Empirical research has given cause to fear that the demographic ageing in industrialized countries is likely to exert a negative impact on educational spending. Although this line of research shows ...in many cases a negative correlation between the proportions of the elderly and educational expenditures, a causal link is difficult to prove. To further analyse this topic, this paper uses a unique and representative survey of Swiss voters of all age groups. Results show that elderly people have a clear tendency to be less willing to spend money on education. They rather prefer to spend public resources on health and social security than on education. Furthermore the paper shows that although the elderly are more conservative and in general less inclined to pay for expenditures in the public sector as a whole, there is still an age effect on the willingness to pay for education after controlling for these factors.
Lung Cancer Screening in the Community Setting Cattaneo, Stephen M.; Meisenberg, Barry R.; Geronimo, Maria C.M. ...
The Annals of thoracic surgery,
June 2018, 2018-06-00, 20180601, Letnik:
105, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Lung cancer has high incidence and high mortality burden, particularly because it is typically diagnosed in later stages. The National Lung Screening Trial demonstrated a lung cancer–specific ...mortality benefit in high-risk current and former smokers with yearly low-dose chest computed tomography (CT). Lung cancer screening is thus recommended, but it is unclear whether the results of the National Lung Screening Trial can be replicated in community settings.
A retrospective review was performed of the lung screening program over its first 5 years, 2012 to 2016. Patients’ demographics, initial screening results, follow-up, and management results were analyzed in relation to the National Lung Screening Trial results. Annual adherence was defined as returning for imaging within 1 year + 90 days.
A total of 1,241 persons underwent initial screening over the 5-year period; 78.6% of findings were benign, and only annual repeat low-dose chest CT was recommended. A total of 29 cancers were identified in 26 participants (2%), of which 72% were stage I. The annual adherence rate to repeat imaging after a low-risk baseline scan was 37%, and the any follow-up rate was 51% despite programmatic efforts to follow screening recommendations. When positive findings required more intensive evaluation, most commonly by repeat chest CT scan, adherence was 88%. A total of 1.1% of all participants had invasive biopsies for benign results. Complications of biopsy were minimal.
This review demonstrates that a community-based program can approximate the results of the National Lung Screening Trial in detecting early lung cancers. Further study of the adherence phenomenon is essential.
About 5% of patients undergoing coronary stenting need to undergo surgery within the next year. The risk of perioperative cardiac ischemic events, particularly stent thrombosis (ST), is high in these ...patients, because surgery has a prothrombotic effect and antiplatelet therapy is often withdrawn in order to avoid bleeding. The clinical and angiographic predictors of ST are well known, and the proximity to an acute coronary syndrome adds to the risk. The current guidelines recommend delaying non‐urgent surgery for at least 6 weeks after the placement of a bare metal stent and for 6–12 months after the placement of a drug‐eluting stent, when the risk of ST is reduced. However, in the absence of formal evidence, these recommendations provide little support with regard to managing urgent operations. When surgery cannot be postponed, stratifying the risk of surgical bleeding and cardiac ischemic events is crucial in order to manage perioperative antiplatelet therapy in individual cases. Dual antiplatelet therapy should not be withdrawn for minor surgery or most gastrointestinal endoscopic procedures. Aspirin can be safely continued perioperatively in the case of most major surgery, and provides coronary protection. In the case of interventions at high risk for both bleeding and ischemic events, when clopidogrel withdrawal is required in order to reduce perioperative bleeding, perioperative treatment with the short‐acting intravenous glycoprotein IIb–IIIa inhibitor tirofiban is safe in terms of bleeding, and provides strong antithrombotic protection. Such surgical interventions should be performed at hospitals capable of performing an immediate percutaneous coronary intervention at any time in the case of acute myocardial ischemia.
Structured
Objectives
To assess whether morphology and dimension of the upper airway differ between patients characterized by various craniofacial morphology.
Setting and Sample Population
Ninety ...young adult patients from the Postgraduate Clinic, Section of Orthodontics, Department of Dentistry, Health, Aarhus University, Denmark, with no obvious signs of respiratory diseases and no previous adeno‐tonsillectomy procedures. Thirty patients were characterized as Class I (−0.5 < ANB < 4.5), 30 as Class II (ANB > 4.5), and 30 as Class III (ANB < −0.5).
Material and Methods
Cone‐beam computed tomography (CBCT) scans obtained in a supine position for all patients. Cephalometric landmarks were identified in 3D. Sagittal and transversal dimensions, cross sections, and partial and total volumes of the upper airway were correlated with the cephalometric measurements in all three planes of space. The cross‐sectional minimal area of the upper airway was assessed as well.
Results
No statistical significant relationships between dimension and morphology of upper airways and skeletal malocclusion were found.
Conclusion
Differences in craniofacial morphology as identified by the sagittal jaw relationship were not correlated with variation in upper airway volumes. A clinical significant relation was detected between minimal area and total upper airway volume.
The Oral Health Impact Profile-14 (OHIP-14) questionnaire assesses quality of life related to people's perception of oral disorders on their well-being. However, a translated and validated Danish ...version of OHIP-14 is not yet available. The purpose of this pilot study was to translate and cross-culturally adapt the English version of the OHIP-14 into Danish (OHIP-14-DK). In addition, to assess its content and face validity, internal consistency and test-retest reliability.
