Effects and Costs of Breast Cancer screening in women with a familial or genetic predisposition

"Women with a BRCA1 or BRCA2 mutation, who have a considerable increased risk of developing breast cancer, now face the choice of intensive screening, prophylactic surgery or chemoprevention. The efficacy of the various medical options and the durability of its effects are of major concern to female BRCA1/2 mutation carriers, and will influence their choices. Although prophylactic mastectomy reduces the rate of breast cancer risk of 90 % or more, the intervention is irreversible, with potential harms that may be unacceptable for certain women. This thesis shows that intensive screening is an appropriate alternative to reduce the risk of breast cancer death for both BRCA1/2 mutation carriers and for women with a clear family history of breast cancer where a mutation has not (yet) been found. Intensive screenings expected to lead to significant breast cancer mortality reductions with no adverse effect on short-term generic health-related quality of life and general distress. Including magnetic resonance imaging in BRCA1/2 mutation carriers (50-85% cumulative lifetime risk for developing breast cancer) surveillance is cost-effective. For moderate-risk women (15-30% cumulative lifetime risk for developing breast cancer), intensive screening with only mammography, alternatively in combination with clinical breast examination, is most cost-effective.

CO2 Energy Reactor – Integrated Mineral Carbonation: Perspectives on Lab-Scale Investigation and Products Valorization

To overcome the challenges of mineral CO2 sequestration, Innovation Concepts B.V. is developing a unique proprietary gravity pressure vessel (GPV) reactor technology and has focussed on generating reaction products of high economic value. The GPV provides intense process conditions through hydrostatic pressurization and heat exchange integration that harvests exothermic reaction energy, thereby reducing energy demand of conventional reactor designs, in addition to offering other benefits. In this paper, a perspective on the status of this technology and outlook for the future is provided. To date, laboratory-scale tests of the envisioned process have been performed in a tubular “rocking autoclave” reactor. The mineral of choice has been olivine [~Mg1.6Fe2+0.4(SiO4) + ppm Ni/Cr], although asbestos, steel slags, and oil shale residues are also under investigation. The effect of several process parameters on reaction extent and product properties has been tested: CO2 pressure, temperature, residence time, additives (buffers, lixiviants, chelators, oxidizers), solids loading, and mixing rate. The products (carbonates, amorphous silica, and chromite) have been physically separated (based on size, density, and magnetic properties), characterized (for chemistry, mineralogy, and morphology), and tested in intended applications (as pozzolanic carbon-negative building material). Economically, it is found that product value is the main driver for mineral carbonation, rather than, or in addition to, the sequestered CO2. The approach of using a GPV and focusing on valuable reaction products could thus make CO2 mineralization a feasible and sustainable industrial process

Productivity Loss Related to Neglected Tropical Diseases Eligible for Preventive Chemotherapy

Neglected Tropical Diseases (NTDs) not only have impact on health and life expectancy of mostly disadvantaged populations, but can also lead to economic consequences, including reduced ability to work. Investments in health improvement of the populations affected by NTDs would also help to increase economic growth of the affected regions, since healthier populations are more economically productive. We performed a systematic literature review to better understand how much NTDs affect people’s economic welfare. Here we present the results for the NTDs that are controlled with preventive chemotherapy (PCT): lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths (ascariasis, trichuriasis, and hookworm infection) and trachoma. Our findings show that PCT NTDs clearly affect productivity, although the actual impact depends on the type and severity of the NTD as well as on the context where the disease occurs. Variation in estimated productivity loss is also caused by differences in research methods. Publications should provide enough information to enable readers to assess the quality and relevance of the study for their purposes

Clinical Practice Variation Needs to be Considered in Cost-Effectiveness Analyses

Background and Objective: The cost-effectiveness of clinical interventions is often assessed using current care as the comparator, with national guidelines as a proxy. However, this comparison is inadequate when clinical practice differs from guidelines, or when clinical practice differs between hospitals. We examined the degree of variation in the way patients w

Extended-Spectrum β-Lactamase Genes of Escherichia coli in Chicken Meat and Humans, the Netherlands

We determined the prevalence and characteristics of extended-spectrum β-lactamase (ESBL) genes of Enterobacteriaceae in retail chicken meat and humans in the Netherlands. Raw meat samples were obtained, and simultaneous cross-sectional surveys of fecal carriage were performed in 4 hospitals in the same area. Human blood cultures from these hospitals that contained ESBL genes were included. A high prevalence of ESBL genes was found in chicken meat (79.8%). Genetic analysis showed that the predominant ESBL genes in chicken meat and human rectal swab specimens were identical. These genes were also frequently found in human blood culture isolates. Typing results of Escherichia coli strains showed a high degree of similarity with strains from meat and humans. These findings suggest that the abundant presence of ESBL genes in the food chain may have a profound effect on future treatment options for a wide range of infections caused by gram-negative bacteria

№ 46. Із щотижневого зведення Секретного відділу ДПУ УСРР № 46/56 за час з 13 до 19 листопада 1927 р.

