Effects of erythropoiesis-stimulating agents on fatigue- and anaemia-related symptoms in cancer patients: systematic review and meta-analyses of published and unpublished data.

Background:Erythropoiesis-stimulating agents (ESAs) reduce the need for red blood cell transfusions; however, they increase the risk of thromboembolic events and mortality. The impact of ESAs on quality of life (QoL) is controversial and led to different recommendations of medical societies and authorities in the USA and Europe. We aimed to critically evaluate and quantify the effects of ESAs on QoL in cancer patients.Methods:We included data from randomised controlled trials (RCTs) on the effects of ESAs on QoL in cancer patients. Randomised controlled trials were identified by searching electronic data bases and other sources up to January 2011. To reduce publication and outcome reporting biases, we included unreported results from clinical study reports. We conducted meta-analyses on fatigue- and anaemia-related symptoms measured with the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and FACT-Anaemia (FACT-An) subscales (primary outcomes) or other validated instruments.Results:We identified 58 eligible RCTs. Clinical study reports were available for 27% (4 out of 15) of the investigator-initiated trials and 95% (41 out of 43) of the industry-initiated trials. We excluded 21 RTCs as we could not use their QoL data for meta-analyses, either because of incomplete reporting (17 RCTs) or because of premature closure of the trial (4 RCTs). We included 37 RCTs with 10 581 patients; 21 RCTs were placebo controlled. Chemotherapy was given in 27 of the 37 RCTs. The median baseline haemoglobin (Hb) level was 10.1 g dl(-1); in 8 studies ESAs were stopped at Hb levels below 13 g dl(-1) and in 27 above 13 g dl(-1). For FACT-F, the mean difference (MD) was 2.41 (95% confidence interval (95% CI) 1.39-3.43; P<0.0001; 23 studies, n=6108) in all cancer patients and 2.81 (95% CI 1.73-3.90; P<0.0001; 19 RCTs, n=4697) in patients receiving chemotherapy, which was below the threshold (⩾3) for a clinically important difference (CID). Erythropoiesis-stimulating agents had a positive effect on anaemia-related symptoms (MD 4.09; 95% CI 2.37-5.80; P=0.001; 14 studies, n=2765) in all cancer patients and 4.50 (95% CI 2.55-6.45; P<0.0001; 11 RCTs, n=2436) in patients receiving chemotherapy, which was above the threshold (⩾4) for a CID. Of note, this effect persisted when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy. There was some evidence that the MDs for FACT-F were above the threshold for a CID in RCTs including cancer patients receiving chemotherapy with Hb levels below 12 g dl(-1) at baseline and in RCTs stopping ESAs at Hb levels above 13 g dl(-1). However, these findings for FACT-F were not confirmed when we restricted the analysis to placebo-controlled RCTs in patients receiving chemotherapy.Conclusions:In cancer patients, particularly those receiving chemotherapy, we found that ESAs provide a small but clinically important improvement in anaemia-related symptoms (FACT-An). For fatigue-related symptoms (FACT-F), the overall effect did not reach the threshold for a CID.British Journal of Cancer advance online publication, 17 April 2014; doi:10.1038/bjc.2014.171 www.bjcancer.com.

Helium transfer from water into quartz crystals: A new approach for porewater dating

