Stage at diagnosis and ovarian cancer survival:Evidence from the international cancer benchmarking partnership

Objective: We investigate what role stage at diagnosis bears in international differences in ovarian cancer survival. Methods: Data from population-based cancer registries in Australia, Canada, Denmark, Norway, and the UK were analysed for 20,073 women diagnosed with ovarian cancer during 2004-07. We compare the stage distribution between countries and estimate stage-specific one-year net survival and the excess hazard up to 18 months after diagnosis, using flexible parametric models on the log cumulative excess hazard scale. Results: One-year survival was 69% in the UK, 72% in Denmark and 74-75% elsewhere. In Denmark, 74% of patients were diagnosed with FIGO stages III-IV disease, compared to 60-70% elsewhere. International differences in survival were evident at each stage of disease; women in the UK had lower survival than in the other four countries for patients with FIGO stages III-IV disease (61.4% vs. 65.8-74.4%). International differences were widest for older women and for those with advanced stage or with no stage data. Conclusion: Differences in stage at diagnosis partly explain international variation in ovarian cancer survival, and a more adverse stage distribution contributes to comparatively low survival in Denmark. This could arise because of differences in tumour biology, staging procedures or diagnostic delay. Differences in survival also exist within each stage, as illustrated by lower survival for advanced disease in the UK, suggesting unequal access to optimal treatment. Population-based data on cancer survival by stage are vital for cancer surveillance, and global consensus is needed to make stage data in cancer registries more consistent. © 2012 Elsevier Inc.

CD2AP is associated with end-stage renal disease in patients with type 1 diabetes

CD2-associated protein (CD2AP) is essential for podocyte function. CD2AP mutations have been found in patients with focal segmental glomerulosclerosis, a disease histologically resembling diabetic nephropathy and often progressing to end-stage renal disease (ESRD). We hypothesised that variations in the CD2AP gene may contribute to susceptibility to glomerular injury in diabetes and investigated if single-nucleotide polymorphisms (SNPs) in CD2AP are associated with diabetic nephropathy in patients with type 1 diabetes. The discovery cohort consisted of 2,251 Finnish patients with type 1 diabetes. SNPs were selected from the HapMap database to cover the CD2AP gene. The associations between genotyped SNPs and diabetic nephropathy or ESRD were analysed with the chi-squared test and logistic regression. Three SNPs were selected for replication in cohorts from Denmark, Italy, the United Kingdom and Ireland. None of the 15 successfully genotyped SNPs were associated with diabetic nephropathy when compared to patients with normal albumin excretion rate. However, when genotype frequencies in patients with ESRD were compared with all other patients, two CD2AP SNPs, rs9369717 and rs9349417, were found to be associated with ESRD. The meta-analysis of the original and two additional European cohorts resulted in significant p values

Pleural mesothelioma incidence in Europe:Evidence of some deceleration in the increasing trends

Objective: To summarize the geographical and temporal variations in incidence of pleural mesothelioma in Europe, using the extensive data available from European general cancer registries, and consider these in light of recent trends in asbestos extraction, use and import in European countries. Material and methods: The data were extracted from the European Cancer Incidence and Mortality database (EUROCIM). The inclusion criteria was acceptance in Volume VII of Cancer Incidence in Five Continents, Truncated age-standardized rates per 100,000 for the ages 40-74 were used to summarise recent geographical variations. Standardized rate ratios and 95% confidence intervals for the periods 1986-1990 and 1991-1995 were compared to assess geographical variations in risk. To investigate changes in the magnitude of most recent trends, regression models fitted to the latest available 10-year period (1988-1997) were compared with trends in the previous decade. Fitted rates in younger (40-64) and older adults (65-74) in the most recent period were also compared. Results: There was a great deal of geographical variation in the risk of mesothelioma, annual rates ranging from around 8 per 100,000 in Scotland, England and The Netherlands, to lower than 1 per 100,000 in Spain (0.96), Estonia (0.85), Poland (0.85) and Yugoslavia, Vojvodina (0.56) among men. The rank of the rates for women was similar to that observed for men, although rates were considerably lower. Between 1978 and 1987, rates in men significantly increased in all countries (excepting Denmark). In the following 10 years, there was a deceleration in trend, and a significant increase was detectable only in England and France. In addition, the magnitude of recent trends in younger men was generally lower than those estimated for older men, in both national and regional cancer registry settings. Conclusions: While mesothelioma incidence rates are still rising in Europe, a deceleration has started in some countries. A decrease may begin in the next few years in certain European populations considering the deceleration of observed trends in mesothelioma and asbestos exposure, as well as the recent ban on its use.

