Development of a state wide tobacco treatment specialist training and certification programme for Massachusetts

OBJECTIVE: To describe the research conducted to structure and develop a statewide tobacco training and certification programme for tobacco treatment specialists (TTSs) in Massachusetts. DESIGN: Qualitative research strategies were used to obtain information on certification development and opinions regarding TTS training and certification from key informants. A role definition and validation study was then conducted to determine the core competencies for TTSs. A comprehensive training programme was developed, piloted, and finalised, and a certification programme was initiated. PARTICIPANTS: Key informants included: individuals involved in the development of their professional certification programmes; tobacco treatment providers from across Massachusetts; and national tobacco treatment experts. MAIN OUTCOME MEASURES: Participants\u27 opinions about the need for and structure of a training and certification programme for individuals specialising in the provision of moderate to intensive tobacco treatment; delineation of core competencies for TTSs, using the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) clinical practice guideline as a foundation for the development of evidence based standards of practice for the treatment of nicotine dependence. RESULTS: The data support a comprehensive training and certification programme for TTSs in Massachusetts. Main concerns include the cost of obtaining certification, the potential to exclude uncertified healthcare professionals from delivering basic tobacco treatment, and the role of the TTS in the healthcare delivery system and the community. The training programme developed for Massachusetts was piloted, and the structure of a statewide training and certification programme for TTSs was finalised. CONCLUSIONS: The research provides support for the need and acceptance of a training and certification programme for TTSs in Massachusetts, and presents the challenges to be addressed. We demonstrated the feasibility of developing and implementing an evidence based training programme, and of initiating a statewide certification programme in Massachusetts. This work will add to a national dialogue on the development of a training and certification programme for tobacco treatment providers and encourage further research into the potential impact of statewide and national certification

Central Mediterranean tephrochronology between 313 and 366 ka. New insights from the Fucino paleolake sediment succession

Thirty-two tephra layers were identified in the time-interval 313–366 ka (Marine Isotope Stages 9–10) of the Quaternary lacustrine succession of the Fucino Basin, central Italy. Twenty-seven of these tephra layers yielded suitable geochemical material to explore their volcanic origins. Investigations also included the acquisition of geochemical data of some relevant, chronologically compatible proximal units from Italian volcanoes. The record contains tephra from some well known eruptions and eruptive sequences of Roman and Roccamonfina volcanoes, such as the Magliano Romano Plinian Fall, the Orvieto–Bagnoregio Ignimbrite, the Lower White Trachytic Tuff and the Brown Leucitic Tuff. In addition, the record documents eruptions currently undescribed in proximal (i.e. near-vent) sections, suggesting a more complex history of the major eruptions of the Colli Albani, Sabatini, Vulsini and Roccamonfinavolcanoes between 313 and 366 ka. Six of the investigated tephra layers were directly dated by single-crystal-fusion 40Ar/39Ar dating, providing the basis for a Bayesian age–depth model and a reassessment of the chronologies for both already known and dated eruptive units and for so far undated eruptions. The results provide a significant contribution for improving knowledge on the peri-Tyrrhenian explosive activity as well as for extending the Mediterranean tephrostratigraphical framework, which was previously based on limited proximal and distal archives for that time interval

Impact of CaSO4-rich soil on Miocene surface preservation and Quaternary sinuous to meandering channel forms in the hyperarid Atacama Desert

The Atacama Desert is the driest and oldest desert on Earth. Despite the abundance evidence for long-term landscape stability, there are subtle signs of localised fluvial erosion and deposition since the onset of hyperaridity in the rock record. In the dry core of the Atacama Desert, pluvial episodes allowed antecedent drainage to incise into uplifting fault scarps, which in turn generated sinuous to meandering channels. Incision of ancient alluvial fan surfaces occurred during intermittent fluvial periods, albeit without signs of surface erosion. Fluvial incision during predominantly hyperarid climate periods is evident from these channels in unconsolidated alluvium. The absence of dense vegetation to provide bank stability and strength led us to investigate the potential role of regionally ubiquitous CaSO4-rich surface cover. This has enabled the preservation of Miocene surfaces and we hypothesize that it provided the required bank stability by adding strength to the upper decimetre to meter of incised alluvium to allow high sinuosity of stream channels to form during pluvial episodes in the Quaternary

Equivalent Helicobacter pylori infection rates in Lynch syndrome mutation carriers with and without a first-degree relative with gastric cancer

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Pleistocene tephrostratigraphy and palaeoclimatology in the central Mediterranean region: ongoing research in Fucino Basin (central Apennines, Italy)

Palaeoclimatic records spanning beyond the radiocarbon range generally derive their chronologies from orbital tuning strategies. These chronologies can introduce a priori assumptions that are difficult to test and, possibly, circular arguments in palaeoclimatic reconstructions. We elaborate two high-resolution, multi-proxy and tephrochronologically-constrained records (F1-F3 and F4-F5) of past environmental and climatic changes in the central Mediterranean region. We perform geochemical (X-ray fluorescence scanning, carbon, nitrogen and sulphur elemental analysis through combustion), isotopic (C and O stable isotope mass spectrometry on bulk carbonates and organic matter), mineralogical (X-ray powder diffraction) and grain-size analyses on lacustrine marls recovered from palaeolake Fucino (Abruzzo, central Italy). Lacustrine sediments were acquired during two scientific drilling campaigns (F1-F3 and F4-F5) interesting the first ca. 85 m of the 1 km-thick and 2 Ma-old Fucino sedimentary succession. We make use of detailed tephrostratigraphic and tephrochronological frameworks to produce robust and independent chronologies based on new and published 40Ar/39Ar and 14C dating of tephra layers. On the basis of our chronologies, the F1-F3 and F4-F5 records continuously span over the last two glacial-interglacial cycles and over the last five glacial-interglacial cycles, respectively. We combine our geological data into proxies for catchment- and regional-scale environmental processes. Our proxy time-series depict prominent orbital and sub-orbital environmental changes that can be tracked in other lacustrine, marine and speleothem records across the Mediterranean and North Atlantic regions. Thanks to tephrostratigraphic correlations and chronological matching, we produce spatially coherent palaeoclimatic reconstructions recognising a complex interplay between regional environmental processes and broad-scale climatic events. We highlight strong orbital forcing for past climate changes