Several important fundamental and applied problems require a quantification of slow rates of groundwater flow. To resolve these problems helium appears to be a promising tracer. In this contribution we discuss a new approach, which gives the helium inventory in a rock – pore water system by using the relevant mineral record, i.e., without extraction and investigation of the porewater samples. Some U- and Th-poor minerals such as quartz (quartz separates from Permo-Carboniferous Formation, sandstone–shale interlayering, Molasses Basin, Northern Switzerland, hereafter PCF, are used in this study) contain excessive helium having migrated into their internal helium-accessible volume (HAV) from the surrounding porewater [I.N. Tolstikhin, B.E. Lehmann, H.H. Loosli, A. Gautschi, Helium and argon isotopes in rocks, minerals and related groundwaters: a case study in Northern Switzerland, Geochim. Cosmochim. Acta 60 (1996) 1497–1514]. These volumes are estimated by using helium as a nano-size penetrating tool, i.e., by saturation of the minerals with helium under controlled pressure–temperature conditions and subsequent measurements of the helium-saturated concentrations. In the quartz separates HAV/total volume ratios vary from 0.017% to 0.16%; along with the measured initial (unsaturated) He concentration the HAV gives the internal helium pressure, the mean value obtained for 7 samples (25 sample aliquots) is P=0.45F0.15 atm (1 r). The product of helium pressure and solubility (7.35_10_3 cc STP He/cc H2O for the temperature and salinity of PCF aquifers reported in [F.J. Pearson, W. Balderer, H.H. Loosli, B.E. Lehmann, A. Matter, T. Peters, H. Schmassmann, A. Gautschi, Applied Isotope Hydrogeology–A Case Study in Northern Switzerland, Elsevier Amsterdam, 1991, 439 pp.]) is the mineral-derived He concentration in the respective porewater, CPW=0.0035F0.0017 cc He/cc H2O. This value is in full accord with measured He concentrations in PCF aquifers, CPCF, varying from 0.0045 to 0.0016 cc He/cc H2O. This agreement validates the proposed approach and also shows that the mineral–porewater helium–concentration equilibrium has been established. Indeed, estimates of the He-migration rates through our quartz samples show that in ~6000 years the internal pressure should equilibrate with He-concentration in related porewater of PCF, and this time interval is short compared to independent estimates [I.N. Tolstikhin, B.E. Lehmann, H.H. Loosli, A. Gautschi, Helium and argon isotopes in rocks, minerals and related groundwaters: a case study in Northern Switzerland, Geochim. Cosmochim. Acta 60 (1996) 1497–1514]. The helium inventory in the rock–porewater assemblage shows that helium abundance in pore waters is indeed important. In shale samples (with ~15% porosity) porewaters contain more helium than the host minerals altogether. Porewater heliumconcentration profiles, available from the mineral record, along with helium production rates are input parameters allowing model(s) of helium migration through a hydrological structure to be developed. Quite high helium concentrations in PCF porewaters imply slow removal mechanisms, which will be discussed elsewhere.

Identification of Trypanosoma brucei components involved in trypanolysis by normal human serum

Normal human serum (NHS) confers human resistance to infection by the parasite Trypanosoma brucei owing to the trypanolytic activity of apolipoprotein L1 (APOL1), present in two serum complexes termed Trypanolytic Factors (TLF-1 and -2). In order to identify parasite components involved in the intracellular trafficking and activity of TLFs, an inducible RNA interference (RNAi) genomic DNA library constructed in bloodstream form T. brucei was subjected to RNAi induction and selection for resistant parasites under NHS conditions favouring either TLF-1 or TLF-2 uptake. While TLF-1 conditions readily selected the haptoglobin-haemoglobin (HP-HB) surface receptor TbHpHbR as expected, given its known ability to bind TLF-1, under TLF-2 conditions no specific receptor for TLF-2 was identified. Instead, the screen allowed the identification of five distinct factors expected to be involved in the assembly of the vacuolar proton pump V-ATPase and consecutive endosomal acidification. These data confirm that lowering the pH during endocytosis is required for APOL1 toxic activity.

Syncytiotrophoblast vesicles show altered micro-RNA and haemoglobin content after ex-vivo perfusion of placentas with haemoglobin to mimic preeclampsia.

BACKGROUND Cell-free foetal haemoglobin (HbF) has been shown to play a role in the pathology of preeclampsia (PE). In the present study, we aimed to further characterize the harmful effects of extracellular free haemoglobin (Hb) on the placenta. In particular, we investigated whether cell-free Hb affects the release of placental syncytiotrophoblast vesicles (STBMs) and their micro-RNA content. METHODS The dual ex-vivo perfusion system was used to perfuse isolated cotyledons from human placenta, with medium alone (control) or supplemented with cell-free Hb. Perfusion medium from the maternal side of the placenta was collected at the end of all perfusion phases. The STBMs were isolated using ultra-centrifugation, at 10,000×g and 150,000×g (referred to as 10K and 150K STBMs). The STBMs were characterized using the nanoparticle tracking analysis, identification of surface markers and transmission electron microscopy. RNA was extracted and nine different micro-RNAs, related to hypoxia, PE and Hb synthesis, were selected for analysis by quantitative PCR. RESULTS All micro-RNAs investigated were present in the STBMs. Mir-517a, mir-141 and mir-517b were down regulated after Hb perfusion in the 10K STBMs. Furthermore, Hb was shown to be carried by the STBMs. CONCLUSION This study showed that Hb perfusion can alter the micro-RNA content of released STBMs. Of particular interest is the alteration of two placenta specific micro-RNAs; mir-517a and mir-517b. We have also seen that STBMs may function as carriers of Hb into the maternal circulation.