"This mere speck on the surface of the waters": Rockall aka Waveland

Rockall is a tiny granite knoll isolated in the stormy waters of the North Atlantic. It is not habitable and has of itself no economic value. However, given its location it has been a prize insofar as at one time it was thought its possession could bring control of an exclusive economic zone. Iceland, Ireland and Denmark laid claim in addition to the UK, which had annexed Rockall in 1955, the last territory to be taken into the British Empire. In 1972 Rockall was declared to be part of Scotland. However the United Nations Convention on the Laws of the Sea (1982) now precludes rocks incapable of supporting life to be awarded economic zones. Interest in Rockall then reverted to symbolism especially in its occupation by Greenpeace in 1997 when the global state of Waveland was declared from Rockall’s summit, with Rockall itself as the capital. Greenpeace stayed on Rockall longer than anybody else and a claim has been established to it thereby, but Waveland itself collapsed with the failure of the company that serviced its online presence.

Derivation of Wave Loads for the Design of Oscillating Wave Surge Converters

This paper deals with the problem of estimating wave pressure loads acting on Oscillating Wave Surge Converters (OWSC) for assessment of fatigue on their components. Recent wave loading data issued from experimental testing of a 25th scale model of a box-shaped OWSC are here used to review the accuracy of the predictions made by an engineering method previously developed to derive wave pressure loads on OWSCs from experimental data. Predictions are shown underestimate wave pressure loads, and other methods subsequently developed are presented. A simplistic experimental method taking in consideration variations of the wetted surface area of the flap is shown to lead to relatively good estimates of wave pressure loads that could be used for fatigue calculations.

Hierarchical demand response using dantzig-wolfe decomposition

Demand Side Management (DSM) programmes are designed to shift electrical loads from peak times. Demand Response (DR) algorithms automate this process for controllable loads. DR can be implemented explicitly in terms of Peak to Average Ratio Reduction (PARR), in which case the maximum peak load is minimised over a prediction horizon by manipulating the amount of energy given to controllable loads at different times. A hierarchical predictive PARR algorithm is presented here based on Dantzig-Wolfe decomposition. © 2013 IEEE.

Fair charging strategies for EVs connected to a low-voltage distribution network

The development of smart grid technologies and appropriate charging strategies are key to accommodating large numbers of Electric Vehicles (EV) charging on the grid. In this paper a general framework is presented for formulating the EV charging optimization problem and three different charging strategies are investigated and compared from the perspective of charging fairness while taking into account power system constraints. Two strategies are based on distributed algorithms, namely, Additive Increase and Multiplicative Decrease (AIMD), and Distributed Price-Feedback (DPF), while the third is an ideal centralized solution used to benchmark performance. The algorithms are evaluated using a simulation of a typical residential low voltage distribution network with 50% EV penetration. © 2013 IEEE.

Generalized Loopy 2U: A New Algorithm for Approximate Inference in Credal Networks

Credal nets generalize Bayesian nets by relaxing the requirement of precision of probabilities. Credal nets are considerably more expressive than Bayesian nets, but this makes belief updating NP-hard even on polytrees. We develop a new efficient algorithm for approximate belief updating in credal nets. The algorithm is based on an important representation result we prove for general credal nets: that any credal net can be equivalently reformulated as a credal net with binary variables; moreover, the transformation, which is considerably more complex than in the Bayesian case, can be implemented in polynomial time. The equivalent binary credal net is updated by L2U, a loopy approximate algorithm for binary credal nets. Thus, we generalize L2U to non-binary credal nets, obtaining an accurate and scalable algorithm for the general case, which is approximate only because of its loopy nature. The accuracy of the inferences is evaluated by empirical tests.

Gender Equality under the Charter of Fundamental Rights - a new lease for positive action?

This paper, which was published as a chapter of a Festskrift for Professor Ruth Nielsen, analyses Article 23 CFREU, the new provision on gender equality. It argues that Article 23 adds to the notion of gender equality in EU law, and not only allows, but also demands positive action measures if necessary to ensure equality between women and men. The provision also demands that positive action measures are suitable to achieve their aim. This implies that the EU legislator has to adapt positive action measure to the specific needs of the sector. The paper offers a critique of the proposal to introduce women quotas in board rooms, as proposed by the EU Commission in late 2012. It argues that the Commission unimaginatively copied rules developed for the German public service into a different sector, although these rules have not proven particularly efficient even in the public service. Consequently, a proposal that is demanding, but adapted to the sector should be developed.

A systematic review of population based epidemiological studies in Myasthenia Gravis

Background: The aim was to collate all myasthenia gravis (MG) epidemiological studies including AChR MG and MuSK MG specific studies. To synthesize data on incidence rate (IR), prevalence rate (PR) and mortality rate (MR) of the condition and investigate the influence of environmental and technical factors on any trends or variation observed.

Methods: Studies were identified using multiple sources and meta-analysis performed to calculate pooled estimates for IR, PR and MR.

Results: 55 studies performed between 1950 and 2007 were included, representing 1.7 billion population-years. For All MG estimated pooled IR (eIR): 5.3 per million person-years (C.I.: 4.4, 6.1), range: 1.7 to 21.3; estimated pooled PR: 77.7 per illion persons (C.I.: 64.0, 94.3), range 15 to 179; MR range 0.1 to 0.9 per millions person-years. AChR MG eIR: 7.3 (C.I.: 5.5, 7.8), range: 4.3 to 18.0; MuSK MG IR range: 0.1 to 0.32. However marked variation persisted between populations studied with similar methodology and in similar areas.

