MOONS : the new Multi-Object Spectrograph for the VLT

MOONS is the new Multi-Object Optical and Near-infrared Spectrograph currently under construction for the Very Large Telescope (VLT) at ESO. This remarkable instrument combines, for the first time, the collecting power of an 8-m telescope, 1000 fibres with individual roboticp ositioners, and both low- and high-resolution simultaneous spectral coverage across the 0.64–1.8 μm wavelength range. This facility will provide the astronomical community with a powerful, world-leading instrument able to serve a wide range of Galactic, extragalactic and cosmological studies. Construction is now proceeding full steam ahead and this overview article presents some of the science goals and the technical description of the MOONS instrument. More detailed information on the MOONS surveys is provided in the other dedicated articles in this Messenger issue.Publisher PD

Delivery of care for adult patients with congenital heart disease in Europe: Results from the Euro Heart Survey

Aims: The increasing number of adults with congenital heart disease (CHD) has prompted the development of recommendations for the management of these patients and for the organization of their healthcare. The aim of this report is to describe the delivery of care in Europe for adults with congenital cardiac anomalies. Methods and results: As part of the Euro Heart Survey on Adult Congenital Heart Disease, we obtained data from 71 voluntarily participating centres that detailed their care practices for these patients. Forty-eight of these centres were specialist centres and 23 were non-specialist centres. We found that only 19% of the specialist centres complied with defined standards for optimal care structure. The criteria that appeared to be most difficult for all centres to achieve were performing 50 congenital heart operations or more per year and involving nurse specialists in the care of these patients. Conclusion: This survey indicated that the provision of care in Europe for adults with congenital

Prognosis and prognostic factors of patients with mesothelioma:A population-based study

BACKGROUND: It is important to regularly update survival estimates of patients with malignant mesothelioma as prognosis may vary according to epidemiologic factors and diagnostic and therapeutic management. METHODS: We assessed overall (baseline) survival as well as related prognostic variables in a large cohort of 1353 patients with a confirmed diagnosis of malignant mesothelioma between 2005 and 2008. RESULTS: About 50% of the patients were 70 years or older at diagnosis and the median latency time since start of asbestos exposure was 49 years. One year after diagnosis, 47% of the patients were alive, 20% after 2 years and 15% after 3 years. Prognostic variables independently associated with worse survival were: older age (HR=1.04 per year 95% CI (1.03–1.06)), sarcomatoid subtype (HR=2.45 95% CI (2.06–2.90)) and non-pleural localisation (HR=1.67 95% CI (1.26–2.22)). CONCLUSION: Survival of patients with malignant mesothelioma is still limited and depends highly on patient age, mesothelioma subtype and localisation. In addition, a substantial part of the patients had a long latency time between asbestos exposure and diagnosis

Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes.

The PROGRESS series (www.progress-partnership.org) sets out a framework of four interlinked prognosis research themes and provides examples from several disease fields to show why evidence from prognosis research is crucial to inform all points in the translation of biomedical and health related research into better patient outcomes. Recommendations are made in each of the four papers to improve current research standards What is prognosis research? Prognosis research seeks to understand and improve future outcomes in people with a given disease or health condition. However, there is increasing evidence that prognosis research standards need to be improved Why is prognosis research important? More people now live with disease and conditions that impair health than at any other time in history; prognosis research provides crucial evidence for translating findings from the laboratory to humans, and from clinical research to clinical practice This first article introduces the framework of four interlinked prognosis research themes and then focuses on the first of the themes - fundamental prognosis research, studies that aim to describe and explain future outcomes in relation to current diagnostic and treatment practices, often in relation to quality of care Fundamental prognosis research provides evidence informing healthcare and public health policy, the design and interpretation of randomised trials, and the impact of diagnostic tests on future outcome. It can inform new definitions of disease, may identify unanticipated benefits or harms of interventions, and clarify where new interventions are required to improve prognosis

Clinical outcomes of biliary drainage of malignant biliary obstruction due to colorectal cancer metastases : a systematic review

Background and aims: Malignant biliary obstruction is an ominous complication of metastatic colorectal cancer (mCRC). Biliary drainage is frequently performed to relieve symptoms of jaundice or enable palliative systemic therapy, but effective drainage can be difficult to accomplish. The aim of this study is to summarize literature on clinical outcomes of biliary drainage in mCRC patients with malignant biliary obstruction.& nbsp; Methods: We searched Medline and EMBASE for studies that included patients with malignant biliary obstruction secondary to mCRC, treated with endoscopic and/or percutaneous biliary drainage. We summarized available data on technical success, clinical success, adverse events, systemic therapy administration and survival after biliary drainage.& nbsp; Results: After screening 3584 references and assessing 509 full-text articles, seven cohort studies were included. In these studies, rates of technical success, clinical success and adverse events varied between 63%-94%, 42%81%, and 19%-39%, respectively. Subsequent chemotherapy was administered in 17%-56% of patients. Overall survival varied between 40 and 122 days across studies (278-365 days in patients who received subsequent chemotherapy, 42-61 days in patients who did not).& nbsp; Conclusions: Successful biliary drainage in mCRC patients can be challenging to achieve and is frequently associated with adverse events. Overall survival after biliary drainage is limited, but is significantly longer in patients treated with subsequent systemic therapy. Expected benefits of biliary drainage should be carefully weighed against its risks

[Targeted therapy:the benefit of new oncological tests].

Voor vele kankervormen komen doelgerichte behandelingen beschikbaar, waarvoor op grond van tumoreigenschappen ook rationele keuzes gemaakt kunnen worden.Er is grote behoefte aan adequate biomarkers die het effect van doelgerichte therapie bij individuele kankerpatiënten kunnen voorspellen, om daarmee de juiste oncologische behandeling voor de juiste patiënt te kunnen bepalen. Zo kunnen nutteloze behandelingen en onnodige bijwerkingen vermeden worden, en kosten worden gereduceerd.Bij borstkanker zijn de oestrogeenreceptor (ER) en de humane epidermale groeifactorreceptor 2 (HER2) voorbeelden van gestandaardiseerde, in gerandomiseerde onderzoeken gevalideerde, predictieve testen van behandeleffecten.Voor genexpressieprofielen die samenhangen met tumorgroei worden ook gerandomiseerde onderzoeksdata verwacht.Het kwantificeren van de predictieve waarde van testen op verwachte behandeleffecten in gerandomiseerde studies is kostbaar en tijdrovend. Gezien de toename van doelgerichte medicijnen en diagnostische en prognostische technieken, wordt in allerlei domeinen gezocht naar alternatieve onderzoeksopzetten die kunnen leiden tot snellere en efficiëntere bewijsvoering.An increasing number of targeted drug treatments are becoming available for many types of cancer. There is a great need for adequate biomarkers that can predict the effect of targeted therapy in individual cancer patients, in order to determine the correct oncological treatment per patient. This way, non-effective treatments can be spared, side-effects avoided, and costs reduced. Oestrogen receptor (ER) and the human epidermal growth factor receptor 2 (HER2) are examples of standardized tests for breast cancer that have been validated in randomised studies. Data from randomised studies is also expected for gene expression profiles that correlate with tumour growth. Quantifying the predictive value of tests for anticipated treatment effects is costly and time-consuming. Given the increasing availability of targeted agents and diagnostic and prognostic techniques, alternative clinical study designs that can lead to quicker and more efficient verification are being sought in many different domains.</p

Valuing Healthcare Goods and Services: A Systematic Review and Meta-Analysis on the WTA-WTP Disparity

Objective: The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services. Methods: A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies. Results: Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52–2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42–2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found. Conclusions and Implications: The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses