Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening

__Abstract__ The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8500 per patient for breast cancer patients and dfl 7200 for cervical cancer patients. More than half of these costs are incurred in the last month before death. The level of home care in the preceding months is quite modest (dfl 120 per month for both diseases), not taking into account informal care. The costs of home care for patients with advanced cancer are only slightly related to the site of the primary tumor from which the metastases originate. Total average costs per patient during advanced disease, including hospital and nursing home care, amount to dfl 42,700 for breast cancer and dfl 29,000 for cervical cancer. This difference in costs is largely attributable to the longer duration of advanced disease for breast cancer, which substantially affects hospitalcosts. The high costs of care to patients with advanced cancer contribute to a favourable cost-effectiveness ration of those screening programmes which reduce mortality and consequently the costs of care to advanced cancer patients

Causality and determination, powers and agency: Anscombean perspectives

Anscombe’s 1971 inaugural lecture at Cambridge, entitled ‘Causality and Determination’, has had a lasting influence on a remarkably broad range of philosophers and philosophical debates, touching on fundamental topics in philosophy of science, action theory, the free will debate, epistemology, philosophy of mind, and metaphysics. Especially where anti-reductionist or pluralist strands of philosophical thought are being seriously considered, one should not be surprised to find references to Anscombe’s lecture. Moreover, there appears to be a growing interest in Anscombe’s comprehensive philosophical outlook, as attested by the recent publication of a weighty collection of essays spanning that outlook in its full breadth in the prestigious Routledge Philosophical Minds series. Against this background it is apt that now, 50 years after the original lecture, a Topical Collection sees the light, circling around the most central themes from Anscombe’s lecture, with a particular emphasis on the question how these hang together, how they form part of the larger philosophical project that Anscombe obviously intended the lecture to highlight. This Introduction motivates the Topical Collection, and introduces the various contributions against that background

Pan-viral protection against arboviruses by activating skin macrophages at the inoculation site

Arthropod-borne viruses (arboviruses) are important human pathogens for which there are no specific antiviral medicines. The abundance of genetically distinct arbovirus species, coupled with the unpredictable nature of their outbreaks, has made the development of virus-specific treatments challenging. Instead, we have defined and targeted a key aspect of the host innate immune response to virus at the arthropod bite that is common to all arbovirus infections, potentially circumventing the need for virus-specific therapies. Using mouse models and human skin explants, we identify innate immune responses by dermal macrophages in the skin as a key determinant of disease severity. Post-exposure treatment of the inoculation site by a topical TLR7 agonist suppressed both the local and subsequent systemic course of infection with a variety of arboviruses from the Alphavirus, Flavivirus, and Orthobunyavirus genera. Clinical outcome was improved in mice after infection with a model alphavirus. In the absence of treatment, antiviral interferon expression to virus in the skin was restricted to dermal dendritic cells. In contrast, stimulating the more populous skin-resident macrophages with a TLR7 agonist elicited protective responses in key cellular targets of virus that otherwise proficiently replicated virus. By defining and targeting a key aspect of the innate immune response to virus at the mosquito bite site, we have identified a putative new strategy for limiting disease after infection with a variety of genetically distinct arboviruses

The multi-objective assembly line worker integration and balancing problem of type-2

[EN] The consideration of worker heterogeneity in assembly lines has received a fair amount of attention in the literature in the past decade. Most of this exploration uses as motivation the example of assembly lines in sheltered work centers for the disabled. Only recently has the community started looking at the situation faced in assembly lines in the general industrial park, when in the presence of worker heterogeneity. This step raises a number of questions around the best way to incorporate heterogeneous workers in the line, maximizing their integration while maintaining productivity levels. In this paper we propose the use of Miltenburg's regularity criterion and cycle time as metrics for integration of workers and productivity, respectively. We then define, model and develop heuristics for a line balancing problem with these two goals. Results obtained through an extensive set of computational experiments indicate that a good planning can obtain trade-off solutions that perform well in both objectives.This research was supported by CAPES -Brazil and MEC-Spain (coordinated project CAPES DGU 258-12/PHB2011-0012-PC ) and by FAPESP -Brazil (grant number: 2010/19983-6 ).Moreira, MC.; Pastor, R.; Costa, A.; Miralles Insa, CJ. (2017). The multi-objective assembly line worker integration and balancing problem of type-2. Computers & Operations Research. 82:114-125. https://doi.org/10.1016/j.cor.2017.01.003S1141258

Erythrocyte-Bound Apolipoprotein B in Relation to Atherosclerosis, Serum Lipids and ABO Blood Group

Introduction:Erythrocytes carry apolipoprotein B on their membrane, but the determining factors of erythrocyte-bound apolipoprotein B (ery-apoB) are unknown. We aimed to explore the determinants of ery-apoB to gain more insight into potential mechanisms.Methods:Subjects with and without CVD were included (N = 398). Ery-apoB was measured on fresh whole blood samples using flow cytometry. Subjects with ery-apoB levels ≤0.20 a.u. were considered deficient. Carotid intima media thickness (CIMT) was determined as a measure of (subclinical) atherosclerosis.Results:Mean ery-apoB value was 23.2% lower in subjects with increased CIMT (0.80±0.09 mm, N = 140) compared to subjects with a normal CIMT (0.57±0.08 mm, N = 258) (P = 0.007, adjusted P<0.001). CIMT and ery-apoB were inversely correlated (Spearman's r: -0.116, P = 0.021). A total of 55 subjects (13.6%) were considered ery-apoB deficient, which was associated with a medical history of CVD (OR: 1.86, 95% CI 1.04-3.33; adjusted OR: 1.55; 95% CI 0.85-2.82). Discontinuation of statins in 54 subjects did not influence ery-apoB values despite a 58.4% increase in serum apolipoprotein B. Subjects with blood group O had significantly higher ery-apoB values (1.56±0.94 a.u.) when compared to subjects with blood group A (0.89±1.15 a.u), blood group B (0.73±0.1.12 a.u.) or blood group AB (0.69±0.69 a.u.) (P-ANOVA = 0.002).Conclusion:Absence or very low values of ery-apoB are associated with clinical and subclinical atherosclerosis. While serum apolipoprotein B is not associated with ery-apoB, the ABO blood group seems to be a significant determinant