What causes childhood leukaemia? Some beliefs of parents of affected children

The theories of parents about the cause of their children's leukaemia have been documented in the course of a case-control study. From a sample of 175 children who were diagnosed as having acute lymphoblastic leukaemia, 91.4% of their parents put forward their theories. Some of these theories were related clearly to material that had been published and therefore had some scientific validity. Other theories often had no apparent scientific basis. Persons who are involved in the care of children with leukaemia should be aware of the wide variety of theories that are held by their parents so that they may provide counselling which could be of help in the relief of feelings of anxiety or guilt among the parents. Parents should always be afforded the opportunity to put forward their own theories so that they may be discussed on a rational basis. It is conceivable that some parents might put forward new hypotheses about leukaemogenesis that could be tested scientifically.

Infectious complications during therapy of acute leukaemia in Saudi Arabia

In 40 febrile neutropenic episodes during the induction and consolidation chemotherapy of acute leukaemia in Riyadh, 51% of organisms causing septicaemia were gram-negative, 26% gram-positive, 8% anaerobes and 15% fungi. In 21 (52%) febrile episodes there were pulmonary infiltrates; of the 12 where aetiology was known, six were due to fungi. Pulmonary infiltrates progressed to adult respiratory distress syndrome and death in nine instances. There was no significant occurrence of parasitic and tropical infections. The results show that the pattern of infections, during therapy of acute leukaemia in developing countries, may have important differences when compared with western centres. Empiric amphotericin B may need to be introduced at an earlier stage in patients with persistent fever or progressive pulmonary infiltrates.

Dasatinib, nilotinib and standard-dose imatinib for the first line treatment of chronic myeloid leukaemia: Systematic reviews and economic analyses

- Background Nilotinib and dasatinib are now being considered as alternative treatments to imatinib as a first-line treatment of chronic myeloid leukaemia (CML). - Objective This technology assessment reviews the available evidence for the clinical effectiveness and cost-effectiveness of dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of Philadelphia chromosome-positive CML. - Data sources Databases [including MEDLINE (Ovid), EMBASE, Current Controlled Trials, ClinicalTrials.gov, the US Food and Drug Administration website and the European Medicines Agency website] were searched from search end date of the last technology appraisal report on this topic in October 2002 to September 2011. - Review methods A systematic review of clinical effectiveness and cost-effectiveness studies; a review of surrogate relationships with survival; a review and critique of manufacturer submissions; and a model-based economic analysis. - Results Two clinical trials (dasatinib vs imatinib and nilotinib vs imatinib) were included in the effectiveness review. Survival was not significantly different for dasatinib or nilotinib compared with imatinib with the 24-month follow-up data available. The rates of complete cytogenetic response (CCyR) and major molecular response (MMR) were higher for patients receiving dasatinib than for those with imatinib for 12 months' follow-up (CCyR 83% vs 72%, p < 0.001; MMR 46% vs 28%, p < 0.0001). The rates of CCyR and MMR were higher for patients receiving nilotinib than for those receiving imatinib for 12 months' follow-up (CCyR 80% vs 65%, p < 0.001; MMR 44% vs 22%, p < 0.0001). An indirect comparison analysis showed no difference between dasatinib and nilotinib for CCyR or MMR rates for 12 months' follow-up (CCyR, odds ratio 1.09, 95% CI 0.61 to 1.92; MMR, odds ratio 1.28, 95% CI 0.77 to 2.16). There is observational association evidence from imatinib studies supporting the use of CCyR and MMR at 12 months as surrogates for overall all-cause survival and progression-free survival in patients with CML in chronic phase. In the cost-effectiveness modelling scenario, analyses were provided to reflect the extensive structural uncertainty and different approaches to estimating OS. First-line dasatinib is predicted to provide very poor value for money compared with first-line imatinib, with deterministic incremental cost-effectiveness ratios (ICERs) of between £256,000 and £450,000 per quality-adjusted life-year (QALY). Conversely, first-line nilotinib provided favourable ICERs at the willingness-to-pay threshold of £20,000-30,000 per QALY. - Limitations Immaturity of empirical trial data relative to life expectancy, forcing either reliance on surrogate relationships or cumulative survival/treatment duration assumptions. - Conclusions From the two trials available, dasatinib and nilotinib have a statistically significant advantage compared with imatinib as measured by MMR or CCyR. Taking into account the treatment pathways for patients with CML, i.e. assuming the use of second-line nilotinib, first-line nilotinib appears to be more cost-effective than first-line imatinib. Dasatinib was not cost-effective if decision thresholds of £20,000 per QALY or £30,000 per QALY were used, compared with imatinib and nilotinib. Uncertainty in the cost-effectiveness analysis would be substantially reduced with better and more UK-specific data on the incidence and cost of stem cell transplantation in patients with chronic CML. - Funding The Health Technology Assessment Programme of the National Institute for Health Research.

