Counselling and predictive testing for familial adenomatous polyposis in a rural South Indian community

Background—Mutations of the APC gene cause familial adenomatous polyposis (FAP), a hereditary colorectal cancer predisposition syndrome.Aims—To conduct a cost comparison analysis of predictive genetic testing versus conventional clinical screening for individuals at risk of inheriting FAP, using the perspective of a third party payer. Methods—All direct health care costs for both screening strategies were measured according to time and motion, and the expected costs evaluated using a decision analysis model.Results—The baseline analysis predicted that screening a prototype FAP family would cost $4975/£3109 by molecular testingand $8031/£5019 by clinical screening strategy, when family members were monitored with the same frequency of clinical surveillance (every two to three years). Sensitivity analyses revealed that the genetic testing approach is cost saving for key variables including the kindred size, the age of screening onset, and the cost of mutation identification in a proband. However, if the APC mutation carriers were monitored at an increased (annual) frequency, the cost of the genetic screening strategy increased to $7483/ £4677 and was especially sensitive to variability in age of onset of screening, family size, and cost of genetic testing of at risk relatives. Conclusions—In FAP kindreds, a predictive genetic testing strategy costs less than conventional clinical screening, provided that the frequency of surveillance is identical using either strategy. An additional significant benefit is the elimination of unnecessary colonic examinations for those family members found to be noncarriers.

Panel discussion: U.S. EPA using modeling and ecosystem services to enhance coastal decision making

This panel will discuss the research being conducted, and the models being used in three current coastal EPA studies being conducted on ecosystem services in Tampa Bay, the Chesapeake Bay and the Coastal Carolinas. These studies are intended to provide a broader and more comprehensive approach to policy and decision-making affecting coastal ecosystems as well as provide an account of valued services that have heretofore been largely unrecognized. Interim research products, including updated and integrated spatial data, models and model frameworks, and interactive decision support systems will be demonstrated to engage potential users and to elicit feedback. It is anticipated that the near-term impact of the projects will be to increase the awareness by coastal communities and coastal managers of the implications of their actions and to foster partnerships for ecosystem services research and applications. (PDF contains 4 pages)

Coastal resource planning system: Integrating evaluation of ecological integrity and ecosystem services valuation

Efficient and effective coastal management decisions rely on knowledge of the impact of human activities on ecosystem integrity, vulnerable species, and valued ecosystem services—collectively, human impact on environmental quality (EQ). Ecosystem-based management (EBM) is an emerging approach to address the dynamics and complexities of coupled social-ecological systems. EBM “is intended to directly address the long-term sustainable delivery of ecosystem services and the resilience of marine ecosystems to perturbations” (Rosenberg and Sandifer, 2009). The lack of a tool that integrates human choices with the ecological connections between contributing watersheds and nearshore areas, and that incorporates valuation of ecosystem services, is a critical missing piece needed for effective and efficient coastal management. To address the need for an integrative tool for evaluation of human impacts on ecosystems and their services, Battelle developed the EcoVal™ Environmental Quality Evaluation System. The EcoVal system is an updated (2009) version of the EQ Evaluation System for Water Resources developed by Battelle for the U.S. Bureau of Reclamation (Dee et al., 1972). The Battelle EQ evaluation system has a thirty-year history of providing a standard approach to evaluate watershed EQ. This paper describes the conceptual approach and methodology of the updated EcoVal system and its potential application to coastal ecosystems. (PDF contains 4 pages)

Long Run Trends in the Price of Energy and Energy Services

4 p.

Solutions for New Terrestrial Broadcasting Systems Offering Simultaneously Stationary and Mobile Services

221 p.

System architecture and deployment scenarios for SESAME: Small cEllS coordinAtion for Multi-tenancy and Edge services

The surge of the Internet traffic with exabytes of data flowing over operators mobile networks has created the need to rethink the paradigms behind the design of the mobile network architecture. The inadequacy of the 4G UMTS Long term Evolution (LTE) and even of its advanced version LTE-A is evident, considering that the traffic will be extremely heterogeneous in the near future and ranging from 4K resolution TV to machine-type communications. To keep up with these changes, academia, industries and EU institutions have now engaged in the quest for new 5G technology. In this paper we present the innovative system design, concepts and visions developed by the 5G PPP H2020 project SESAME (Small cEllS coordinAtion for Multi-tenancy and Edge services). The innovation of SESAME is manifold: i) combine the key 5G small cells with cloud technology, ii) promote and develop the concept of Small Cellsas- a-Service (SCaaS), iii) bring computing and storage power at the mobile network edge through the development of nonx86 ARM technology enabled micro-servers, and iv) address a large number of scenarios and use cases applying mobile edge computing. Topics:

A survey of research and scientific services in East Africa, 1947-56

This "Survey of Research and Scientific Services in East Arica 1947-1956" has been prepared by Dr. E. B. Worthington, who held the post of Scientific Secretary in the Office of the Chief Secretary to the East African Governor's Conference and subsequently in the Administrator's Office of the East Mrica High Commission during the period January, 1947-May, 1951. Dr. Worthington is now Secretary General of the Scientific Council for, Arica South of the Sahara

Strategies for designing and developing services for manufacturing firms

Product/service-systems (PSS) are in effect an approach to designing integrated products and services with a focus on both customer and product life cycle activities. A range of service-oriented design strategies can be found in current literature, from product-oriented DfX approaches to more customer-oriented approaches, such as integrated solutions. In this article, design strategies related to different types of services are mapped. Case studies from two industrial companies are used to confront the existing literature in order to improve the understanding of how manufacturing companies may align their product and service development activities with their business strategies. © 2010.

The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Economic crisis and public services: note 1, December 2008

The paper examines the impact of the economic crisis on public services, including government reponses and implications for companies operating in public services.

Energy production and ecosystem services

Ecosystems provide a range of goods and services that contribute toward human well-being. It is increasingly recognized that factors such as a growing and increasingly affluent world population, coupled with increased globalization of trade, are significantly influencing the delivery of ecosystem goods and services. This chapter argues that future energy policy must be designed based on a broad set of environmental and social considerations that examine the national and international implications of each energy technology. This approach ensures a more holistic overview of the costs and benefits associated with energy production, allowing society to make more informed choices about their futures, including how their energy is sourced, generated, and delivered.