The impact of vaccination on adenocarcinoma associated with non-vaccine type HPV : a mathematical model with two HPV types

The human papilloma virus (HPV) is the main cause of cervical cancer in women and HPV is the most common sexually transmitted infection. To prevent women from developing cervical cancer there are two methods in use, the primary method being vaccination against HPV and the secondary being screening. Some long term effects of screening and vaccination will not be observed during the first decades of vaccination, and therefore predictive mathematical models serve as an indicator of what to anticipate in the future. In this thesis we studied two types of cervical cancer, adenocarcinoma and squamous cell carcinoma. We determined how vaccination against a virus, associated with squamous cell carcinoma, together with screening programs affects adenocarcinomas caused by non-vaccine type HPV. A precancerous adenocarcinoma lesion, which is located deeper in the glandular cervical tissue, is difficult to detect directly in screening but can be found indirectly by uncovering a common type of cervical cancer, squamous cell carcinoma, which is easier to detect in screening. These two cancers are mostly associated with two different strains of HPV. When vaccinating against the strain that is found in squamous cell carcinomas the elimination of the precancerous stages of squamous cell carcinomas mean that the detection method for adenocarcinoma is impaired, which allows for a possible increase in adenocarcinoma prevalence. In this thesis we studied this possible increase. To predict the effect vaccination has on adenocarcinoma, we constructed a mathematical model of two HPV types, which were associated with squamous cell carcinoma and adenocarcinoma respectively. We modeled a vaccine that protects against the HPV types associated with squamous cell carcinoma but not adenocarcinoma. The model included the simplified natural history of HPV, the progression of the disease, the vaccination program and the screening program. For the two virus infections we developed a deterministic compartmental progression model. In the computations we modeled a cohort of women through their lifetime and studied the precancerous findings in screenings and the number of cancer cases in the cohort. To understand which model components contributed to the adenocarcinoma incidence a sensitivity analysis was conducted by varying the screening sensitivity, the force of infection and the recovery rates. The model yielded an increase in adenocarcinomas when vaccinating against the virus associated with squamous cell carcinoma. The incidence of adenocarcinoma correlated with the non-vaccine type HPV infections that would otherwise be found in screenings without vaccination. The increase in adenocarcinomas was more prominent in a sexually active population. Compared to the reduction in squamous cell carcinoma provided by the vaccine, the adenocarcinoma increase was, although positive, very minor

Weight-based pay-as-you-throw pricing model : Encouraging sorting in households through waste fees

Highlights • A new pricing model for weight-based pay-as-you-throw systems is defined. • Waste fees are formulated by a linear function dependent of the service level. • The pricing model can support sorting and reduce residual waste generation. • The pricing model is an actionable tool for waste management operators.Municipal solid waste is associated with different systemic challenges, such as climate change, resource scarcity, and ocean plastic pollution. European countries are striving towards more circular material use and the European Commission has advocated the use of economic incentives to boost recycling. The pay-as-you-throw (PAYT) scheme is an economic instrument that applies the ‘polluter pays’ principle by charging for waste according to the actual amount of generated waste. Volume-based PAYT fees have shown to be potentially less effective in waste prevention and recycling than weight-based fees. This paper illustrates how waste management operators can price residual waste with weight-based fees that encourage recycling, are fair with respect to service levels, and cover the current income for municipal waste operators. The result, obtained by forming equations satisfying the above conditions, is a model with a linear, discrete price function, where the price of the residual waste generated by the citizen is a function of the service level. This model encourages efficient source separation through internal subsidies, wherein a citizen can decrease the price of household waste by 32% if they increase the sorting efficiency from a default of 40% to 80% efficiency. The application of the model was illustrated in a case example. The model developed in this study can be used to implement weight-based PAYT schemes locally, thereby supporting the formulation of waste management systems that facilitate waste reduction and recycling

Punnitukseen perustuva kotitalouksien jätemaksujärjestelmä : Toteuttajan tietopaketti

Euroopan unionin jätedirektiivi edellyttää jäsenmailta yhdyskuntajätteen 50 prosentin kierrätystavoitteen saavuttamista vuoteen 2020 mennessä. Tavoitteet tiukentuivat kesällä 2018 voimaantulleen uuden jätedirektiivin myötä. Euroopan unionin uutena tavoitteena on, että yhdyskuntajätteestä kierrätettäisiin 55 prosenttia vuonna 2025, 60 prosenttia vuonna 2030 ja 65 prosenttia vuonna 2035. Lajittelua tehostavat käytännöt -hanke (LAJITEHO) käynnistyi vuonna 2017 ympäristöministeriön yhdyskuntajätteen kierrätystä edistävällä kokeilurahoituksella. Hankkeen toteuttivat ympäristöministeriö, Suomen ympäristökeskus SYKE, Suomen Kiertovoima ry KIVO ja Pirkanmaan Jätehuolto Oy. LAJITEHO-hankkeen tavoitteena on ollut yhdyskuntajätteen kierrätysasteen noston kannalta soveltuvien painoperusteisten PAYT ’Pay As You Throw’ -menetelmien tutkiminen, PAYT-järjestelmän kehittäminen asiakaslähtöiseksi, lajitteluun kannustavaksi järjestelmäksi sekä löytää Suomen olosuhteisiin soveltuvia ratkaisuja. Hankkeessa on koottu tietoa ja laadittu työkaluja jätelaitoksille painoperusteisen järjestelmän käyttöönoton tueksi. Tähän raporttiin on koottu selvitykset koskien painoperusteisen PAYT-järjestelmän juridisia ja hallinnollisia reunaehtoja, kolmen painoperusteisen PAYT-järjestelmän esimerkkitapausta Euroopasta, SWOT-analyysia, tietoa punnitustekniikan käytöstä keräysvälineiden tyhjennyksessä, selvityksen järjestelmän ympäristövaikutuksista, viestinnän tukiaineiston, sekä jätemaksujen hinnoittelumallin

Executing circular economy strategies in practice in Finland. Results and experiences from Circwaste project

A Europe-wide circular economy policy was launched in 2014 when the European Commission published the first strategic policy programme for circular economy. It was compiled to provide very comprehensive impacts and dimensions of sustainable development: sustainable growth and a climate neutral, resource efficient and competitive economy. The targets of a circular economy are that the value of products, materials and resources is maintained in the economy for as long as possible, economic growth is decoupled from resource use, generation of waste and environmental loads are minimised, and pressure on the Earth’s resources and biodiversity is minimised. The European Union is supporting the sustainability transition with research and development funding. In Finland, Circwaste – Towards Circular Economy is one of the biggest development projects accelerating the transition to a circular economy. During the period 2016–2020, the project has produced monitoring data on the development of circular economy and the sustainability of waste management, highlighted the circular economy concept, promoted stakeholder collaboration, supported strategic national processes, strengthened know-how and mainstreamed and concretised circular economy thinking. This interim report presents all the relevant results so far. It is crucial that data is produced from different angles on implementing the circular economy. More information is needed both to support decision making and on connections between and reflections on different factors. The key figures for Finland show quite clear coupling of the use of natural resources, waste amounts and economic growth. The circular material use rate is ca. 7%, which can be considered quite modest. Quantitative national targets for decreasing the use of natural resources are needed. Instead of country comparisons, the focus should be on trends in order to learn from the past and to identify the policy instruments needed to achieve the level aspired to. One of the key findings is the need for regional indicators and data for decisionmaking. The work done within Circwaste is the first effort towards a systematic monitoring scheme for monitoring circular economy regionally. The study showed that the production of regional waste data is challenging, that the estimated recycling rates have not increased adequately to reach the EU targets and that there could therefore be a need for municipallevel recycling targets. The transition to a circular economy also causes fundamental social changes in society. In the project, new indicators were developed for measuring social impacts: circular economy employment, education and employment for vulnerable groups, publicly shared resources, accessibility of recycling services and sustainable vehicle fuels. The first baseline data show advances towards the circular economy: the accessibility of waste management services has improved, the Finnish educational system has been able to respond quickly to the need for circular economy education, circular economy activities have potential for the employment of vulnerable groups and economic activities related to recycling, repair and reuse have grown. The regions and municipalities emerge as key actors in facilitating a socially just transition towards a circular economy. The study on innovative material processing technologies gathered data on technologies for elemental recycling, especially for plastic waste but also for making new fibres from textiles waste. Financial issues are key to the survival of these technologies and there is a need for governmental financial support. Public procurers can be considered key players in the circular economy, creating demand for more sustainable products and services. Implementing circular economy in municipalities requires commitment, financial planning, interaction with regional actors and inclusion of circular economy in financial rules. The construction sector is a major consumer of natural resources, but the municipalities can make construction more sustainable through public procurements and planning. As buyers, they can require the use of recycled raw materials and soils in construction projects. Obligations for ecological compensation and goals of no net loss of biodiversity would decrease the pressure on natural resources. To support municipalities in their work, a national organisation for providing municipal auditing, development, education and business support services could be established. Employing circular economy experts in each municipality to work as crossadministrative coordinators could enhance the transition. The project has created a lot of political, theoretical and practical content on the concept and field of circular economy. The next steps are to further develop and widen, as well as deepen, the results and to provide national support in searching for answers and solutions for decreasing the use of natural resources, achieving the MSW recycling targets and creating a more sustainable society

Ikäneuvolatarkastukset SuperSeniorit-päivillä

Suomessa ikääntyneiden määrä kasvaa suurten ikäluokkien saavuttaessa eläkeiän. Nykyään ikääntyneet ovat hyväkuntoisempia ja asuvat kotona pidempään kuin ennen. Suomen vanhuspolitiikan tavoitteena on tukea ikääntyneiden kotona asumista mahdollisimman pitkään ennaltaehkäisevien palveluiden avulla. Palveluita suunniteltaessa tulee huomioida ikääntymisen erityispiirteet. Tämän takia ikäneuvoloita on perustettu eri kuntiin edistämään ikääntyneiden terveyttä. Opinnäytetyö toteutettiin toiminnallisena opinnäytetyönä. Toimeksiantajana toimi Turun ammattikorkeakoulu, joka järjesti SuperSeniorit-päivät. Tarkoituksena oli suunnitella, toteuttaa ja arvioida ikäneuvolatarkastuksia SuperSeniorit-päivillä. Ikäneuvolatarkastuksien tavoitteena oli lisätä tietoisuutta ikääntyneiden omasta terveydentilastaan ja edistää heidän terveyttään. Ikäneuvolatarkastukset toteutettiin onnistuneesti ja ne olivat suosittuja SuperSeniorit-päivillä. Ikääntyneiden terveyttä kartoitettiin kokonaisvaltaisesti esitietolomakkeen, haastattelun, mittausten ja testien avulla sekä terveysneuvontaa annettiin yksilöllisen tarpeen mukaan. Tutkimukset osoittavat ikäneuvolan olevan vaikuttavaa sekä vastaavan ikääntyneiden tarpeisiin kustannustehokkaasti

Transport infrastructure investment : climate and environmental effects in cost benefit analysis in the Nordic countries

A study performed by TØI, DTU and VTI and funded by the Nordic Council, compares the handling of climate and environmental effects in CBA in transport projects in the Nordic countries. The main emphasis has been the comparison of recommended methods and assessments between the countries for noise, air pollution and climate effects. Important findings:- For noise Finland take nuisance in consideration while the other countries also include health effects.- For PM, the values are related to PM2.5 in Denmark and Finland, to PM10 in Norway and to both PM2.5 and PM10 in Sweden.- For NOX, the values in Finland and Sweden are almost negligible compared to the values used in Denmark and Norway.- The most extreme difference between values in the Nordic countries relate to global warming emissions where the values of emissions in 2020 vary from €24/ton CO2 in Denmark (with an alternative calculation of €197/ton) to €665/ton in Sweden

Transport Infrastructure Investment. Climate and environmental effects in cost benefit analysis in the Nordic Countries

This study funded by the Nordic Council, compares the handling of climate and environmental effects in CBA in transport projects in the Nordic countries. The main emphasis has been the comparison of recommended methods and assessments between the countries for noise, air pollution and climate effects.Important findings:• For noise Finland take nuisance in consideration while the other countries also include health effects.• For PM, the values are related to PM2.5 in Denmark and Finland, to PM10 in Norway and to both PM2.5 and PM10 in Sweden.• For NOX, the values in Finland and Sweden are almost negligible compared to the values used in Denmark and Norway.• The most extreme difference between values in the Nordic countries relate to global warming emissions where the values of emissions in 2020 vary from €24/ ton CO2 in Denmark (with an alternative calculation of €197/ton) to €665/ton inSweden.<br/

Value of travel time by road type

Travel time is less costly if it is comfortable or can be used productively. One could hence argue that the value of travel time (VTT) of car travellers in economic appraisal should be differentiated by road type, reflecting differences in road quality. We explain the theoretical foundation for such a differentiation, review the relevant literature and show the results of an empirical case study based on actual route choice of highway drivers in Norway. We find little existing literature discussing the link between road type and VTT, but closely related findings suggest that that the impact on VTT could be substantial. Our empirical case study also suggests that the VTT is lower on higher quality road types. Applying this to economic appraisal would imply higher user benefits of road projects that improve road quality

Immunogenicity and safety of an investigational quadrivalent meningococcal conjugate vaccine administered as a booster dose in children vaccinated against meningococcal disease 3 years earlier as toddlers : A Phase III, open-label, multi-center study

Booster doses of meningococcal conjugate vaccines induce long-term protection against invasive meningococcal disease. We evaluated the immunogenicity and safety of a booster dose of MenACYW-TT in pre-school children who were primed 3 years earlier with MenACYW-TT or MCV4-TT (Nimenrix®). In this Phase III, open-label, multi-center study (NCT03476135), children (4–5 years old), who received a primary dose of MenACYW-TT or MCV4-TT as toddlers in a previous study, received a booster dose of MenACYW-TT. Titers of antibody against meningococcal serogroups A, C, W and Y were measured by serum bactericidal assay using human (hSBA) and baby rabbit (rSBA) complement in samples collected before (D0) and 30 days after (D30) booster vaccination. Safety was assessed over the 30-day study period. Ninety-one participants received the booster dose. In both study groups, hSBA titers increased from D0 to D30; serogroup C titers [95% confidence interval] were higher in the MenACYW-TT-primed vs MCV4-TT-primed group at D0 (106 [73.2, 153] vs 11.7 [7.03, 19.4], respectively) and D30 (5894 [4325, 8031] vs 1592 [1165, 2174], respectively); rSBA results were similar. Nearly all participants achieved ≥1:8 hSBA and rSBA titers at D30, which were higher or comparable to those observed post-primary dose, suggesting rapid booster responses. At D0, all hSBA and rSBA titers were higher than those observed pre-primary dose, suggesting persistence of immunogenicity. The MenACYW-TT booster dose was well-tolerated and had similar safety outcomes across study groups. These findings suggest that MenACYW-TT elicits robust booster responses in children primed 3 years earlier with MenACYW-TT or MCV4-TT.publishedVersionPeer reviewe