Development and voluntarism in football clubs

Volunteers are still the most important resource for amateur football clubs. However, stable voluntary engagement can no longer be granted. This difficulty is confirmed by existing research across various European countries. From a club management point of view, a detailed understanding of how to attract volunteers and retain them is becoming a high priority. The purpose of this study is (1) to analyse the influence of individual characteristics and corresponding organisational conditions on volunteering and (2) to examine the decision-making processes in relation to implement effective strategies for recruiting volunteers. To answer these questions, the current state of research is summarised and then a multi-level-framework is developed which is based on the structural-individualistic social theory. The individual and context factors for volunteering are estimated in different multi-level models based on a sample of n=1,434 sport club members from 36 sport clubs in Switzerland. Results indicate that volunteering is not just an outcome of individual characteristics such as lower workloads, higher income, children belonging to the sport club, longer club membership, or a strong commitment to the club. It is also influenced by club-specific structural conditions. Concerning decision-making processes an in-depth analysis of recruitment practices for volunteers was conducted in selected clubs (case study design). based on the garbage can model. The results show that systematically designed decision-making processes with a clear regulation of responsibilities seem to solve personnel problems more purposefully and more quickly. Based on the findings some recommendations for volunteer management in football clubs are worked out.

Vor dem deutschen Delegiertentag

hb.

Der verdammliche Juden-Speiss, oder, Rechtmässiges und historisches Bedencken von der Juden verdammlichen Geldwucher ...

durch Christlieb Wucherfeind

Die Berufe der Juden in Bayern : von Paula Weiner-Odenheimer ; hrsg. vom Verein für die Statistik der Juden in München

Veröffentlichungen des Büros für die Statistik der Juden, Berlin, Heft 10

Texas electronics waste management: A policy analysis for the 21st century

Electronic waste is a fairly new and largely unknown phenomenon. Accordingly, governments have only recently acknowledged electronic waste as a threat to the environment and public health. In attempting to mitigate the hazards associated with this rapidly growing toxic waste stream, governments at all levels have started to implement e-waste management programs. The legislation enacted to create these programs is based on extended producer responsibility or EPR policy. ^ EPR shifts the burden of final disposal of e-waste from the consumer or municipal solid waste system to the manufacturer of electronic equipment. Applying an EPR policy is intended to send signals up the production chain to the manufacturer. The desired outcome is to change the methods of production in order to reduce production outputs/inputs with the ultimate goal of changing product design. This thesis performs a policy analysis of the current e-waste policies at the federal and state level of government, focusing specifically on Texas e-waste policies. ^ The Texas e-waste law known, as HB 2714 or the Texas Computer TakeBack Law, requires manufacturers to provide individual consumers with a free and convenient method for returning their used computers to manufacturers. The law is based on individual producer responsibility and shared responsibility among consumer, retailers, recyclers, and the TCEQ. ^ Using a set of evaluation criteria created by the Organization for Economic Co-operation and Development, the Texas e-waste law was examined to determine its effectiveness at reducing the threat of e-waste in Texas. Based on the outcomes of the analysis certain recommendations were made for the legislature to incorporate into HB 2714. ^ The results of the policy analysis show that HB 2714 is a poorly constructed law and does not provide the desired results seen in other states with EPR policies. The TakeBack Law does little to change the collection methods of manufacturers and even less to change their production habits. If the e-waste problem is to be taken seriously, HB 2714 must be amended to reflect the proposed changes in this thesis.^