Conclusions: We report marked variation in observed frequencies of MG. We show evidence of increasing frequency of MG with year of study and improved study quality. This probably reflects improved case ascertainment. But other factors must also influence disease onset resulting in the observed variation in IR across geographically and genetically similar populations.

Explaining variation in cancer survival between 11 jurisdictions in the International Cancer Benchmarking Partnership: a primary care vignette survey

OBJECTIVES: The International Cancer Benchmarking Partnership (ICBP) is a collaboration between 6 countries and 12 jurisdictions with similar primary care-led health services. This study investigates primary care physician (PCP) behaviour and systems that may contribute to the timeliness of investigating for cancer and subsequently, international survival differences.

DESIGN: A validated survey administered to PCPs via the internet set out in two parts: direct questions on primary care structure and practice relating to cancer diagnosis, and clinical vignettes, assessing management of scenarios relating to the diagnosis of lung, colorectal or ovarian cancer.

PARTICIPANTS: 2795 PCPs in 11 jurisdictions: New South Wales and Victoria (Australia), British Columbia, Manitoba, Ontario (Canada), England, Northern Ireland, Wales (UK), Denmark, Norway and Sweden.

PRIMARY AND SECONDARY OUTCOME MEASURES: Analysis compared the cumulative proportion of PCPs in each jurisdiction opting to investigate or refer at each phase for each vignette with 1-year survival, and conditional 5-year survival rates for the relevant cancer and jurisdiction. Logistic regression was used to explore whether PCP characteristics or system differences in each jurisdiction affected the readiness to investigate.

RESULTS: 4 of 5 vignettes showed a statistically significant correlation (p<0.05 or better) between readiness to investigate or refer to secondary care at the first phase of each vignette and cancer survival rates for that jurisdiction. No consistent associations were found between readiness to investigate and selected PCP demographics, practice or health system variables.

CONCLUSIONS: We demonstrate a correlation between the readiness of PCPs to investigate symptoms indicative of cancer and cancer survival rates, one of the first possible explanations for the variation in cancer survival between ICBP countries. No specific health system features consistently explained these findings. Some jurisdictions may consider lowering thresholds for PCPs to investigate for cancer-either directly, or by specialist referral, to improve outcomes.

Investigating Intra-individual Dietary Changes and Radiocarbon Ages Using High Resolution δ13C, δ15N Isotope Ratios and 14C Ages Obtained From Dentine Increments

Ten medieval permanent teeth were subjected to incremental dentine sectioning and stable isotope analysis to investigate dietary changes in high resolution. In addition to this, eight increments were also selected for 14C measurements to examine possible intra-individual age differences. Results reveal the cessation of weaning, various dietary profiles and in some cases significantly different 14C ages obtained from a single tooth. This case study illustrates how 14C measurements can function as a proxy alongside the commonly used carbon and nitrogen stable isotope values to interpret the diet of past individuals

2P/Encke, the Taurid complex NEOs and the Maribo and Sutter's Mill meteorites

Aims. 2P/Encke is a short period comet that was discovered in 1786 and has been extensively observed and studied for more than 200years. The Taurid meteoroid stream has long been linked with 2P/Encke owing to a good match of their orbital elements, even thoughthe comet’s activity is not strong enough to explain the number of observed meteors. Various small near-Earth objects (NEOs) havebeen discovered with orbits that can be linked to 2P/Encke and the Taurid meteoroid stream. Maribo and Sutter’s Mill are CM typecarbonaceous chondrite that fell in Denmark on January 17, 2009 and April 22, 2012, respectively. Their pre-atmospheric orbits placethem in the middle of the Taurid meteoroid stream, which raises the intriguing possibility that comet 2P/Encke could be the parentbody of CM chondrites.
Methods. To investigate whether a relationship between comet 2P/Encke, the Taurid complex associated NEOs, and CM chondritesexists, we performed photometric and spectroscopic studies of these objects in the visible wavelength range. We observed 2P/Enckeand 10 NEOs on August 2, 2011 with the FORS instrument at the 8.2 m Very Large Telescope on Cerro Paranal (Chile).
Results. Images in the R filter, used to investigate the possible presence of cometary activity around the nucleus of 2P/Encke andthe NEOs, show that no resolved coma is present. None of the FORS spectra show the 700 nm absorption feature due to hydratedminerals that is seen in the CM chondrite meteorites. All objects show featureless spectra with moderate reddening slopes at λ < 800nm. Apart for 2003 QC10 and 1999 VT25, which show a flatter spectrum, the spectral slope of the observed NEOs is compatible withthat of 2P/Encke. However, most of the NEOs show evidence of a silicate absorption in lower S/N data at λ > 800 nm, which is notseen in 2P/Encke, which suggests that they are not related.
Conclusions. Despite similar orbits, we find no spectroscopic evidence for a link between 2P/Encke, the Taurid complex NEOs andthe Maribo and Sutter’s Mill meteorites. However, we cannot rule out a connection to the meteorites either, as the spectral differencesmay be caused by secondary alteration of the surfaces of the NEOs.