Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: Design of a multicenter randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>It has been estimated that between 5% and 10% of women diagnosed with breast cancer have a hereditary form of the disease, primarily caused by a <it>BRCA1 </it>or <it>BRCA2 </it>gene mutation. Such women have an increased risk of developing a new primary breast and/or ovarian tumor, and may therefore opt for preventive surgery (e.g., bilateral mastectomy, oophorectomy). It is common practice to offer high-risk patients genetic counseling and DNA testing after their primary treatment, with genetic test results being available within 4-6 months. However, some non-commercial laboratories can currently generate test results within 3 to 6 weeks, and thus make it possible to provide <it>rapid </it>genetic counseling and testing (RGCT) prior to primary treatment. The aim of this study is to determine the effect of RGCT on treatment decisions and on psychosocial health.</p> <p>Methods/Design</p> <p>In this randomized controlled trial, 255 newly diagnosed breast cancer patients with at least a 10% risk of carrying a <it>BRCA </it>gene mutation are being recruited from 12 hospitals in the Netherlands. Participants are randomized in a 2:1 ratio to either a RGCT intervention group (the offer of RGCT directly following diagnosis with tests results available before surgical treatment) or to a usual care control group. The primary behavioral outcome is the uptake of direct bilateral mastectomy or delayed prophylactic contralateral mastectomy. Psychosocial outcomes include cancer risk perception, cancer-related worry and distress, health-related quality of life, decisional satisfaction and the perceived need for and use of additional decisional counseling and psychosocial support. Data are collected via medical chart audits and self-report questionnaires administered prior to randomization, and at 6 month and at 12 month follow-up.</p> <p>Discussion</p> <p>This trial will provide essential information on the impact of RGCT on the choice of primary surgical treatment among women with breast cancer with an increased risk of hereditary cancer. This study will also provide data on the psychosocial consequences of RGCT and of risk-reducing behavior.</p> <p>Trial registration</p> <p>The study is registered at the Netherlands Trial Register (NTR1493) and ClinicalTrials.gov (NCT00783822).</p

Petrophysical and geostatistical analysis of porosity-permeability and occurrence of facies types in continental carbonates of the Ballık area, Denizli (Turkey)

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Permeability simulations on natural and virtual rock samples. Can multiple point geostatistics generate rock models that overcome spatial scale dependency?

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Evaluation of the cold chain of fresh-cut endive from farmer to plate

In this study, the cold chain and its impact on food stuff microbiology was evaluated for fresh-cut endive. A survey was carried out to analyze endive temperature throughout the supply chain from producer, via processor and distributor to the restaurant. Data loggers accompanying the endive on its route provided a temperature profile of the endive. The effect of the outdoor temperature on initial cooling was evaluated and critical points regarding cold chain management in the supply chain were identified. Our experiments indicate that the cold chain is generally properly maintained. In parallel with temperature monitoring, indicator microorganisms were assessed at different points in the supply chain to examine the effects of endive temperature, temperature fluctuations, and the outdoor temperature on microbial food safety. Small temperature fluctuations in the supply chain had a small effect on the total level of aerobic mesophilic bacteria. However, at the best before-date, total coliforms and Enterobacteriaceae levels were significantly higher in endive samples subject to temperature fluctuations in the supply chain, compared to endive stored in optimal conditions. To our knowledge, this is the first study that combines microbiological analysis with the temperature profile of fresh-cut produce in a realistic food supply chain.status: publishe

Assessing the Environmental Impact of Demountable Space-Dividing Walls: A Scenario Analysis Approach in a Semi-Detached Case Study Dwelling

The transition towards sustainable construction is crucial, and demountable building elements are frequently advocated for achieving this goal. While these elements offer relocatability during refurbishments, their adoption may increase initial environmental impact due to higher material use and steel connections. To address this, a quantitative assessment of demountable building elements in refurbishment scenarios at the building level is needed, filling a gap in the existing literature. This study bridges the gap by comparing the total environmental impact of demountable and traditional space-dividing walls in refurbishment scenarios for a semi-detached dwelling. Using a life cycle assessment, seven space-dividing wall types, including metal studs, wood structures, and masonry walls, are evaluated under four refurbishment scenarios spanning a 60-year building lifespan. The results reveal that traditional metal stud walls have a lower environmental impact in scenarios with limited refurbishments. In contrast, demountable walls become more environmentally beneficial only when refurbishing at least 60% of the wall area with three or more refurbishments. This conclusion was further validated through sensitivity analysis on the refurbishment rate, refurbished area, and impact assessment method. In this study, the assumed environmental benefits of demountable walls are challenged, providing a robust evaluation in a specific building typology and offering insights for policymakers and industry professionals on the environmental implications of incorporating demountable building elements

Lattice Boltzmann Simulations of Fluid Flow in Continental Carbonate Reservoir Rocks and in Upscaled Rock Models Generated with Multiple-Point Geostatistics

Microcomputed tomography (CT) and Lattice Boltzmann Method (LBM) simulations were applied to continental carbonates to quantify fluid flow. Fluid flow characteristics in these complex carbonates with multiscale pore networks are unique and the applied method allows studying their heterogeneity and anisotropy. 3D pore network models were introduced to single-phase flow simulations in Palabos, a software tool for particle-based modelling of classic computational fluid dynamics. In addition, permeability simulations were also performed on rock models generated with multiple-point geostatistics (MPS). This allowed assessing the applicability of MPS in upscaling high-resolution porosity patterns into large rock models that exceed the volume limitations of the CT. Porosity and tortuosity control fluid flow in these porous media. Micro- and mesopores influence flow properties at larger scales in continental carbonates. Upscaling with MPS is therefore necessary to overcome volume-resolution problems of CT scanning equipment. The presented LBM-MPS workflow is applicable to other lithologies, comprising different pore types, shapes, and pore networks altogether. The lack of straightforward porosity-permeability relationships in complex carbonates highlights the necessity for a 3D approach. 3D fluid flow studies provide the best understanding of flow through porous media, which is of crucial importance in reservoir modelling.status: publishe

Hand hygiene: resolving an enigma?

Much experimental evidence points to poor hand hygiene as a likely major contributor to the occurrence of foodborne illnesses. Microorganisms are easily transferred from hands to other surfaces or vice versa, by cross contamination. Cross contamination is therefore an important contamination source of foodborne illness bacteria. In this review, we focused on the most important techniques used to minimize the risk of cross contamination by hands, including washing and disinfecting of hands, and the use of gloves. The efficacy as well as the inherent advantages and disadvantages of each technique are thoroughly discussed. Additional measures that can be taken to minimize the risk of contamination are also referred to. Finally, the legal requirements and the recommendations of relevant voluntary quality systems, such as British Retail Consortium (BRC), International Food Standard (IFS), and ISO 22000, concerning hand hygiene are summarized. With the information provided herein, a well-informed decision can be made to select the appropriate techniques to use in specific circumstances or environments.status: publishe

Goede handhygiëne in de voedingssector: een tipje van de sluier opgelicht

Uit tal van wetenschappelijk onderzoek blijkt dat een gebrekkige handhygiëne vaak de bron is van voedselinfecties. Door kruisbesmetting kunnen micro-organismen snel en eenvoudig overgedragen worden van de handen naar voedingsmiddelen en potentieel voedselinfecties veroorzaken. In dit overzichtsartikel worden de belangrijkste technieken om kruisbesmetting via de handen tegen te gaan onder de loep genomen. Zowel de effectiviteit als de voor- en nadelen van het wassen van handen, het desinfecteren van handen en het dragen van handschoenen worden besproken. Met behulp van deze informatie kunnen procedures met betrekking tot handhygiëne opgesteld worden om zo de kans op besmetting van voedingsmiddelen te reduceren tot een minimum. Bovendien wordt er aangegeven wat wettelijk verplicht is in voedingsbedrijven om een goede hygiëne te waarborgen en welke maatregelen door kwaliteitssystemen zoals BRC, IFS en ISO 22000 vereist worden.nrpages: 20status: publishe