Classifications of the Campylobacter fetus subspecies fetus and venerealis were first described in 1959 and were based on the source of isolation (intestinal versus genital) and the ability of the strains to proliferate in the genital tract of cows. Two phenotypic assays (1% glycine tolerance and H2S production) were described to differentiate the subspecies. Multiple molecular assays have been applied to differentiate the C. fetus subspecies, but none of these tests is consistent with the phenotypic identification methods. In this study, we defined the core genome and accessory genes of C. fetus, which are based on the closed genomes of five C. fetus strains. Phylogenetic analysis of the core genomes of 23 C. fetus strains of the two subspecies showed a division into two clusters. The phylogenetic core genome clusters were not consistent with the phenotypic classifications of the C. fetus subspecies. However, they were consistent with the molecular characteristics of the strains, which were determined by multilocus sequence typing, sap typing, and the presence/absence of insertion sequences and a type I restriction modification system. The similarity of the genome characteristics of three of the phenotypically defined C. fetus subsp. fetus strains to C. fetus subsp. venerealis strains, when considering the core genome and accessory genes, requires a critical evaluation of the clinical relevance of C. fetus subspecies identification by phenotypic assays

Subclinical thyroid dysfunction and cognitive decline in old age

<p>Background: Subclinical thyroid dysfunction has been implicated as a risk factor for cognitive decline in old age, but results are inconsistent. We investigated the association between subclinical thyroid dysfunction and cognitive decline in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).</p> <p>Methods: Prospective longitudinal study of men and women aged 70–82 years with pre-existing vascular disease or more than one risk factor to develop this condition (N = 5,154). Participants taking antithyroid medications, thyroid hormone supplementation and/or amiodarone were excluded. Thyroid function was measured at baseline: subclinical hyper- and hypothyroidism were defined as thyroid stimulating hormones (TSH) <0.45 mU/L or >4.50 mU/L respectively, with normal levels of free thyroxine (FT4). Cognitive performance was tested at baseline and at four subsequent time points during a mean follow-up of 3 years, using five neuropsychological performance tests.</p> <p>Results: Subclinical hyperthyroidism and hypothyroidism were found in 65 and 161 participants, respectively. We found no consistent association of subclinical hyper- or hypothyroidism with altered cognitive performance compared to euthyroid participants on the individual cognitive tests. Similarly, there was no association with rate of cognitive decline during follow-up.</p> <p>Conclusion: We found no consistent evidence that subclinical hyper- or hypothyroidism contribute to cognitive impairment or decline in old age. Although our data are not in support of treatment of subclinical thyroid dysfunction to prevent cognitive dysfunction in later life, only large randomized controlled trials can provide definitive evidence.</p&gt

The impact of storms and stratification on sediment transport in the Rhine region of freshwater influence

We present measurements of along and across-shore sediment transport in a region of the Dutch coast 10 kilometers north of the Rhine River mouth. This section of the coast is characterized by strong vertical density stratification because it is within the mid-field region of the Rhine region of freshwater influence, where processes typical of the far-field, such as tidal straining, are modified by the passage of distinct freshwater lenses at the surface. The experiment captured two storms, and a wide range of wind, wave, tidal and stratification conditions. We focus primarily on the mechanisms leading to cross-shore sediment flux at a mooring location in 12m of water, which are responsible for the exchange of sediment between the near-shore and the inner shelf. Net transport during storms was directed offshore and influenced by cross-shelf winds, while net transport during spring tides was determined by the mean state of stratification. Tidal straining dominated during neap tides; however, cross-shore transport was negligible due to small sediment concentrations. The passage of freshwater lenses manifested as strong pulses of offshore transport primarily during spring tides. We observe that both barotropic and baroclinic processes are relevant for cross-shore transport at depth and, since transport rates due to these competing processes were similar, the net transport direction will be determined by the frequency and sequencing of these modes of transport. Based on our observations, we find that wind- and wave-driven transport during storms tends move fine sediment offshore, while calmer, more stratified conditions move it back onshore