A choice experiment to identify the most important elements of a successful cancer screening program according to those who research and manage such programs.

PURPOSE: The relationship between cancer screening activities in Europe and the health systems in which they are embedded varies, with some screening programs organized largely separately and others using existing health service staff and facilities. Whatever the precise arrangements, the opportunity for screening to achieve health gain depends on many elements interacting within and beyond the health system, from an accurate register identifying the target population to a means to ensure and monitor follow-up. METHOD: A conjoint analysis was undertaken with 66 cancer screening experts from 31 countries taking part in EU-TOPIA (towards improved screening for breast, cervical and colorectal cancer in all of Europe) to identify priorities for an effective screening program, taking a whole system perspective. Ten attributes, each with two levels, were derived from a review of the literature and consultation with experts in cancer screening. Statistical software generated 12 profiles that were ranked by respondents and analyzed using standard conjoint analysis. FINDINGS AND CONCLUSION: The most important attributes were having up-to-date and evidence-based guidelines, followed by mechanisms for systematic monitoring of screening uptake, having a population register covering all of the eligible population and monitoring long-term outcomes. In discussions about the results, participants argued that quality assurance and adherence to guidelines were important, even though they generated low scores in the experiment. This difference may be due some attributes being interrelated, more wide-ranging or the sequential nature of establishing an effective screening program, with guidelines being the first stage of the process

Nonparametric construction of probability maps under local stationarity

The environmental contamination risk can be evaluated in a specific area by approximating the probability that the pollutant under study exceeds a critical value. This issue requires the estimation of the distribution function involved, which can be addressed by applying the indicator kriging methodology or by approximating the sill of the variogram of the underlying indicator process. These approaches demand an appropriate characterization of the indicator variogram, which in turn requires a previous specification of the trend function, if the latter is suspected to be non-constant. Since accuracy of the results will be strongly dependent on the adequate approximation of both functions, we suggest proceeding in a different way to avoid these requirements. Thus, in the current paper, two kerneltype estimators are proposed, based on first approximating the distribution at the sampled sites and then obtaining a weighted average of the resulting values, to derive a valid estimator at each (sampled or unsampled) location. Consistency of the kernel approaches is proved under rather general conditions, such as local stationarity and the existence of derivatives up to the second order of the distribution function. Numerical studies have been carried out to illustrate the performance of our proposals when compared to those procedures requiring the approximation of the indicator variogram. In a final step, the kernel-type estimation of the distribution function has been applied to map the risk of contamination by arsenic in the Central Region of Portugal. With this aim, biomonitoring data of arsenic concentrations were used to detect those zones with higher risk of arsenic accumulation, which is mainly located on the northern part of the region.The authors would like to thank the helpful suggestions and comments from the Editor, the Associate Editor, and the Reviewers. The authors are also grateful to Karen J. Duncan for her contribution in the language revision. The first author’s work has been partially supported by the Spanish National Research and Development Program project [TEC2015-65353-R], by the European Regional Development Fund (ERDF), and by the Galician Regional Government under project GRC 2015/018 and under agreement for funding AtlantTIC (Atlantic Research Center for Information and Communication Technologies). The second author acknowledges financial support from the Portuguese Funds through FCT-“Fundação para a Ciência e a Tecnologia,” within the Project UID/MAT/00013/2013.info:eu-repo/semantics/publishedVersio

Stability of DON and OTA during the breadmaking process and determination of process and performance criteria

The fate of deoxynivalenol (DON) and ochratoxin A (OTA) during the breadmaking process was studied. In particular, toxin content was analysed in mixed baking ingredients before kneading, after fermentation and proofing, and finally after baking. Fermentation and proofing were carried out at 30 C for 1 h, while baking was performed at different temperature levels (from 170 to 210 C) and baking times from 45 to 135 min, in a full factorial design. DON increased from unkneaded mix to fermented dough, and decreased due to baking; this trend depended on the initial concentration of DON in the flour. The level in the bread was significantly lower than in the initial mix of ingredients. In contrast, deoxynivalenol-3-glucoside (DON-3-G) content increased both during kneading and fermentation, and also during baking. Moreover, the results confirmed the high stability of OTA as no significant change in its content could be observed as a result of the breadmaking process. As conclusion, the design of bakery product processes may help to control DON in final products, because although quite stable, its levels can be reduced to some extent. However, high levels of DON-3-G were released during baking, and this point should be further investigated. Mycotoxins have been always considered as stable compounds; however, in depth knowledge of the processing steps that may lead to some reduction (although limited) and those which can stimulate their release from conjugated forms, will definitely help in their control in finished foodstuffs.The authors are grateful to the Spanish government (projects AGL2010-22182-C04-04 and AGL2011-24862) for the financial support. A. Vidal thanks the Spanish Government (Ministry of Education) for the pre-doctoral grant. H. Morales is grateful to the Portuguese Government. (Ministerio da Ciecia, Tecnologia e Ensino Superior; FCT Fundacao para a Ciencia e a Tecnologia) Grant ref. SFRH/BPD/38011/2007