The English version of OHIP-14 was translated into Danish following a standard protocol of cross-cultural adaptation. Stages I-IV: translation phase to generate a pre-final version "OHIP-14-DK". Stage V: pre-testing phase. A random sample of 22 orthodontic patients (mean age 24.7 years, SD ±14.8; 14 females, 8 males) were selected at the Section of Orthodontics, Aarhus University, Denmark. All patients self-completed the OHIP-14-DK and were then interviewed to assess its content and face validity. Internal consistency was assessed with Cronbach's alpha coefficients. All patients completed the same questionnaire again at a one-week interval. Test-retest reliability was assessed using Spearman's correlation coefficient and intra-class correlation coefficient (ICC).
The initial and back translations were very similar: the OHIP-14-DK proved to have a good level of equivalence with no translation errors or deviations. Furthermore, the OHIP-14-DK seemed well-adapted to Danish culture and was understood by individuals down to 12 years of age. Pre-testing demonstrated good face and content validity; interviews had a response rate of 100% and confirmed that each item was understandable without inducing reluctance or hesitation. Thus, responses were related to their corresponding item. Therefore, no final adjustments were required for the pre-tested version. Cronbach's alpha for the OHIP-14-DK subscales fell in the 0.75-0.84 range, indicating an adequate-to-good internal consistency. Spearman's correlation coefficient for the OHIP-14-DK total score was 0.77. The ICC for the OHIP-14-DK total score was 0.91.
The OHIP-14-DK seems well adapted to Danish culture, proved to be face and content valid and also showed good internal consistency and excellent reliability. However, its psychometric properties still need to be tested.
Not applicable.
Cancer recurrence after surgery remains an unresolved clinical problem
. Myeloid cells derived from bone marrow contribute to the formation of the premetastatic microenvironment, which is required ...for disseminating tumour cells to engraft distant sites
. There are currently no effective interventions that prevent the formation of the premetastatic microenvironment
. Here we show that, after surgical removal of primary lung, breast and oesophageal cancers, low-dose adjuvant epigenetic therapy disrupts the premetastatic microenvironment and inhibits both the formation and growth of lung metastases through its selective effect on myeloid-derived suppressor cells (MDSCs). In mouse models of pulmonary metastases, MDSCs are key factors in the formation of the premetastatic microenvironment after resection of primary tumours. Adjuvant epigenetic therapy that uses low-dose DNA methyltransferase and histone deacetylase inhibitors, 5-azacytidine and entinostat, disrupts the premetastatic niche by inhibiting the trafficking of MDSCs through the downregulation of CCR2 and CXCR2, and by promoting MDSC differentiation into a more-interstitial macrophage-like phenotype. A decreased accumulation of MDSCs in the premetastatic lung produces longer periods of disease-free survival and increased overall survival, compared with chemotherapy. Our data demonstrate that, even after removal of the primary tumour, MDSCs contribute to the development of premetastatic niches and settlement of residual tumour cells. A combination of low-dose adjuvant epigenetic modifiers that disrupts this premetastatic microenvironment and inhibits metastases may permit an adjuvant approach to cancer therapy.
To evaluate
the differences of various Invisalign® attachments in their effectiveness during derotation of an upper second premolar in terms of forces and moments created and compare them to the ...3Shape® box attachment as well as to no attachment at all.
A Force System Identification (FSI) machine, comprising two load sensors, was used in this study. Sensor 1 was connected to the test tooth (i.e. upper second premolar) carrying a different attachment design, and the fixed sensor (Sensor 2) was connected to the base model. Once the corresponding aligner was passively seated on the teeth, 12 different setups (i.e. 11 different attachments and one setup with no attachment at all) were tested by rotating the test tooth 4.5° mesially and 4.5° distally, in increments of 0.45°.
The vertical rectangular attachments were able to generate the highest derotational moment on both mesial and distal rotations but also received the most side effects (intrusive force, torque, and tipping). The no-attachment setup performed least favorably in terms of derotational ability but exhibited the least side effects. In the
-axis, all attachments received a buccal root torque with a lingual force during disto-rotation and a lingual root torque with a buccal force during mesio-rotation.
Attachments are necessary for derotating an upper second premolar. An aligner incremental change of more than 1° derotation can generate high moments. The vertical rectangular attachments perform best in derotations; however, they exhibit the most side effects. Finally, despite presenting the least side effects, derotation of a premolar with no attachment is not as efficient.
Background: The aim of this study was to evaluate the accuracy and the repeatability of two reference systems for three-dimensional facial scans (FSs) compared with a reference system based on ...cone-beam computed tomography (CBCT). Subjects and methods: A total of sixty subjects, thirty growing participants (8–17 years old) and thirty non-growing participants (older than 21 years old), with FSs and full-field-of-view CBCT were included. Two different reference systems on the same FS were constructed. To assess validity, the two reference systems based on FSs were compared with the reference systems built using the CBCT scans. After two weeks, all of the FSs were reassessed to evaluate intra-operator repeatability. Reliability and repeatability were evaluated by means of parametric and non-parametric tests, intra-class correlation, the Dahlberg formula, and Bland–Altman plots (p < 0.05). Results: Both reference systems presented good reliability and showed a small difference with respect to the CBCT-based sagittal plane (Sagittal FS1 = 1.90 ± 0.98°; Sagittal FS2 = 1.80 ± 1.13°; p = 0.232). Between them, the two reference systems showed a small difference in the position of the sagittal plane (Sagittal FS1^Sagittal FS2 = 1.39 ± 1.13°). Conclusions: Both reference systems assessed in this study showed good intra-operator repeatability and their use may be suggested as reliable reference systems for FSs.
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