Funding the utilization of community health workers in Texas

Community health workers (CHWs) are volunteers or paid members of communities that perform outreach, patient assistance, health education, and assist in navigation of healthcare system amongst other duties. The utilization of CHWs in hospital and community setting provides health benefits to their communities while reducing cost to the overall healthcare system. ^ The general population of Texas lacks adequate access to primary care. An important indicator of such a crisis is excessive usage of emergency department services in Texas, especially by the large minority population within the state. Also, unmanaged chronic diseases have been shown to be correlated with the excessive usage of emergency services. According to a recent survey of 25 Houston metropolitan area hospitals, almost 54% of the ER visits could have been resolved in primary care settings. A Galveston based study also indicated that the ER usage was higher amongst African-Americans and Latinos. Meanwhile, 28.5% of the total ER visits were made by Latinos from the surrounding areas (Begley et al., 2007). There is substantial evidence present which indicates enormous cost-savings that CHWs have produced in Texas and nationwide through reduction in unnecessary ER visits along with better management of chronic diseases (Fedder et al, 2003). ^ This paper provides an analysis regarding the need and importance for sustainable and stable sources of funding for Community health workers (CHWs) in Texas utilizing Kingdon's model of Agenda Setting as framework. The policy analysis is also aimed at reporting on the policy process and actions taken by Children at Risk to address this critical issue. Children at Risk, a Houston based advocacy organization, has created a legislative proposal that calls on the Texas Health and Human Commission to apply for a Medicaid §§1115 waiver to provide sustainable sources of funding for CHWs, Rep. John Zerwas sponsored HB 2244 bill and it was filed on March 3, 2011. The bill would affect the use of CHWs in Texas in two ways: 1) through the establishment and operation of a program designed to train and educate CHWs 2) by creating a statewide training and certification advisory committee. The advisory committee is required in the bill to submit recommendations for providing sustainable funding and employment for CHWs. The HB 2244 failed to move out of the House Public Health committee. However, HB2244 was amended into HB 2610 introduced by Representative Guillen. The House Bill 2610 is geared towards establishing a community-based navigator program in order to assist individuals applying for public assistance through the Internet. The House Bill 2610 was signed by the Governor and will be effective September 1, 2011.^

Impacto clínico de la pancitopenia en pacientes hospitalizados

Objetivo: Determinar etiología, manifestaciones clínicas, morbimortalidad y recursos diagnósticos y terapéuticos utilizados en pacientes internados con pancitopenia. Material y métodos: Estudio protocolizado, descriptivo y observacional de 14 meses. Criterios de inclusión: pacientes internados con pancitopenia definida por hemoglobina (Hb) <12 g/dL; plaquetas <150.000/ mL y leucocitos <3.800/mL. Los datos fueron analizados con Epi Info 6.04. Resultados: Se diagnosticaron 54 casos de pancitopenia. Prevalencia: 22/1.000 egresos. Edad media: 48,72 años (DS±20,64); 29,63% fueron > 65 años y 53,70% hombres. Permanencia media: 17,13 días (DS±13,22) vs 7,25 días (DS±5,4) del Servicio (p<0.0001). Charlson medio: 7,16 (DS±2,96) y APACHEII medio: 12 (DS±5,04). El 83,33% (45/54, IC95%70,71-92,08) de las pancitopenias fueron secundarias a compromiso medular, 22 casos (40,74%; IC95%27,57-54,97) postquimioterapia (15 en neoplasias oncohematológicas y 7 en sólidas), 11 (20,37%; IC95%10,63-33,53) por mieloptisis y 4 casos (7,41%; IC95%2,06-17,89) por megaloblastosis. El 16,66% (9/54; IC95%7,92- 29,29) fue secundaria a hiperesplenismo y el 16,66% asociadas a infecciones (3 casos por SIDA). Se realizó estudio de médula ósea en 19 casos (35,18%). El 96,29% (IC95%87,25-99,55) presentó comórbidas. El síndrome de respuesta inflamatoria sistémica (85,19%), síndrome anémico (77,8%) y púrpura (50%) fueron las manifestaciones clínicas más frecuentes. Presentó sepsis el 81,48% (IC95%68,57-90,75) y el 29,63% (IC95%17,98-46,31) hemorragias. El 81,48% tuvo infecciones; el 50% de origen nosocomial y el 65,91% clínicamente documentadas. El 34,09% (IC95%20,49-49,92) tuvo aislamiento microbiológico, con hemocultivos positivos en 29,55%. El 51,85% (IC95%37,84-65,66) desarrolló neutropenia febril (75% postquimioterapia). El 64,81% recibió hemoderivados y factores estimulantes de colonias (G-CSF) el 46,34% (IC95%32,62-60,39). La mortalidad fue mayor a la media global del Servicio (16,66 vs 8,65%)(p=0.07).- Conclusiones: Las pancitopenias en pacientes hospitalizados se caracterizaron por ser secundarias a compromiso medular, hiperesplenismo e infecciones, asociarse a permanencia prolongada, altos índices de comorbilidad, complicaciones infecciosas, y mayor mortalidad que la media global del Servicio.