Nodular Sarcoidosis Masquerading as Cancer.

Nodular lung disease is a rare pulmonary manifestation of sarcoidosis and resembles metastatic neoplasm disease. Nodular sarcoidosis is rare, varying from 1.6% to 4% of patients with sarcoidosis. Radiographic nodules measure from 1 to 5 cm in diameter that typically consist of coalescent granulomas. There is limited data on this form of sarcoidosis and its presentation can mimic primary or metastatic pulmonary neoplasms. Nodular sarcoidosis has a favorable prognosis, and resolution can be seen with oral corticosteroids. Herein, we present such a case of nodular pulmonary sarcoidosis with a lung nodule measured up to 6 cm

Economics of Biofortification

Micronutrient malnutrition affects billions of people world-wide, causing serious health problems. Different micronutrient interventions are currently being used, but their overall coverage is relatively limited. Biofortification that is, breeding staple food crops for higher micronutrient contents has been proposed as a new agriculture-based approach. Yet, as biofortified crops are still under development, relatively little is known about their economic impacts and wider ramifications. In this article, the main factors that will influence their future success are discussed, and a methodology for economic impact assessment is presented, combining agricultural, nutrition, and health aspects. Ex ante studies from India and other developing countries suggest that biofortified crops can reduce the problem of micronutrient malnutrition in a cost-effective way, when they are targeted to specific situations. Projected social returns on research investments are high and competitive with productivity-enhancing agricultural technologies. These promising results notwithstanding, biofortification should be seen as a complement rather than a substitute for existing micronutrient interventions, since the magnitude and complexity of the problem necessitate a multiplicity of approaches. Further research is needed to corroborate these findings and to address certain issues still unresolved at this stage.micronutrient malnutrition, public health, biofortification, agricultural technology, impact analysis, developing countries, Food Consumption/Nutrition/Food Safety, I1, I3, O1, O3, Q1,

Potential Impacts of Iron Biofortification in India

Iron deficiency is a widespread nutritional problem in developing countries, causing impaired physical activity and cognitive development, as well as maternal mortality. Although food fortification and supplementation programmes have been effective in some countries, their overall success remains limited. Biofortification, that is, breeding crops for higher micronutrient content, is a relatively new approach. We propose a methodology for ex-ante impact assessment of iron biofortification, which builds on disability-adjusted life years (DALYs) and a large household data set. Our analysis of iron-rich rice and wheat in India indicates sizeable potential health benefits. The cost-effectiveness of iron biofortification compares favourably with other interventions.biofortification, plant breeding, iron deficiency anaemia, health benefits, DALYs, cost-effectiveness, cost-benefit analysis, India, Research and Development/Tech Change/Emerging Technologies, I120, I180, I310, O150, O220, O330, Q180.,

Health benefits of biofortification - an ex-ante analysis of iron-rich rice and wheat in India

Hunger is acknowledged to impose a heavy burden on humankind with severe negative health consequences. Micronutrient malnutrition, or "hidden hunger", is an even more widespread problem, to which economic development and income growth alone are not expected to provide a solution any time soon. Existing micronutrient interventions like pharmaceutical supplementation or industrial fortification have their limitations and can be complemented by a new approach: breeding food crops for higher micronutrient densities. Knowledge about the cost-effectiveness of this new tool, also termed biofortification, is scarce. In this study, a framework for economic impact analysis is developed, which is then used for evaluation of iron-rich rice and wheat in India. Health benefits are measured and quantified using "disability-adjusted life years" (DALYs). The impact of biofortification is based on a representative data set of food consumption at the household level. Juxtaposing imputed health benefits with research and development costs proves the cost-effectiveness of the intervention; under pessimistic assumptions saving one healthy life year through biofortification only costs US$ 1.90, a cost which even declines to 36 Cents under optimistic assumptions. Extending the study to include a cost-benefit analysis shows that iron biofortification, with an internal rate of return of 74-152%, can also be a worthwhile public investment.Food Consumption/Nutrition/Food Safety,

Micronutrient malnutrition and the impact of modern plant breeding on public health in India: How cost-effective is biofortification?

