To revise the staging system for cutaneous melanoma on the basis of data from an expanded American Joint Committee on Cancer (AJCC) Melanoma Staging Database.
The melanoma staging recommendations ...were made on the basis of a multivariate analysis of 30,946 patients with stages I, II, and III melanoma and 7,972 patients with stage IV melanoma to revise and clarify TNM classifications and stage grouping criteria.
Findings and new definitions include the following: (1) in patients with localized melanoma, tumor thickness, mitotic rate (histologically defined as mitoses/mm(2)), and ulceration were the most dominant prognostic factors. (2) Mitotic rate replaces level of invasion as a primary criterion for defining T1b melanomas. (3) Among the 3,307 patients with regional metastases, components that defined the N category were the number of metastatic nodes, tumor burden, and ulceration of the primary melanoma. (4) For staging purposes, all patients with microscopic nodal metastases, regardless of extent of tumor burden, are classified as stage III. Micrometastases detected by immunohistochemistry are specifically included. (5) On the basis of a multivariate analysis of patients with distant metastases, the two dominant components in defining the M category continue to be the site of distant metastases (nonvisceral v lung v all other visceral metastatic sites) and an elevated serum lactate dehydrogenase level.
Using an evidence-based approach, revisions to the AJCC melanoma staging system have been made that reflect our improved understanding of this disease. These revisions will be formally incorporated into the seventh edition (2009) of the AJCC Cancer Staging Manual and implemented by early 2010.
Meat Consumption and Sustainability Parlasca, Martin C; Qaim, Matin
Annual review of resource economics,
10/2022, Letnik:
14, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Meat has become a controversial topic in public debates, as it involves multiple sustainability dimensions. Here, we review global meat consumption trends and the various sustainability dimensions ...involved, including economic, social, environmental, health, and animal welfare issues. Meat has much larger environmental and climate footprints than plant-based foods and can also be associated with negative health effects. Technological options can help to increase the sustainability of meat production, but changes in consumption are required as well. At least in high-income countries, where people consume a lot of meat on average, notable reductions will be important. However, vegetarian lifestyles for all would not necessarily be the best option. Especially in low-income countries, nutritious plant-based foods are not available or affordable year-round. Also, livestock production is an important source of income for many poor households. More research is needed on how to promote technological and behavioral changes while managing sustainability trade-offs.
Tackling the sustainability iceberg Meinlschmidt, Jan; Schleper, Martin C.; Foerstl, Kai
International journal of operations & production management,
10/2018, Letnik:
38, Številka:
10
Journal Article
Recenzirano
Purpose
The purpose of this paper is to investigate how buying firms manage their lower tier sustainability management (LTSM) in their supply networks and what contextual factors influence the choice ...of approaches. As most of the environmental and social burden is caused in lower tiers, the authors use the iceberg analogy.
Design/methodology/approach
Findings from 12 case studies and 53 interviews, publicly available and internal firm data are presented. In an abductive research approach, transaction cost economics (TCE) conceptually guides the analytical iteration processes between theory and data.
Findings
This study provides eight LTSM approaches grouped into three categories: direct (holistic, product-, region-, and event-specific) indirect (multiplier-, alliance- and compliance-based) and neglect (tier-1-based). Focal firms choose between these approaches depending on the strength of observed contextual factors (stakeholder salience, structural supply network complexity, product and industry salience, past supply network incidents, socio-economic and cultural distance and lower tier supplier dependency), leading to perceived sustainability risk (PSR).
Research limitations/implications
By depicting TCE’s theoretical boundaries in predicting LTSM governance modes, the theory is elevated to the supply network level of analysis. Future research should investigate LTSM at the purchasing category level of analysis to compare and contrast PSR profiles for different purchase tasks and to validate and extend the framework.
Practical implications
This study serves as a blueprint for the development of firms’ LTSM capabilities that suit their unique PSR profiles. It offers knowledge regarding what factors influence these profiles and presents a model that links the effectiveness of different LTSM approaches to resource intensity.
