The myth of small data:How to produce small area estimates regarding lifestyle, health and healthcare to support an integrated population-based healthcare. Methods and outcomes

Innovatieve schattingsmethode geeft inzicht in lokale zorgvraag, leefstijl en gezondheid De Nederlandse gezondheidszorg is van goede kwaliteit, maar slaat een groot gat in de begroting van de overheid. Om de kosten enigszins te temperen is het devies om de zorg beter af te stemmen op de vraag naar zorg en niet visa versa. Daarnaast moet de zorg en dan met name de eerstelijnszorg georganiseerd worden in de buurt en afgestemd zijn op de behoeften van de inwoners. De ontwikkelde innovatieve schattingsmethode kan ingezet worden om een betere afstemming tussen vraag en aanbod op lokaal niveau te faciliteren. Het afstemmen van de lokale vraag naar zorg op het aanbod van zorg blijkt in de praktijk een complexe zaak. Allereerst zijn er veel partijen mee gemoeid, zoals verzekeraars, gemeenten en zorgverleners. Daarnaast is er een groot verschil in leefstijl, gezondheid en zorgbehoefte tussen buurten. De behoefte aan zorg wordt namelijk sterk beïnvloed door de bevolkingssamenstelling van een buurt. Zo zal een buurt met een hoog percentage ouderen een hogere zorgvraag hebben dan een buurt met een laag percentage ouderen. Bovendien zijn de cijfers over deze verschillen op lokaal niveau niet (makkelijk) voorhanden. Vooral privacy issues spelen een grote rol in de beschikbaarheid van zorggegevens op lokaal niveau. De schattingsmethode is ontwikkeld om voor alle vier-positie postcodegebieden in Nederland de vraag naar zorg te schatten en daarmee te voorzien in de belangrijke gegevenskloof. De schattingsmethode gebruikt een statistisch model en twee essentiële databestanden. Het eerste databestand bevat voor ieder vier-positie postcodegebied zeven sociaal-demografische kenmerken, zoals de leeftijdssamenstelling, percentage eenpersoonshuishouden en de stedelijkheidsgraad van het gebied. Het tweede databestand bevat een nationale steekproef van zorggegevens of van gegevens over gezondheid en leefstijl. Vervolgens stelt het statistische model de relatie vast tussen de zeven sociaal-demografische kenmerken en de vraag naar zorg of de gezondheidssituatie en de leefstijl van een buurt waarvoor er gegevens voorhanden zijn. Daarna worden de relaties toegepast op de bevolkingssamenstelling van alle vier-positiepostcodegebieden in Nederland. Het resultaat van de schattingsmethode zijn gegevens voor alle vier-positiepostcode gebieden in Nederland over de vraag naar zorg, de gezondheidssituatie en de leefstijl van het gebied. De gegevens zijn schattingen op basis van de bevolkingssamenstelling en zijn dus niet de werkelijke gegevens. Uit nader onderzoek blijkt dat het verschil tussen de werkelijke cijfers uit medische gegevens van huisartsenpraktijken en de geschatte cijfers groter of kleiner worden door huisartsenpraktijkkenmerken. Zo hebben huisartsenpraktijken met vrouwelijke huisartsen meer consulten dan uit de resultaten van de schattingsmethode blijkt. Ook duale praktijken en praktijken met andere zorgverleners in dienst hebben meer consulten dan verwacht mag worden op basis van de bevolkingssamenstelling. Lokale schattingen over de vraag naar zorg, gezondheid en leefstijl op basis van de schattingsmethode maken lokale initiatieven voor preventieve interventies mogelijk, net als initiatieven voor lokale gezondheidsbevordering. Daarnaast faciliteren de schattingen een betere afstemming tussen de lokale behoefte aan zorg en het lokale aanbod aan zorg voor goede zorg tegen lagere kosten

Алгоритм функціонування системи захисту

Детально розглянуті алгоритми виявлення атак у середовищі мереж зв'язку.In detail the algorithms of exposure of attacks are considered in the environment of communication network