Millions of people worldwide suffer from micronutrient malnutrition or ?hidden hunger?. The related deficiencies can have devastating consequences for the life, health and well-being of the affected individuals, but they may also perpetuate a vicious circle of undernutrition, low economic productivity and poverty. Hence, in many developing countries vitamin and mineral deficiencies are public health problems of primary concern. While economic development and rising incomes can only address undernutrition in the long run, conventional approaches also have weaknesses of their own. Therefore, ?biofortification? may be a promising intervention. The idea is to breed food crops for higher micronutrient content, which can be done through cross-breeding or genetic engineering. Targeting staple crops that fortify themselves has several advantages: the enriched crops simply follow the normal food chain and are eaten by the poor in bigger quantities. Moreover, the underlying germplasm of micronutrient-rich crops only needs to be developed once and can then be used around the world ? and farmers can grow and reproduce biofortified crops year on year and share the micronutrient-dense seeds. Therefore, the initial investments in R&D of biofortification can be followed by a continuous stream of benefits that accumulates over time and space, which suggests that biofortification can be a very cost-effective intervention. However, a more rigorous and comprehensive assessment of biofortification is still outstanding. This book has been written to narrow this knowledge gap and to offer a sound basis for future research and policy decisions regarding biofortification ? covering both, crops that are produced through conventional breeding and genetically modified organisms (GMOs). For this ex ante evaluation of biofortification, an impact assessment of five different crops (iron-rich rice and wheat, zinc-rich rice and wheat and beta-carotene-rich Golden Rice) has been done for India to determine their effectiveness. The main contribution of this study lies in the development of a methodology that reproduces the whole sequence of effects between the cultivation of the micronutrient-rich crops and their ultimate health impacts, taking into account various micronutrient levels in the crops, different rates of adoption and acceptance, and the ensuing improvements in individual nutrition status. To this end in this book the disability-adjusted life years (DALYs) framework has been refined and applied to determine the disaggregate burden of disease of iron deficiency anaemia (IDA), zinc deficiency (ZnD) and vitamin A deficiency (VAD) in India. The assessment of the potential impact of the biofortified crops has been complemented by an economic evaluation, because mere effectiveness is a poor guide to policy making when resources are limited. Therefore, a cost-effectiveness analysis (CEA) and a cost-benefit analysis (CBA) have been carried out for each of the crops to determine their efficiency and their overall social profitability. The attributable costs of the R&D for the crops as well as the costs for related dissemination and extension activities within India have been juxtaposed to the expected health benefits. The resulting cost-effectiveness measure ($/DALY saved) has been compared to alternative micronutrient programmes and to benchmarks of international organisations for assessing public health interventions. By attaching a minimum value to each DALY saved, the benefits of biofortification were translated into monetary terms to calculate a lower bound of the social rates of return of the crops. These economic indicators could then be compared to those of other agricultural technologies. While conventionally bred biofortified crops are less contentious, genetically modified crops (GM crops) and, thus, the transgenic Golden Rice are controversially discussed in the ongoing debate about plant biotechnology. Therefore, related issues are discussed in more depth in special sections of this book, where the validity of common claims about Golden Rice is scrutinized. The study concludes that biofortification has the potential to help control vitamin and mineral deficiencies in a lasting and sustainable way ? even though the commitment and the support of key stakeholders may be necessary to achieve its full impact. The various economic analysis have also shown that biofortification promises to be a very cost-effective, efficient and socially profitable intervention, both if compared to alternative public health measures and if compared to other agricultural innovations. Nevertheless, to control micronutrient deficiencies, the importance of a more comprehensive strategy is underlined; in such a strategy other micronutrient interventions like targeted supplementation, fortification, dietary diversification, nutrition education and poverty reduction may all have a role to play.Schätzungen zufolge leiden