Broughton Archipelago Clam Terrace Survey : final report

During a 1995 aerial video survey of the coastline of Johnstone Strait, an unusual shoreline feature was noted and termed “clam terraces” (inset) because of the terrace-type morphology and the apparent association with high clam productivity on the sandflats. Typical alongshore lengths of the terrace ridges are 20-50m, and across-shore widths are typically 20-40m. An area with an especially high density of clam terraces was noted in the Broughton Archipelago, between Broughton and Gilford Islands of southeastern Queen Charlotte Strait. Clam terraces in this area were inventoried from the aerial video imagery to quantify their distribution. The terraces accounted for over 14 km of shoreline and 365 clam terraces were documented. A three-day field survey by a coastal geomorphologist, archeologist and marine biologist was conducted to document the features and determine their origin. Nine clam terraces were surveyed. The field observations confirmed that: the ridges are comprised of boulder/cobblesized material, ridge crests are typically in the range of 1-1.5m above chart datum, sandflats are comprised almost entirely of shell fragments (barnacles and clams) and sandflats have very high shellfish production. There are an abundance of shell middens in the area (over 175) suggesting that the shellfish associated with the terraces were an important food source of aboriginal peoples. The origin of the ridges is unknown; they appear to be a relict feature in that they are not actively being modified by present-day processes. The ridges may be a relict sea-ice feature, although the mechanics of ridge formation is uncertain. Sand accumulates behind the ridge because the supply rate of the shell fragments exceeds the dispersal rate in these low energy environments. The high density areas of clam terraces correspond to high density areas of shell middens, and it is probable that the clam terraces were subjected to some degree of modification by aboriginal shellfish gatherers over the thousands of years of occupation in the region. (Document contains 39 pages)

Enhancing Seed Availability For the Hard Clam (Mercenaria mercenaria) Aquaculture Industry By Applying Remote Setting Techniques

The goal of this study was to test a technology that may help ensure a reliable and consistent supply of high quality and inexpensive clam seed to growers, thus fostering an emerging aquaculture industry by eliminating a seed shortage that limits sustainability. The overall objectives were to develop, test and demonstrate technical procedures and determine the financial feasibility of transferring remote setting technology from the Pacific Northwest molluscan shellfish industry to the hard clam aquaculture industry in Florida. (PDF has 44 pages.)

Organizational Structures and Strategies For the Hard Clam Aquaculture Industry in Florida

This study provides guidance on statewide organization for the commercial hard clam culture industry in Florida. The study characterizes the structure of and identifies strategies for successful agricultural and aquacultural organizations designed to provide the resources needed to solve current and projected industry problems. Objectives were to 1) characterize the structure of successful and relevant organizations, 2) identify successful revenue generating strategies, 3) provide the hard clam culture industry with options to help facilitate their organizational decisions, and 4) assist clam growers in Florida in developing an umbrella organizational strategy that will meet their future industry needs. (PDF has 60 pages.)

Effects of the Maryland hydraulic clam dredge on populations of the soft-shell clam, Mya arenaria: final contract report

Final report on a three year study designed to investigate the effects of the Maryland hydraulic escalator clam dredge on populations and recruitment of the soft-shell clam, Mya arenaria. Experimental plots were established in the Potomac river, Maryland, and were dredged ina commerical manner by removing only legal size clams. quarterly samples were taken in the experimental and control plots by means of a van Veen grab for juvenile clams and the hydraulic dredge for older, deeper burrowing clams. Sediment samples were taken at selected periods for organic carbon and grain size analysis. Clams were separated into two size-groups. (PDF contains 38 pages)