Fruit Detectability Analysis for Different Camera Positions in Sweet-Pepper

For robotic harvesting of sweet-pepper fruits in greenhouses a sensor system is required to detect and localize the fruits on the plants. Due to the complex structure of the plant, most fruits are (partially) occluded when an image is taken from one viewpoint only. In this research the effect of multiple camera positions and viewing angles on fruit visibility and detectability was investigated. A recording device was built which allowed to place the camera under different azimuth and zenith angles and to move the camera horizontally along the crop row. Fourteen camera positions were chosen and the fruit visibility in the recorded images was manually determined for each position. For images taken from one position only with the criterion of maximum 50% occlusion per fruit, the fruit detectability (FD) was in no case higher than 69%. The best single positions were the front views and looking with a zenith angle of 60° upwards. The FD increased when a combination was made of multiple viewpoint positions. With a combination of five favourite positions the maximum FD was 90%

Uptake and toxicity studies of poly-acrylic acid functionalized silicon nanoparticles in cultured mammalian cells

Poly-acrylic acid (PAAc) terminated silicon nanoparticles (SiNPs) have been synthesized and employed as a synchronous fluorescent signal indicator in a series of cultured mammalian cells: HHL5, HepG2 and 3T3-L1. Their biological effects on cell growth and proliferation in both human and mouse cell lines have been studied. There was no evidence of in vitro cytotoxity in the cells exposed to PAAc terminated SiNPS when assessed by cell morphology, cell proliferation and viability, and DNA damage assays. The uptake of the nanocrystals by both HepG2 and 3T3-L1 cells was investigated by confocal microscopy and flow cytometry, which showed a clear time-dependence at higher concentrations. Reconstructed 3-D confocal microscope images exhibited that the PAAc-SiNPs were evenly distributed throughout the cytosol rather than attached to outer membrane. This study provides fundamental evidence for the safe application and further modification of silicon nanoparticles, which could broaden their application as cell markers in living systems and in micelle encapsulated drug delivery systems

Generating HPV specific T helper cells for the treatment of HPV induced malignancies using TCR gene transfer

<p>Abstract</p> <p>Background</p> <p>Infection with high risk Human Papilloma Virus (HPV) is associated with cancer of the cervix, vagina, penis, vulva, anus and some cases of head and neck carcinomas. The HPV derived oncoproteins E6 and E7 are constitutively expressed in tumor cells and therefore potential targets for T cell mediated adoptive immunotherapy. Effective immunotherapy is dependent on the presence of both CD4+ and CD8+ T cells. However, low precursor frequencies of HPV16 specific T cells in patients and healthy donors hampers routine isolation of these cells for adoptive transfer purposes. An alternative to generate HPV specific CD4+ and CD8+ T cells is TCR gene transfer.</p> <p>Methods</p> <p>HPV specific CD4+ T cells were generated using either a MHC class I or MHC class II restricted TCR (from clones A9 and 24.101 respectively) directed against HPV16 antigens. Functional analysis was performed by interferon-γ secretion, proliferation and cytokine production assays.</p> <p>Results</p> <p>Introduction of HPV16 specific TCRs into blood derived CD4+ recipient T cells resulted in recognition of the relevant HPV16 epitope as determined by IFN-γ secretion. Importantly, we also show recognition of the endogenously processed and HLA-DP1 presented HPV16E6 epitope by 24.101 TCR transgenic CD4+ T cells and recognition of the HLA-A2 presented HPV16E7 epitope by A9 TCR transgenic CD4+ T cells.</p> <p>Conclusion</p> <p>Our data indicate that TCR transfer is feasible as an alternative strategy to generate human HPV16 specific CD4+ T helper cells for the treatment of patients suffering from cervical cancer and other HPV16 induced malignancies.</p

Interleukin-10 and soluble tumor necrosis factor receptor II are potential biomarkers of Plasmodium falciparum infections in pregnant women: a case-control study from Nanoro, Burkina Faso.