über zwei Dritteln der Weltbevölkerung an Mikronährstoffmangel. Dieser ?verdeckte Hunger? kann verheerende Folgen für deren Leben, Gesundheit und Wohlbefinden haben. In vielen Ländern stellen diese Mangelerscheinungen ein Problem ersten Ranges für die öffentliche Gesundheit dar. Sind solche Mangelerscheinungen weitverbreitet, so schränken sie zudem die allgemeine Produktivität und das Wirtschaftswachstum ein. Wirtschaftliche Entwicklung kann nur langfristig dazu beitragen, das Problem der Mangelernährung zu lösen. Herkömmliche Ansätze zur Behebung des Problems haben ihre eigenen Schwächen. Daher könnten die jüngsten Entwicklungen in Bezug auf natürliche Anreicherung vielversprechend sein. Die zugrundeliegende Idee ist, Nahrungsmittelpflanzen mit erhöhtem Mikronährstoffgehalt zu züchten. Geschieht diese bei Grundnahrungsmitteln welche in der Ernährung der Armen überwiegen, so kann man davon ausgehen, dass die Zielgruppe automatisch erreicht wird. Allerdings ist das Hauptargument ein ökonomisches: Da eine weitestgehend einmalige Investition in die Entwicklung dieser angereicherten Feldfrüchte verschiedenen Ländern nutzen kann, und da diese Pflanzen von Bauern überall nachgebaut und vervielfältigt werden können, könnte daraus fortgesetzt und weit gestreut Nutzen gezogen werden. Diese Investition verspricht daher akkumulierende Gewinne in Form von besserer Gesundheit, gesteigertem Gemeinwohl und Wirtschaftswachstum abzuwerfen. D.h. natürliche Anreicherung könnte sich als sehr kosteneffizient erweisen. In einer Welt des Mangels wiegt ein solches Argument schwer: Ressourcen im Gesundheitswesen besser zu nutzen, bedeutet Leben zu retten. Gegenwärtig befindet sich die Entwicklung von natürlich angereicherten Feldfrüchten in einem fortgeschrittenen Stadium. Es fehlt jedoch an einer gründlichen und umfassenden Einschätzung dieses Ansatzes. Um für zukünftige Forschungs- und Politikentscheidungen eine solide Basis zu schaffen, ist eine konsistente Analysen dieses neuartigen Ansatzes notwendig. Dies ist der Beitrag dieser Studie, die empirische auf Indien ausgerichtet ist. Nach einem umfangreichen und detaillierten Übersichtskapitel, in dem insbesondere aud der Sonderfall des Goldenen Reis diskutiert wird, wird im Hauptteil der Studie der analytische Ansatz für die Quantifizierung der durch Eisen-, Zink- und Vitamin A-Mangel verursachten Krankhietslast entwickelt. Dieser Ansatz baut auf der Methode der ?gesunden Lebensjahre? auf (engl. ?disability-adjusted life years? bzw. DALYs). Gegenüber früheren Studien werden hier allerdings die Gesundheitsfolgen der Mangelerscheinungen deutlicher herausgearbeitet und es werden mehr Ernährungs- und Krankheitsdaten verwendet. Die Anwendung dieses Modells auf Indien zeigt, dass durch Eisenmangel jährlich 4 Mio. gesunde Lebensjahre verloren gehen, durch Zinkmangel 2,8 Mio. und durch Vitamin A-Mangel 2,3 Mio. Gestützt auf ausführliche Nahrungsmittel-Konsumdaten einer repräsentativen Haushaltsbefragung in Indien, wird in der Studie für verschiedene Szenarien der Konsum der angereicherten Feldfrüchte simuliert. Die Ergebnisse zeigen, dass die angereicherten Getreidearten die Krankheitslast der drei Mangelerscheinungen über 50 Prozent reduzieren können. Aufbauend auf diesen geschätzten Gesundheitsnutzen wird eine Analyse der Kosteneffizienz durchgeführt. Die Kosten für die Bewahrung eines gesunden Lebensjahrs belaufen sich dabei auf 0,46-35,47 US$, wobei die Anreicherung mit Eisen am günstigsten und Goldener Reis etwas teuerer ist. In jedem Fall ist natürliche Anreicherung jedoch kosteneffizienter als alternativen Eingriffe, die 5-599 US$ kosten. Natürliche Anreicherung erfüllt auch die von internationalen Organisationen vorgeschlagenen DALY-Grenzwerte mit Leichtigkeit. Eine herkömmliche Kosten-Nutzen-Analyse ergibt einen interne Zinsfuß für die Entwicklung der verschiedenen angereicherten Feldfrüchte von 30-168 Prozent. Diese Ergebnisse liegen über den Renditen anderer landwirtschaftlicher Projekte. Unter Beachtung der Einschränkungen von ex ante Analysen wird das günstige Ergebnis der Bewertung hervorgehoben. In Anbetracht der Schwankungen der Ergebnisse bei unterschiedlichen Projektionen, wird jedoch auch auf die Bedeutung des Engagements und der Unterstützung durch alle Akteure und Beteiligten hingewiesen, um das volle Potential natürlicher Anreicherung ausschöpfen zu können. Ebenso wird die Wichtigkeit einer umfassenden Strategie zur Bekämpfung von Mikronährstoffmangel als Problem der öffentlichen Gesundheit unterstrichen, welche eine Kombination verschiedener Eingriffe beinhaltet. Die derzeitigen Ergebnisse werden dahingehend bewertet, dass sie die laufenden Bemühungen um natürliche Anreicherung rechtfertigen. Zukünftige Forschung mag diese Ergebnisse bekräftigen und bestätigen, dass natürliche Anreicherung eine sehr kosteneffizienten Maßnahme ist die dazu beitragen kann Mikronährstoffmangel zu kontrollieren und verdeckten Hunger zu verringern