Atrazine and cancer incidence among pesticide applicators in the agricultural health study (1994-2007).

Atrazine is a triazine herbicide used widely in the United States. Although it is an animal carcinogen, the mechanism in rodents does not appear to operate in humans. Few epidemiologic studies have provided evidence for an association

Nanotoxicology: An Emerging Discipline Evolving from Studies of Ultrafine Particles

Although humans have been exposed to airborne nanosized particles (NSPs; < 100 nm) throughout their evolutionary stages, such exposure has increased dramatically over the last century due to anthropogenic sources. The rapidly developing field of nanotechnology is likely to become yet another source through inhalation, ingestion, skin uptake, and injection of engineered nanomaterials. Information about safety and potential hazards is urgently needed. Results of older bio-kinetic studies with NSPs and newer epidemiologic and toxicologic studies with airborne ultrafine particles can be viewed as the basis for the expanding field of nanotoxicology, which can be defined as safety evaluation of engineered nanostructures and nanodevices. Collectively, some emerging concepts of nanotoxicology can be identified from the results of these studies. When inhaled, specific sizes of NSPs are efficiently deposited by diffusional mechanisms in all regions of the respiratory tract. The small size facilitates uptake into cells and transcytosis across epithelial and endothelial cells into the blood and lymph circulation to reach potentially sensitive target sites such as bone marrow, lymph nodes, spleen, and heart. Access to the central nervous system and ganglia via translocation along axons and dendrites of neurons has also been observed. NSPs penetrating the skin distribute via uptake into lymphatic channels. Endocytosis and biokinetics are largely dependent on NSP surface chemistry (coating) and in vivo surface modifications. The greater surface area per mass compared with larger-sized particles of the same chemistry renders NSPs more active biologically. This activity includes a potential for inflammatory and pro-oxidant, but also antioxidant, activity, which can explain early findings showing mixed results in terms of toxicity of NSPs to environmentally relevant species. Evidence of mitochondrial distribution and oxidative stress response after NSP endocytosis points to a need for basic research on their interactions with subcellular structures. Additional considerations for assessing safety of engineered NSPs include careful selections of appropriate and relevant doses/concentrations, the likelihood of increased effects in a compromised organism, and also the benefits of possible desirable effects. An interdisciplinary team approach (e.g., toxicology, materials science, medicine, molecular biology, and bioinformatics, to name a few) is mandatory for nanotoxicology research to arrive at an appropriate risk assessment

Treatment of Gastric Adenocarcinoma May Differ Among Hospital Types in the United States, a Report from the National Cancer Data Base

The concept that complex surgical procedures should be performed at high-volume centers to improve surgical morbidity and mortality is becoming widely accepted. We wanted to determine if there were differences in the treatment of patients with gastric cancer between community cancer centers and teaching hospitals in the United States. Data from the 2001 Gastric Cancer Patient Care Evaluation Study of the National Cancer Data Base comprising 6,047 patients with gastric adenocarcinoma treated at 691 hospitals were assessed. The mean number of patients treated was larger at teaching hospitals (14/year) when compared to community centers (5–9/year) (p < 0.05). The utilization of laparoscopy and endoscopic ultrasonography were significantly more common at teaching centers (p < 0.01). Pathologic assessment of greater than 15 nodes was documented in 31% of specimen at community hospitals and 38% at teaching hospitals (p < 0.01). Adjusted for cancer stage, chemotherapy and radiation therapy were utilized with equal frequency at all types of treatment centers. The 30-day postoperative mortality was lowest at teaching hospitals (5.5%) and highest at community hospitals (9.9%) (p < 0.01). These data support previous publications demonstrating that patients with diseases requiring specialized treatment have lower operative mortality when treated at high-volume centers