Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

OBJECTIVES: To investigate epidemiological, social, diagnostic and economic aspects of chlamydia screening in non-genitourinary medicine settings. METHODS: Linked studies around a cross-sectional population-based survey of adult men and women invited to collect urine and (for women) vulvovaginal swab specimens at home and mail these to a laboratory for testing for Chlamydia trachomatis. Specimens were used in laboratory evaluations of an amplified enzyme immunoassay (PCE EIA) and two nucleic acid amplification tests [Cobas polymerase chain reaction (PCR), Becton Dickinson strand displacement amplification (SDA)]. Chlamydia-positive cases and two negative controls completed a risk factor questionnaire. Chlamydia-positive cases were invited into a randomised controlled trial of partner notification strategies. Samples of individuals testing negative completed psychological questionnaires before and after screening. In-depth interviews were conducted at all stages of screening. Chlamydia transmission and cost-effectiveness of screening were investigated in a transmission dynamic model. SETTING AND PARTICIPANTS: General population in the Bristol and Birmingham areas of England. In total, 19,773 women and men aged 16-39 years were randomly selected from 27 general practice lists. RESULTS: Screening invitations reached 73% (14,382/19,773). Uptake (4731 participants), weighted for sampling, was 39.5% (95% CI 37.7, 40.8%) in women and 29.5% (95% CI 28.0, 31.0%) in men aged 16-39 years. Chlamydia prevalence (219 positive results) in 16-24 year olds was 6.2% (95% CI 4.9, 7.8%) in women and 5.3% (95% CI 4.4, 6.3%) in men. The case-control study did not identify any additional factors that would help target screening. Screening did not adversely affect anxiety, depression or self-esteem. Participants welcomed the convenience and privacy of home-sampling. The relative sensitivity of PCR on male urine specimens was 100% (95% CI 89.1, 100%). The combined relative sensitivities of PCR and SDA using female urine and vulvovaginal swabs were 91.8% (86.1, 95.7, 134/146) and 97.3% (93.1, 99.2%, 142/146). A total of 140 people (74% of eligible) participated in the randomised trial. Compared with referral to a genitourinary medicine clinic, partner notification by practice nurses resulted in 12.4% (95% CI -3.7, 28.6%) more patients with at least one partner treated and 22.0% (95% CI 6.1, 37.8%) more patients with all partners treated. The health service and patients costs (2005 prices) of home-based postal chlamydia screening were 21.47 pounds (95% CI 19.91 pounds, 25.99) per screening invitation and 28.56 pounds (95% CI 22.10 pounds, 30.43) per accepted offer. Preliminary modelling found an incremental cost-effectiveness ratio (2003 prices) comparing screening men and women annually to no screening in the base case of 27,000 pounds/major outcome averted at 8 years. If estimated screening uptake and pelvic inflammatory disease incidence were increased, the cost-effectiveness ratio fell to 3700 pounds/major outcome averted. CONCLUSIONS: Proactive screening for chlamydia in women and men using home-collected specimens was feasible and acceptable. Chlamydia prevalence rates in men and women in the general population are similar. Nucleic acid amplification tests can be used on first-catch urine specimens and vulvovaginal swabs. The administrative costs of proactive screening were similar to those for opportunistic screening. Using empirical estimates of screening uptake and incidence of complications, screening was not cost-effective.

Diagnostic and prognostic implications of the PAX8-PPARγ translocation in thyroid carcinomas-a TMA-based study of 226 cases

AIMS Follicular thyroid carcinoma (FTC) has been a diagnostic challenge for decades. The PAX8-PPARγ rearrangement has been detected in FTC and classic papillary thyroid carcinomas (PTCs). The aims of this study were to assess the presence of PAX8-PPARγ by using tissue microarrays in a large cohort of different thyroid neoplasms, and to assess its diagnostic and prognostic implications. METHODS AND RESULTS Fluorescence in-situ hybridization (FISH) analysis for PAX8-PPARγ was performed on 226 thyroid tumours, comprising FTCs (n = 59), PTCs (n = 126), poorly differentiated thyroid carcinomas (PDs; n = 34), follicular thyroid adenomas (FTAs; n = 5), and follicular tumours of unknown malignant potential (FTUMPs; n = 2). PAX8-PPARγ was detected in 12% of FTCs, 1% of PTCs, 7% of PDs, and in both cases of FTUMP. There was no correlation between the extent of capsular or vascular invasion and PAX8-PPARγ, or between lymph node or haematogenous metastasis and PAX8-PPARγ. Overall survival (OS), tumour-specific survival (TSS) and relapse-free-survival (RFS) were not influenced by PAX8-PPARγ. CONCLUSIONS In this study, we demonstrate for the first time the presence of PAX8-PPARγ in PDs and FTUMPs, whereas in FTCs and PTCs the prevalence of PAX8-PPARγ is lower than previously reported. PAX8-PPARγ did not correlate with invasiveness or affect prognosis in any tumour type.

Biological, diagnostic and therapeutic relevance of the MET receptor signaling in head and neck cancer.

Head and neck cancer constitutes the 6th most common malignancy worldwide and affects the crucial anatomical structures and physiological functions of the upper aerodigestive tract. Classical therapeutic strategies such as surgery and radiotherapy carry substantial toxicity and functional impairment. Moreover, the loco-regional control rates as well as overall survival still need to be improved in subgroups of patients. The scatter-factor/hepatocyte growth factor receptor tyrosine kinase MET is an established effector in the promotion, maintenance and progression of malignant transformation in a wide range of human malignancies, and has been gaining considerable interest in head and neck cancer over the last 15 years. Aberrant MET activation due to overexpression, mutations, tumor-stroma paracrine loops, and cooperative/redundant signaling has been shown to play prominent roles in epithelial-to-mesenchymal transition, angiogenesis, and responses to anti-cancer therapeutic modalities. Accumulating preclinical and translational evidence highly supports the increasing interest of MET as a biomarker for lymph node and distant metastases, as well as a potential marker of stratification for responses to ionizing radiation. The relevance of MET as a therapeutic molecular target in head and neck cancer described in preclinical studies remains largely under-evaluated in clinical trials, and therefore inconclusive. Also in the context of anti-cancer targeted therapy, a large body of preclinical data suggests a central role for MET in treatment resistance towards multiple therapeutic modalities in malignancies of the head and neck region. These findings, as well as the potential use of combination therapies including MET inhibitors in these tumors, need to be further explored.

Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study

BACKGROUND AND PURPOSE The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population. METHODS We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal. RESULTS CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6). CONCLUSION CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.

Organic-walled dinoflagellate cysts analysis and statistical analysis of 116 surface sediment samples from the eastern Indian Ocean

Assemblages of organic-walled dinoflagellate cysts (dinocysts) from 116 marine surface samples have been analysed to assess the relationship between the spatial distribution of dinocysts and modern local environmental conditions [e.g. sea surface temperature (SST), sea surface salinity (SSS), productivity] in the eastern Indian Ocean. Results from the percentage analysis and statistical methods such as multivariate ordination analysis and end-member modelling, indicate the existence of three distinct environmental and oceanographic regions in the study area. Region 1 is located in western and eastern Indonesia and controlled by high SSTs and a low nutrient content of the surface waters. The Indonesian Throughflow (ITF) region (Region 2) is dominated by heterotrophic dinocyst species reflecting the region's high productivity. Region 3 is encompassing the area offshore north-west and west Australia which is characterised by the water masses of the Leeuwin Current, a saline and nutrient depleted southward current featuring energetic eddies.

Experimental and statistical investigation of canonical problems in sloshing

En hidrodinámica, el fenómeno de Sloshing se puede definir como el movimiento de la superficie libre de un fluido dentro de un contenedor sometido a fuerzas y perturbaciones externas. El fluido en cuestión experimenta violentos movimientos con importantes deformaciones de su superficie libre. La dinámica del fluido puede llegar a generar cargas hidrodinámicas considerables las cuales pueden afectar la integridad estructural y/o comprometer la estabilidad del vehículo que transporta dicho contenedor. El fenómeno de Sloshing ha sido extensivamente investigado matemática, numérica y experimentalmente, siendo el enfoque experimental el más usado debido a la complejidad del problema, para el cual los modelos matemáticos y de simulación son aun incapaces de predecir con suficiente rapidez y precisión las cargas debidas a dicho fenómeno. El flujo generado por el Sloshing usualmente se caracteriza por la presencia de un fluido multifase (gas-liquido) y turbulencia. Reducir al máximo posible la complejidad del fenómeno de Sloshing sin perder la esencia del problema es el principal reto de esta tesis doctoral, donde un trabajo experimental enfocado en casos canónicos de Sloshing es presentado y documentado con el objetivo de aumentar la comprensión de dicho fenómeno y por tanto intentar proveer información valiosa para validaciones de códigos numéricos. El fenómeno de Sloshing juega un papel importante en la industria del transporte marítimo de gas licuado (LNG). El mercado de LNG en los últimos años ha reportado un crecimiento hasta tres veces mayor al de los mercados de petróleo y gas convencionales. Ingenieros en laboratorios de investigación e ingenieros adscritos a la industria del LNG trabajan continuamente buscando soluciones económicas y seguras para contener, transferir y transportar grandes volúmenes de LNG. Los buques transportadores de LNG (LNGC) han pasado de ser unos pocos buques con capacidad de 75000 m3 hace unos treinta años, a una amplia flota con una capacidad de 140000 m3 actualmente. En creciente número, hoy día se construyen buques con capacidades que oscilan entre 175000 m3 y 250000 m3. Recientemente un nuevo concepto de buque LNG ha salido al mercado y se le conoce como FLNG. Un FLNG es un buque de gran valor añadido que solventa los problemas de extracción, licuefacción y almacenamiento del LNG, ya que cuenta con equipos de extracción y licuefacción a bordo, eliminando por tanto las tareas de transvase de las estaciones de licuefacción en tierra hacia los buques LNGC. EL LNG por tanto puede ser transferido directamente desde el FLNG hacia los buques LNGC en mar abierto. Niveles de llenado intermedios en combinación con oleaje durante las operaciones de trasvase inducen movimientos en los buques que generan por tanto el fenómeno de Sloshing dentro de los tanques de los FLNG y los LNGC. El trabajo de esta tesis doctoral lidia con algunos de los problemas del Sloshing desde un punto de vista experimental y estadístico, para ello una serie de tareas, descritas a continuación, se han llevado a cabo : 1. Un dispositivo experimental de Sloshing ha sido configurado. Dicho dispositivo ha permitido ensayar secciones rectangulares de tanques LNGC a escala con movimientos angulares de un grado de libertad. El dispositivo experimental ha sido instrumentado para realizar mediciones de movimiento, presiones, vibraciones y temperatura, así como la grabación de imágenes y videos. 2. Los impactos de olas generadas dentro de una sección rectangular de un LNGC sujeto a movimientos regulares forzados han sido estudiados mediante la caracterización del fenómeno desde un punto de vista estadístico enfocado en la repetitividad y la ergodicidad del problema. 3. El estudio de los impactos provocados por movimientos regulares ha sido extendido a un escenario más realístico mediante el uso de movimientos irregulares forzados. 4. El acoplamiento del Sloshing generado por el fluido en movimiento dentro del tanque LNGC y la disipación de la energía mecánica de un sistema no forzado de un grado de libertad (movimiento angular) sujeto a una excitación externa ha sido investigado. 5. En la última sección de esta tesis doctoral, la interacción entre el Sloshing generado dentro en una sección rectangular de un tanque LNGC sujeto a una excitación regular y un cuerpo elástico solidario al tanque ha sido estudiado. Dicho estudio corresponde a un problema de interacción fluido-estructura. Abstract In hydrodynamics, we refer to sloshing as the motion of liquids in containers subjected to external forces with large free-surface deformations. The liquid motion dynamics can generate loads which may affect the structural integrity of the container and the stability of the vehicle that carries such container. The prediction of these dynamic loads is a major challenge for engineers around the world working on the design of both the container and the vehicle. The sloshing phenomenon has been extensively investigated mathematically, numerically and experimentally. The latter has been the most fruitful so far, due to the complexity of the problem, for which the numerical and mathematical models are still incapable of accurately predicting the sloshing loads. The sloshing flows are usually characterised by the presence of multiphase interaction and turbulence. Reducing as much as possible the complexity of the sloshing problem without losing its essence is the main challenge of this phd thesis, where experimental work on selected canonical cases are presented and documented in order to better understand the phenomenon and to serve, in some cases, as an useful information for numerical validations. Liquid sloshing plays a key roll in the liquified natural gas (LNG) maritime transportation. The LNG market growth is more than three times the rated growth of the oil and traditional gas markets. Engineers working in research laboratories and companies are continuously looking for efficient and safe ways for containing, transferring and transporting the liquified gas. LNG carrying vessels (LNGC) have evolved from a few 75000 m3 vessels thirty years ago to a huge fleet of ships with a capacity of 140000 m3 nowadays and increasing number of 175000 m3 and 250000 m3 units. The concept of FLNG (Floating Liquified Natural Gas) has appeared recently. A FLNG unit is a high value-added vessel which can solve the problems of production, treatment, liquefaction and storage of the LNG because the vessel is equipped with a extraction and liquefaction facility. The LNG is transferred from the FLNG to the LNGC in open sea. The combination of partial fillings and wave induced motions may generate sloshing flows inside both the LNGC and the FLNG tanks. This work has dealt with sloshing problems from a experimental and statistical point of view. A series of tasks have been carried out: 1. A sloshing rig has been set up. It allows for testing tanks with one degree of freedom angular motion. The rig has been instrumented to measure motions, pressure and conduct video and image recording. 2. Regular motion impacts inside a rectangular section LNGC tank model have been studied, with forced motion tests, in order to characterise the phenomenon from a statistical point of view by assessing the repeatability and practical ergodicity of the problem. 3. The regular motion analysis has been extended to an irregular motion framework in order to reproduce more realistic scenarios. 4. The coupled motion of a single degree of freedom angular motion system excited by an external moment and affected by the fluid moment and the mechanical energy dissipation induced by sloshing inside the tank has been investigated. 5. The last task of the thesis has been to conduct an experimental investigation focused on the strong interaction between a sloshing flow in a rectangular section of a LNGC tank subjected to regular excitation and an elastic body clamped to the tank. It is thus a fluid structure interaction problem.

Mendelism and the problem of mental defect.

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