Mikron�hrstoffmangel? Ein gesundheits�konomischer Bewertungsansatz

Micronutrient malnutrition is a serious problem in many developing countries. Recently, agricultural technologies have been discussed as a complement to other intervention programs. Plant breeding, targeted at developing staple foods with higher contents of essential vitamins and trace minerals, could benefit the poor in particular. Yet, the economic repercussions of such innovations are still unclear. Because traditional models of technology assessment are inappropriate to capture the specific ramifications, we suggest a health economics approach. Herein, micronutrient malnutrition is understood as a phenomenon that causes health costs through diseases and premature deaths. Details of the methodology are discussed within an ex ante study of Golden Rice in the Philippines. This technology promises to reduce vitamin A deficiency among the local population. Although it will not completely eliminate the problem, the expected benefits are sizeable. Depending on the underlying assumptions, internal rates of return on research investments range between 66 % and 133 %. This confirms that micronutrientdense staple crops can be an efficient way to reduce deficiency problems among the poor. However, due to uncertainty with respect to certain parameters, the numerical results should be interpreted as preliminary.micronutrient malnutrition, agricultural technology, Vitamin A, Golden Rice, health effects, Philippines, Food Consumption/Nutrition/Food Safety, Food Security and Poverty, Health Economics and Policy, Research and Development/Tech Change/Emerging Technologies,

Can genetic engineering for the poor pay off? : an ex-ante evaluation of Golden Rice in India

Genetic engineering (GE) in agriculture is a controversial topic in science and society at large. While some oppose genetically modified crops as proxy of an agricultural system they consider unsustainable and inequitable, the question remains whether GE can benefit the poor within the existing system and what needs to be done to deliver these benefits? Golden Rice has been genetically engineered to produce provitamin A. The technology is still in the testing phase, but, once released, it is expected to address one consequence of poverty ? vitamin A deficiency (VAD) ? and its health implications. Current interventions to combat VAD rely mainly on pharmaceutical supplementation, which is costly in the long run and only partially successful. We develop a methodology for ex-ante evaluation, taking into account the whole sequence of effects between the cultivation of the crop and its ultimate health impacts. In doing so we build on a comprehensive, nationally representative data set of household food consumption in India. Using a refined disability-adjusted life year (DALY) framework and detailed health data, this study shows for India that under optimistic assumptions this country?s annual burden of VAD of 2.3 million DALYs lost can be reduced by 59.4% hence 1.4 million healthy life years could be saved each year if Golden Rice would be consumed widely. In a low impact scenario, where Golden Rice is consumed less frequently and produces less provitamin A, the burden of VAD could be reduced by 8.8%. However, in both scenarios the cost per DALY saved through Golden Rice (US$ 3.06-19.40) is lower than the cost of current supplementation efforts, and it outperforms international cost-effectiveness thresholds. Golden Rice should therefore be considered seriously as a complementary intervention to fight VAD in rice-eating populations in the medium term

