenkarzinoms (NSCLC) nach Linearbeschleuniger-basierter stereotaktischer Radiochirurgie (SRS) oder fraktionierter stereotaktischer Radiotherapie (FSRT). Material und Methoden: Wir führten eine retrospektive Analyse der Überlebenszeit von 90 Patienten mit Hirnmetastasen des NSCLC durch, deren Hirnmetastasen zwischen 04/2004 und 05/2014 mittels SRS oder FSRT ohne eine vorherige Ganzhirnbestrahlung (WBRT) oder eine vorherige chirurgische Resektion behandelt wurden. Nachsorgedaten wurden bis Mai 2015 erfasst. Potentielle Prognosefaktoren wurden in der univariaten und multivariablen Datenanalyse untersucht. Die erfassten Prognose-Bewertungsziffern waren das Golden Grading System (GGS), das Disease- Specific Prognostic Assessment (DS- GPA), sowie die Indices RADES II und NSCLC- RADES (1-4). Diese wurden univariat analysiert sowie auf ihren prädiktiven Wert hin untersucht. Ergebnisse: Das mediane Nachsorge-Zeitintervall für Patienten, die beim letzten Kontakt noch am Leben waren, betrug 14 Monate. Die 6-Monats- Überlebensrate bzw. die 12-Monats-Überlebensrate lagen bei 51% bzw. 29,9%. Statistisch signifikante positive Prädiktoren für die Überlebenszeit waren in der univariaten Datenanalyse ein niedriges Stadium nach der International Union Against Cancer (UICC) zum Diagnosezeitpunkt des NSCLC, ein Adenokarzinom als histologischer Subtyp, eine vorherige Lungen- oder Lungenteilresektion und ein niedriges Gesamtvolumen der Hirnmetastasen. In der multivariablen Datenanalyse blieb das Adenokarzinom als histologischer Subtyp ein signifikanter Faktor. Ein höherer Karnofsky-Index (KI) sowie die Abwesenheit von extrakraniellen Metastasen (ECM) waren ebenfalls signifikante Faktoren in der multivariablen Datenanalyse. Von den Prognose-Bewertungsziffern waren RADES II und NSCLC-RADES signifikante Prädiktoren der Überlebenszeit. NSCLC- RADES konnte jedoch nicht zwischen den Subgruppen mit mittlerem und niedrigem Risiko differenzieren. Das DS-GPA sowie das GGS waren in der univariaten Datenanalyse keine signifikanten Prädiktoren der Überlebenszeit. Zusammenfassung: Im untersuchten Patientenkollektiv war RADES II die präziseste Prognose-Bewertungsziffer. Die ideale Prognose-Bewertungsziffer wurde jedoch noch nicht gefunden. Wir schlagen aufgrund unserer Ergebnisse den histologischen Subtyp als prädiktiven Faktor für eine neue oder weiterentwickelte Prognose-Bewertungsziffer vor.Abstract Background: Our purpose was to analyze the long-term clinical outcome and to identify prognostic factors after Linac-based stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) on patients with brain metastases from non-small cell lung cancer (NSCLC). Materials and methods: We performed a retrospective analysis of survival on 90 patients who underwent SRS or FSRT of intracranial NSCLC metastases between 04/2004 and 05/2014 that had not undergone prior surgery or whole brain radiotherapy (WBRT) for brain metastases. Follow-up data was analyzed until May 2015. Potential prognostic factors were examined in univariate and multivariable analyses. The Golden Grading System (GGS), the Disease-Specific Graded Prognostic Assessment (DS- GPA), the RADES II prognostic index as well as the NSCLC-RADES (1-4) were calculated and their predictive values were tested in univariate analysis. Results: The median follow-up time of the surviving patients was 14 months. The overall survival (OS) rate was 51% after 6 months and 29.9% after 12 months. Statistically significant factors of better OS after univariate analysis were lower International Union Against Cancer (UICC) stage at first diagnosis, adenocarcinoma histology, prior surgery of the primary tumor and lower total brain metastases volume. After multivariable analysis adenocarcinoma histology remained a significant factor; higher Karnofsky Performance Score (KPS) and the presence of extracranial metastases (ECM) were significant in the multivariable analysis as well. The RADES II and the NSCLC- RADES indices were significant predictors of OS. However, the NSCLC-RADES failed to differentiate between intermediate- and low-risk patients. The DS- GPA and GGS were not statistically significant predictors of survival in univariate analysis. Conclusion: The RADES II index had the highest predictive value in the examined patient cohort. Nevertheless, the ideal prognostic index has not been defined yet. Our results indicate that the histologic subtype of NSCLC could add to the prognostic value of specialized future indices