The pathology of familial breast cancer: Morphological aspects

A small proportion of breast cancers are due to a heritable predisposition. Recently, two predisposition genes, BRCA1 and BRCA2, have been identified and cloned. The morphological features of tumours from patients harbouring mutations in the BRCA1 and BRCA2 genes differ from each other and from sporadic breast cancers. Both are of higher grade than are sporadic cases. An excess of medullary/atypical medullary carcinoma has been reported in patients with BRCA1 mutations. Multifactorial analysis, however, shows that the only features independently associated with BRCA1 mutations are a high mitotic count, pushing tumour margins and a lymphocytic infiltrate. For BRCA2 mutation, an association with tubular/lobular carcinoma has been suggested, but not substantiated in a larger Breast Cancer Linkage Consortium study. In multifactorial analysis, the independent features were a lack of tubule formation and pushing tumour margins only. The morphological analysis has implications for clinical management of patients

Towards Uniform Online Spherical Tessellations

The problem of uniformly placing N points onto a sphere finds applications in many areas. An online version of this problem was recently studied with respect to the gap ratio as a measure of uniformity. The proposed online algorithm of Chen et al. was upper-bounded by 5.99 and then improved to 3.69, which is achieved by considering a circumscribed dodecahedron followed by a recursive decomposition of each face. We analyse a simple tessellation technique based on the regular icosahedron, which decreases the upper-bound for the online version of this problem to around 2.84. Moreover, we show that the lower bound for the gap ratio of placing up to three points is 1+5√2≈1.618 . The uniform distribution of points on a sphere also corresponds to uniform distribution of unit quaternions which represent rotations in 3D space and has numerous applications in many areas

Technology Assessment: Nosocomial Infection Solutions

This study presents a technology assessment for reducing nosocomial infections. Nosocomial infections (also known as hospital-acquired infection or HAI) present numerous problems for healthcare institutions including increased costs, increased use of hazardous cleaners, and patient reluctance toward treatment. The goal is to incorporate more than the traditional economic point of view in evaluating alternatives for reducing infections. The Analytical Hierarchy Process is used to assess the feasibility of candidate technologies. Traditional criteria such as infection reduction and cost are used in addition compatibility with existing procedures, and staff acceptance was used for evaluating technologies. Infection reduction and staff acceptance were determined to be the most important criterion through expert interviews. The analysis established that utilizing RFID for handwashing compliance was the superior technology given its superior reduction in HAIs and good staff and patent acceptance

Designing the Function of Health Technology Assessment as a Support for Hospital Management

Investment in Health Technologies (HTs) is one of the crucial points for hospital managers. It affects the goals and strategic orientation of the whole Health Organization. Decision-making regarding the employment of new technologies involves, prevalently, the hospital level, which directly concerns the healthcare delivery process and its design. Hospital-Based Health Technology Assessment (HB-HTA) is aimed at selecting the portfolio of new HTs that provides the best balance between competing targets, namely, cost containment and quality improvement. This objective is achievable by thinking about how to improve the service delivered, through the use of innovative cost-effective HT. Accordingly, the HTA role deals with the operational modalities of hospital departments, and it is strictly related to outcomes desired and in respect to budgets. This evaluative process should be coherent with specific health organization necessities given that each one is concerned with its own geographic area, its own specific patients’ epidemiology, the social environment, and financial resources’ availability. However, HTA is usually run by practitioners whose competences contemplate mainly clinical and technical aspects; hence, the absence of a focus on performance management (PM) represents the main weakness of this function. Thus, starting from the current body of literature in the fields of PM and HT management, this work theoretically identifies how to design an HB-HTA func- tion and which the main relevant evaluation perspectives are. By explaining the implementation stages, it will be shown how HTA at the hospital level should be able to combine the different perspectives of business performance (financial and nonfinancial) with clinical needs

Early Onset of Overweight and Obesity among Low-Income 1- to 5-Year Olds in New York City

Early-childhood obesity has reached epidemic proportions, particularly among low-income, minority, urban children. Understanding the progression of obesity prevalence rates from infancy through early childhood can inform public health efforts to combat this epidemic and create developmentally appropriate strategies. In this study, we assessed the prevalence of overweight and obesity among urban 1- to 5-year olds and estimated risk by age and gender. We surveyed the medical records of a random sample of 1,713 children seen at a New York City primary-care network. Outcome measures were weight-for-length for <2-year olds and body mass index for 2- to 5-year olds. Overweight was defined as percentiles ≥85% to <95%, obesity ≥95%. Analysis utilized chi-square, logistic regression, and z tests. Between 1 and 5 years of age, overweight increased 3.7% to 20.8% and obesity 7.5% to 29.8% (p < 0.01). Risk increased with age: compared with 1-year olds, 5-year olds were 8.2 times as likely (95% confidence interval (CI) = 5.5–12.21) to be overweight or obese. Boys were more likely to be obese than girls (adjusted odds ratio = 1.3; 95% CI = 1–1.64). Significant increases in overweight and obesity occurred between ages 1 and 3 years (overweight, 3.7% to 16%, p < 0.01; obesity, 7.5% to 30.2%, p < 0.01). Among urban children, more than half were overweight or obese by age 5. Overweight and obesity rates increased dramatically between the ages of 1 and 3 years. Interventions aimed at this age period may have the greatest impact at preventing childhood obesity