BACKGROUND: Diagnosis of malaria in pregnancy is problematic due to the low sensitivity of conventional diagnostic tests (rapid diagnostic test and microscopy), which is exacerbated due to low peripheral parasite densities, and lack of clinical symptoms. In this study, six potential biomarkers to support malaria diagnosis in pregnancy were evaluated. METHODS: Blood samples were collected from pregnant women at antenatal clinic visits and at delivery. Microscopy and real-time PCR were performed for malaria diagnosis and biomarker analyses were performed by ELISA (interleukin 10, IL-10; tumor necrosis factor-α, TNF-α; soluble tumor necrosis factor receptor II, sTNF-RII; soluble fms-like tyrosine kinase 1, sFlt-1; leptin and apolipoprotein B, Apo-B). A placental biopsy was collected at delivery to determine placental malaria. RESULTS: IL-10 and sTNF-RII were significantly higher at all time-points in malaria-infected women (p < 0.001). Both markers were also positively associated with parasite density (p < 0.001 and p = 0.003 for IL-10 and sTNF-RII respectively). IL-10 levels at delivery, but not during pregnancy, were negatively associated with birth weight. A prediction model was created using IL-10 and sTNF-RII cut-off points. For primigravidae the model had a sensitivity of 88.9% (95%CI 45.7-98.7%) and specificity of 83.3% (95% CI 57.1-94.9%) for diagnosing malaria during pregnancy. For secundi- and multigravidae the sensitivity (81.8% and 56.5% respectively) was lower, while specificity (100.0% and 94.3% respectively) was relatively high. Sub-microscopic infections were detected in 2 out of 3 secundi- and 5 out of 12 multigravidae. CONCLUSIONS: The combination of biomarkers IL-10 and sTNF-RII have the potential to support malaria diagnosis in pregnancy. Additional markers may be needed to increase sensitivity and specificity, this is of particular importance in populations with sub-microscopic infections or in whom other inflammatory diseases are prevalent

Increase in the prevalence of mutations associated with sulfadoxine-pyrimethamine resistance in Plasmodium falciparum isolates collected from early to late pregnancy in Nanoro, Burkina Faso.

BACKGROUND: Pregnant women are a high-risk group for Plasmodium falciparum infections, which may result in maternal anaemia and low birth weight newborns, among other adverse birth outcomes. Intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy (IPTp-SP) is widely implemented to prevent these negative effects of malaria. However, resistance against SP by P. falciparum may decrease efficacy of IPTp-SP. Combinations of point mutations in the dhps (codons A437, K540) and dhfr genes (codons N51, C59, S108) of P. falciparum are associated with SP resistance. In this study the prevalence of SP resistance mutations was determined among P. falciparum found in pregnant women and the general population (GP) from Nanoro, Burkina Faso and the association of IPTp-SP dosing and other variables with mutations was studied. METHODS: Blood spots on filter papers were collected from pregnant women at their first antenatal care visit (ANC booking) and at delivery, from an ongoing trial and from the GP in a cross-sectional survey. The dhps and dhfr genes were amplified by nested PCR and products were sequenced to identify mutations conferring resistance (ANC booking, n = 400; delivery, n = 223; GP, n = 400). Prevalence was estimated with generalized estimating equations and for multivariate analyses mixed effects logistic regression was used. RESULTS: The prevalence of the triple dhfr mutation was high, and significantly higher in the GP and at delivery than at ANC booking, but it did not affect birth weight. Furthermore, quintuple mutations (triple dhfr and double dhps mutations) were found for the first time in Burkina Faso. IPTp-SP did not significantly affect the occurrence of any of the mutations, but high transmission season was associated with increased mutation prevalence in delivery samples. It is unclear why the prevalence of mutations was higher in the GP than in pregnant women at ANC booking. CONCLUSION: The high number of mutants and the presence of quintuple mutants in Burkina Faso confirm concerns about the efficacy of IPTp-SP in the near future. Other drug combinations to tackle malaria in pregnancy should, therefore, be explored. An increase in mutation prevalence due to IPTp-SP dosing could not be confirmed