Extending the tephra and palaeoenvironmental record of the Central Mediterranean back to 430 ka: A new core from Fucino Basin, central Italy

Here we present the first tephrostratigraphic, palaeomagnetic, and multiproxy data from a new ∼98 m-deep sediment core retrieved from the Fucino Basin, central Italy, spanning the last ∼430 kyr. Palaeoenvironmental proxy data (Ca-XRF, gamma ray and magnetic susceptibility) show a cyclical variability related to interglacial-glacial cycles since the Marine Isotope Stage (MIS) 12-MIS 11 transition. More than 130 tephra layers are visible to the naked eye, 11 of which were analysed (glass-WDS) and successfully correlated to known eruptions and/or other equivalent tephra. In addition to tephra already recognised in the previously investigated cores spanning the last 190 kyr, we identified for the first time tephra from the eruptions of: Tufo Giallo di Sacrofano, Sabatini (288.0 ± 2.0 ka); Villa Senni, Colli Albani (367.5 ± 1.6 ka); Pozzolane Nere and its precursor, Colli Albani (405.0 ± 2.0 ka, and 407.1 ± 4.2 ka, respectively) and Castel Broco, Vulsini (419–490 ka). The latter occurs at the bottom of the core and has been 40Ar/39Ar dated at 424.3 ± 3.2 ka, thus providing a robust chronological constrain for both the eruption itself and the base of the investigated succession. Direct 40Ar/39Ar dating and tephra geochemical fingerprinting provide a preliminary radioisotopic-based chronological framework for the MIS 11-MIS 7 interval, which represent a foundation for the forthcoming multiproxy studies and for investigating the remaining ∼110 tephra layers that are recorded within this interval. Such future developments will contribute towards an improved MIS 11-MIS 7 Mediterranean tephrostratigraphy, which is still poorly explored and exploited

Identification of familial colorectal cancer and hereditary colorectal cancer syndromes through the Dutch population-screening program: results ofa pilot study

Objectives: In 2014, a population-screening program using immuno-faecal occult blood testing (I-FOBT) has started in the Netherlands. The aims of this study were to evaluate the proportion of individuals in the Dutch screening program with a positive I-FOBT that fulfill the criteria for familial colorectal cancer (FCC) and to evaluate the proportion of participants that needs genetic counseling or colonoscopic surveillance.Material and methods: This retrospective observational study was performed in two large hospitals. Individuals aged between 55 and 75 years with a positive I-FOBT that underwent colonoscopy were included. A detailed family history was obtained in all individuals.Results: A total of 657 individuals with a positive I-FOBT test underwent colonoscopy. A total of 120 (18.3%) participants were found to have a positive family history for CRC, 20 (3.0%) fulfilled the FCC criteria, 4 (0.6%) the Bethesda guidelines and 1 (0.2%) participant the Amsterdam criteria. Multiple adenomas (>10) were found in 21 (3.2%) participants. No cases of serrated polyposis were identified. Based on these criteria and guidelines, a total of 35 (5.3%) required referral to the clinical geneticist and the relatives of 20 (3.0%) participants should be referred for surveillance colonoscopy.Conclusion: Obtaining a detailed family history at the time of intake of participants with a positive I-FOBT in the Dutch surveillance program increased the identification of participants with familial CRC.Molecular tumour pathology - and tumour geneticsMTG2 - Moleculaire genetica van gastrointestinale tumore

Consequences of testing for mismatch repair deficiency of colorectal cancer in clinical practice

Molecular tumour pathology - and tumour geneticsMTG2 - Moleculaire genetica van gastrointestinale tumore

Service Renaming in Component Composition

In component-based systems, the behavior of components is usually described at component interfaces and the components are characterized as requester (active) and provider (reactive) components. Two interacting components are considered compatible if all possible sequences of services requested by one component can be provided by the other component. This concept of component compatibility can be extended to sets of interacting components, however, in the case of several requester components interacting with one or more provider components, as is typically the case of cleint-server applications, the requests from different components can be interleaved and then verifying component compatibility must take into account all possible interleavings of requests. Such interleaving of requests can lead to unexpected behavior of the composed system, e.g. a deadlock can occur. Service renaming is proposed as a method of systematic eliminating of such unexpected effects and streamlining component compositions

Deep drilling reveals massive shifts in evolutionary dynamics after formation of ancient ecosystem

The scarcity of high-resolution empirical data directly tracking diversity over time limits our understanding of speciation and extinction dynamics and the drivers of rate changes. Here, we analyze a continuous species-level fossil record of endemic diatoms from ancient Lake Ohrid, along with environmental and climate indicator time series since lake formation 1.36 million years (Ma) ago. We show that speciation and extinction rates nearly simultaneously decreased in the environmentally dynamic phase after ecosystem formation and stabilized after deep-water conditions established in Lake Ohrid. As the lake deepens, we also see a switch in the macroevolutionary trade-off, resulting in a transition from a volatile assemblage of short-lived endemic species to a stable community of long-lived species. Our results emphasize the importance of the interplay between environmental/climate change, ecosystem stability, and environmental limits to diversity for diversification processes. The study also provides a new understanding of evolutionary dynamics in long-lived ecosystems