Exploring the non-Gaussianity of the cosmic infrared background and its weak gravitational lensing

Gravitational lensing deflects the paths of photons, altering the statistics of cosmic backgrounds and distorting their information content. We take the cosmic infrared background (CIB), which provides plentiful information about galaxy formation and evolution, as an example to probe the effect of lensing on non-Gaussian statistics. Using the Websky simulations, we first quantify the non-Gaussianity of the CIB, revealing additional detail on top of its well-measured power spectrum. To achieve this, we use needlet-like multipole-band filters to calculate the variance and higher-point correlations. Using our simulations, we show the two-, three- and four-point spectra, and compare our calculated power spectra and bispectra to Planck values. We then lens the CIB, shell-by-shell with corresponding convergence maps, to capture the broad redshift extent of both the CIB and its lensing convergence. The lensing of the CIB changes the three- and four-point functions by a few tens of per cent at large scales, unlike with the power spectrum, which changes by less than two per cent. We expand our analyses to encompass the full intensity probability distribution functions (PDFs) involving all n -point correlations as a function of scale. In particular, we use the relative entropy between lensed and unlensed PDFs to create a spectrum of templates that can allow estimation of lensing. The underlying CIB model is missing the important role of star bursting, which we test by adding a stochastic lognormal term to the intensity distributions. The no v el aspects of our filtering and lensing pipeline should pro v e useful for any radiant background, including line intensity maps

Potential impacts of iron biofortification in India

Iron deficiency is a widespread nutritional problem in developing countries, causing impaired physical activity and cognitive development, as well as maternal mortality. Although food fortification and supplementation programmes have been effective in some countries, their overall success remains limited. Biofortification, that is, breeding crops for higher micronutrient content, is a relatively new approach. We propose a methodology for ex-ante impact assessment of iron biofortification, which builds on disability-adjusted life years (DALYs) and a large household data set. Our analysis of iron-rich rice and wheat in India indicates sizeable potential health benefits. The cost-effectiveness of iron biofortification compares favourably with other interventions

Zinc-enriched fertilisers as a potential public health intervention in Africa

Background In this review, we examine the potential of Zn-enriched fertilisers to alleviate human dietary Zn deficiency. The focus is on ten African countries where dietary Zn supply is low and where fertiliser subsidies are routinely deployed on cereal crops. Scope Dietary Zn supply and deficiency prevalence were quantified from food supply and composition data. Typical effects of soil (granular) and foliar Zn applications on Zn concentrations in maize (Zea mays L.), rice (Oryza sativa L.) and wheat (Triticum aestivum L.) grains were based on a systematic literature review. Reductions in disease burdens attributable to Zn deficiency and cost-effectiveness were estimated using a disability-adjusted life years (DALYs) approach. Conclusions Baseline Zn supply in 2009 ranged from 7.1 (Zambia) to 11.9 (Mali) mg capita−1 day−1; prevalence of Zn deficiency ranged from 24 (Nigeria) to 66 % (Zambia). In reviewed studies, soil Zn application led to an increase in median Zn concentration in maize, rice and wheat grains of 23, 7 and 19 %; foliar application led to increases of 30, 25 and 63 %. Enriching granular fertilisers within current subsidy schemes would be most effective in Malawi, reducing DALYs lost due to Zn deficiency by 10 %. The cost per DALY saved ranged from US$624 to 5893 via granular fertilisers and from US$ 46 to 347 via foliar fertilisers. Foliar applications are likely to be more cost effective than soil applications due to fixation of Zn in the soil but may be more difficult to deploy. Zinc fertilisation is likely to be less cost-effective than breeding in the longer term although other micronutrients such as selenium could be incorporated