European household waste management schemes: Their effectiveness and applicability in England.

This paper reviews European household waste management schemes and provides an insight into their effectiveness in reducing or diverting household waste. The paper also considers the feasibility of replicating such schemes in England. Selected case studies include those implemented using variable charging schemes, direct regulation and household incentivisation (reduced disposal charges). A total of 15 case studies were selected from developed countries in the EU where some schemes have operated for more than a decade. Criteria for assessing the effectiveness and replicability of schemes were developed using scheme progress towards targets, response time, compatibility with government policy, ease of administration and operation, and public acceptance as attributes. The study demonstrates the capability of these schemes to significantly reduce household waste and suggests changes to allow their possible adoption in England. One of the main barriers to their adoption is the Environmental Protection Act, 1990 that prevents English local authorities (LAs) from implementing the variable charging method for household waste management. This barrier could be removed through a change in legislation. The need to derive consistent data and standardise the method of measuring the effectiveness of schemes is also highlighted

A Study on the Effects Administration of One Dose of 300.000 I.u. Oral Vitamin a and Deworming for Prevention and Treatment of Vitamin a Deficiency

Suatu penyelidikan tentang pencegahan dan pengobatan defisiensi citamin A pada anak-anak prasekolah telah dikerjakan didesa Tegal dan Iwul, Bogor dengan memberikan preparat vitamin A oral dosis tinggi. Preparat tersebut mengandung emulsi retinyl-palminate 300.000 I.U. yang dicampur dengan 100 I.U. citamin E (tocopheryl acetate). Dua golongan anak yaitu 100 tanpa dan 75 dengan xerophthalmia dipergunakan untuk studi tersebut. Mereka dibagi lagi dalam 4 kelompok. Kelompok pertama diberikan hanya vitamin A oral. Kelompok kedua diberikan obat cacing (deworming) terlebih dahulu sebelum diberikan vitamin A oral, dengan combantrin (pyrantel pamoate) single dose 10 mg/kg. berat badan. Kelompok ketiga diberi obat cacing dan placebo dan kelompok keempat hanya diberi placebo. Ternyata pada pemeriksaan setelah 6 dan 12 bulan kemudian semua anak tanpa xerophthalmia tetap terlindung dari xeropthalmia setelah diberikan vitamin A baik dengan atau tanpa deworming terlebih dahulu. Sedangkan 5-8 persen anak dengan xerophthalmia tidak dapat disembuhkan. Obat ca­cing tidak jelas menunjukkan pengaruhnya untuk memperbaiki penggunaan oral vitamin A, tetapi obat cacing dan vitamin A oral tersebut menunjukkan pengaruh baik terhadap keadaan gizi. Sedangkan terhadap kejadian penyakit, pengaruhnya tidak begitu jelas

Evasion of anti-growth signaling: a key step in tumorigenesis and potential target for treatment and prophylaxis by natural compounds

The evasion of anti-growth signaling is an important characteristic of cancer cells. In order to continue to proliferate, cancer cells must somehow uncouple themselves from the many signals that exist to slow down cell growth. Here, we define the anti-growth signaling process, and review several important pathways involved in growth signaling: p53, phosphatase and tensin homolog (PTEN), retinoblastoma protein (Rb), Hippo, growth differentiation factor 15 (GDF15), AT-rich interactive domain 1A (ARID1A), Notch, insulin-like growth factor (IGF), and Krüppel-like factor 5 (KLF5) pathways. Aberrations in these processes in cancer cells involve mutations and thus the suppression of genes that prevent growth, as well as mutation and activation of genes involved in driving cell growth. Using these pathways as examples, we prioritize molecular targets that might be leveraged to promote anti-growth signaling in cancer cells. Interestingly, naturally-occurring phytochemicals found in human diets (either singly or as mixtures) may promote anti-growth signaling, and do so without the potentially adverse effects associated with synthetic chemicals. We review examples of naturally-occurring phytochemicals that may be applied to prevent cancer by antagonizing growth signaling, and propose one phytochemical for each pathway. These are: epigallocatechin-3-gallate (EGCG) for the Rb pathway, luteolin for p53, curcumin for PTEN, porphyrins for Hippo, genistein for GDF15, resveratrol for ARID1A, withaferin A for Notch and diguelin for the IGF1-receptor pathway. The coordination of anti-growth signaling and natural compound studies will provide insight into the future application of these compounds in the clinical setting

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit