A Comparative study of Integrated River Basin Projects in Europe

Since climate changes became more obvious and since growing concern about our responsibility for the environment started, water management became more important. Projects carried out in river basin areas often impose changes in spatial functions that are situated in these areas. The analysis of scarcity issues regarding spatial functions observed in a river basin area is at the core of economic and spatial sciences. Water functions are predominant in a river basin area and problems related to these functions highlight the increasing scarcity of water in the world. Scarcity could be a shortage of water quantity, but also a shortage of water of a certain quality or protection against an abundance of water. Evaluation processes are the heart of public decision-making when spatial projects are carried out. For decades, project evaluation was carried out by measuring tangible streams of cost and benefits summarised in a cost-benefit analysis. Recently, environmental and social aspects gradually get more attention in the public decision making process by means of for example multi-criteria analysis. This method is a tool to evaluate the scores of totally different indicators with the great advantage that they do not necessarily have to be expressed in streams of costs. In this paper we carry out a comparative analysis of evaluation techniques for projects carried out in river basin areas. We evaluate for which projects certain techniques are used and to which extend the chosen technique is related to for example environmental, institutional and communicative indicators. The method used for this evaluation is a rough set analysis. For this analysis projects concerning river basins, carried out in different river regions of Europe, with different kind of problems are used, to obtain a broad overview.

Initial results of in vivo non-invasive cancer imaging in the human breast using near-infrared photoacoustics

Near-infrared photoacoustic images of regions-of-interest in 4 of the 5 cases of patients with symptomatic breasts reveal higher intensity regions which we attribute to vascular distribution associated with cancer. Of the 2 cases presented here, one is especially significant where benign indicators dominate in conventional radiological images, while photoacoustic images reveal vascular features suggestive of malignancy, which is corroborated by histopathology. The results show that photoacoustic imaging may have potential in visualizing certain breast cancers based on intrinsic optical absorption contrast. A future role for the approach could be in supplementing conventional breast imaging to assist detection and/or diagnosis.\ud \u

Between-hospital variation in indicators of quality of care: a systematic review

Background: Efforts to mitigate unwarranted variation in the quality of care require insight into the 'level' (eg, patient, physician, ward, hospital) at which observed variation exists. This systematic literature review aims to synthesise the results of studies that quantify the extent to which hospitals contribute to variation in quality indicator scores. Methods: Embase, Medline, Web of Science, Cochrane and Google Scholar were systematically searched from 2010 to November 2023. We included studies that reported a measure of between-hospital variation in quality indicator scores relative to total variation, typically expressed as a variance partition coefficient (VPC). The results were analysed by disease category and quality indicator type. Results: In total, 8373 studies were reviewed, of which 44 met the inclusion criteria. Casemix adjusted variation was studied for multiple disease categories using 144 indicators, divided over 5 types: intermediate clinical outcomes (n=81), final clinical outcomes (n=35), processes (n=10), patient-reported experiences (n=15) and patient-reported outcomes (n=3). In addition to an analysis of between-hospital variation, eight studies also reported physician-level variation (n=54 estimates). In general, variation that could be attributed to hospitals was limited (median VPC=3%, IQR=1%-9%). Between-hospital variation was highest for process indicators (17.4%, 10.8%-33.5%) and lowest for final clinical outcomes (1.4%, 0.6%-4.2%) and patient-reported outcomes (1.0%, 0.9%-1.5%). No clear pattern could be identified in the degree of between-hospital variation by disease category. Furthermore, the studies exhibited limited attention to the reliability of observed differences in indicator scores. Conclusion: Hospital-level variation in quality indicator scores is generally small relative to residual variation. However, meaningful variation between hospitals does exist for multiple indicators, especially for care processes which can be directly influenced by hospital policy. Quality improvement strategies are likely to generate more impact if preceded by level-specific and indicator-specific analyses of variation, and when absolute variation is also considered. PROSPERO registration number: CRD42022315850.</p

Creatine Kinase–Mediated ATP Supply Fuels Actin-Based Events in Phagocytosis

Phagocytosis requires locally coordinated cytoskeletal rearrangements driven by actin polymerization and myosin motor activity. How this actomyosin dynamics is dependent upon systems that provide access to ATP at phagosome microdomains has not been determined. We analyzed the role of brain-type creatine kinase (CK-B), an enzyme involved in high-energy phosphoryl transfer. We demonstrate that endogenous CK-B in macrophages is mobilized from the cytosolic pool and coaccumulates with F-actin at nascent phagosomes. Live cell imaging with XFP-tagged CK-B and β-actin revealed the transient and specific nature of this partitioning process. Overexpression of a catalytic dead CK-B or CK-specific cyclocreatine inhibition caused a significant reduction of actin accumulation in the phagocytic cup area, and reduced complement receptor–mediated, but not Fc-γR–mediated, ingestion capacity of macrophages. Finally, we found that inhibition of CK-B affected phagocytosis already at the stage of particle adhesion, most likely via effects on actin polymerization behavior. We propose that CK-B activity in macrophages contributes to complement-induced F-actin assembly events in early phagocytosis by providing local ATP supply

Augmenting contact matrices with time-use data for fine-grained intervention modelling of disease dynamics: A modelling analysis

AbstractBackgroundSocial distancing is an important public health intervention to reduce or interrupt the sustained community transmission of emerging infectious pathogens, such as SARS-CoV-2 during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to explore the impact on the epidemic curve of fewer contacts when individuals reduce the time they spend on selected daily activities.MethodsWe combined the large-scale empirical data of a social contact survey and a time-use survey to estimate contact matrices by age group (0-15, 16-24, 25-44, 45-64, 65+) and daily activity (work, schooling, transportation, and four leisure activities: social visits, bar/cafe/restaurant visits, park visits, and non-essential shopping). We assumed that reductions in time are proportional to reductions in contacts. The derived matrices were then applied in an age-structured dynamic-transmission model of COVID-19 to explore the effects.FindingsThe relative reductions in the derived contact matrices were highest when closing schools (in ages 0-14 years), workplaces (15-64 years), and stopping social visits (65+ years). For COVID-19, the closure of workplaces, schools, and stopping social visits had the largest impact on reducing the epidemic curve and delaying its peak, while the predicted impact of fewer contacts in parks, bars/cafes/restaurants, and non-essential shopping were minimal.InterpretationWe successfully augmented contact matrices with time-use data to predict the highest impact of social distancing measures from reduced contacts when spending less time at work, school, and on social visits. Although the predicted impact from other leisure activities with potential for close physical contact were minimal, changes in mixing patterns and time-use immediately after re-allowing social activities may pose increased short-term transmission risks, especially in potentially crowded environments indoors.Research in contextEvidence before this studyWe searched PubMed for mathematical models using social contact matrices and time-use data to explore the impact of reduced social contacts as seen from social distancing measures adopted during the coronavirus disease 2019 (COVID-19) pandemic with the search string ((social OR physical) AND distancing) OR (contact* OR (contact matri*)) AND (time-use) AND (model OR models OR modeling OR modelling) from inception to May 06, 2020, with no language restrictions. We found several studies that used time-use data to re-create contact matrices based on time spent in similar locations or to calculate the length of exposure. We identified no study that augmented social contact matrices with time-use data to estimate the impact on transmission dynamics of reducing selected social activities and lifting these restrictions again, as seen during the COVID-19 pandemic.Added value of this studyOur study combines the empirical data of two large-scale, representative surveys to derive social contact matrices that enrich the frequency of contacts with the duration of exposure for selected social activities, which allows for more fine-grained mixing patterns and infectious disease modelling. We successfully applied the resulting matrices to estimate reductions in contacts from social distancing measures such as adopted during the COVID-19 pandemic, as well as the effect on the epidemic curve from increased social contacts when lifting such restrictions again.Implications of all the available evidenceSocial distancing measures are an important public health intervention to limit the close-contact transmission of emerging infectious pathogens by reducing the social mixing of individuals. Our model findings suggest a higher fraction of close-contact transmission occurs at work, schools, and social visits than from visits to parks, bars/cafes/restaurants, and non-essential shopping. The minimal predicted impact is suggestive of lifting the restrictions on certain activities and excluding them from the list of social distancing measures, unless required to maintain sufficient healthcare capacity. However, potential replacement effects of activities and in mixing patterns remain unclear, particularly immediately after re-allowing social activities again.</jats:sec

Drug-drug interactions with tyrosine-kinase inhibitors:A clinical perspective

In the past decade, many tyrosine-kinase inhibitors have been introduced in oncology and haemato-oncology. Because this new class of drugs is extensively used, serious drug-drug interactions are an increasing risk. In this Review, we give a comprehensive overview of known or suspected drug-drug interactions between tyrosine-kinase inhibitors and other drugs. We discuss all haemato-oncological and oncological tyrosine-kinase inhibitors that had been approved by Aug 1, 2013, by the US Food and Drug Administration or the European Medicines Agency. Various clinically relevant drug interactions with tyrosine-kinase inhibitors have been identified. Most interactions concern altered bioavailability due to altered stomach pH, metabolism by cytochrome P450 isoenzymes, and prolongation of the QTc interval. To guarantee the safe use of tyrosine-kinase inhibitors, a drugs review for each patient is needed. This Review provides specific recommendations to guide haemato-oncologists, oncologists, and clinical pharmacists, through the process of managing drug-drug interactions during treatment with tyrosine-kinase inhibitors in daily clinical practice