Originality/value
This study extends the application of TCE and adds empirically to the literature on multi-tier and sustainable supply chain management.
Hearing in Insects Göpfert, Martin C; Hennig, R. Matthias
Annual review of entomology,
03/2016, Letnik:
61, Številka:
1
Journal Article
Recenzirano
Insect hearing has independently evolved multiple times in the context of intraspecific communication and predator detection by transforming proprioceptive organs into ears. Research over the past ...decade, ranging from the biophysics of sound reception to molecular aspects of auditory transduction to the neuronal mechanisms of auditory signal processing, has greatly advanced our understanding of how insects hear. Apart from evolutionary innovations that seem unique to insect hearing, parallels between insect and vertebrate auditory systems have been uncovered, and the auditory sensory cells of insects and vertebrates turned out to be evolutionarily related. This review summarizes our current understanding of insect hearing. It also discusses recent advances in insect auditory research, which have put forward insect auditory systems for studying biological aspects that extend beyond hearing, such as cilium function, neuronal signal computation, and sensory system evolution.
The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research aimed to measure the ...cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years' follow-up.
A controlled interrupted time series study was conducted. Participants were registered with general practices in the Clinical Practice Research Datalink (CPRD) in England and received health checks between 1 April 2010 and 31 December 2013. Control participants, who did not receive a health check, were matched for age, sex, and general practice. Outcomes were blood pressure, body mass index (BMI), smoking, and total cholesterol (TC) and high-density lipoprotein cholesterol (HDL). Analyses estimated the net effect of health check by year, allowing for the underlying trend in risk factor values and baseline differences between cases and controls, adjusting for age, sex, deprivation, and clustering by general practice. There were 127,891 health check participants and 322,910 matched controls. Compared with controls, health check participants had lower BMI (cases mean 27.0, SD 4.8; controls 27.3, SD 5.6, Kg/m2), systolic blood pressure (SBP) (cases 129.0, SD 14.3; controls 129.3, SD 15.0, mm Hg), and smoking (21% in health check participants versus 27% in controls), but total and HDL cholesterol were similar. Health check participants were more likely to receive weight management advice (adjusted hazard ratio HR 5.03, 4.98 to 5.08, P < 0.001), smoking cessation interventions (HR 3.20, 3.13 to 3.27, P < 0.001), or statins (HR 1.24, 1.21 to 1.27, P < 0.001). There were net reductions in risk factor values up to six years after the check for BMI (-0.30, -0.39 to -0.20 Kg/m2, P < 0.001), SBP (-1.43, -1.70 to -1.16 mm Hg, P < 0.001), and smoking (17% in health check participants versus 25% in controls; odds ratio 0.90, 0.87 to 0.94, P < 0.001). The main study limitation was that residual confounding may be present because randomisation was not employed; health check-associated measurement introduced differential recording that might cause bias.
Our results suggest that people who take up a health check generally have lower risk factor values than controls and are more likely to receive risk factor interventions. Risk factor values show net reductions up to six years following a health check in BMI, blood pressure, and smoking, which may be of public health importance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To understand the dynamics behind the worldwide spread of the mcr-1 gene, we determined the population structure of Escherichia coli and of mobile genetic elements (MGEs) carrying the mcr-1 gene. ...After a systematic review of the literature we included 65 E. coli whole genome sequences (WGS), adding 6 recently sequenced travel related isolates, and 312 MLST profiles. We included 219 MGEs described in 7 Enterobacteriaceae species isolated from human, animal and environmental samples. Despite a high overall diversity, 2 lineages were observed in the E. coli population that may function as reservoirs of the mcr-1 gene, the largest of which was linked to ST10, a sequence type known for its ubiquity in human faecal samples and in food samples. No genotypic clustering by geographical origin or isolation source was observed. Amongst a total of 13 plasmid incompatibility types, the IncI2, IncX4 and IncHI2 plasmids accounted for more than 90% of MGEs carrying the mcr-1 gene. We observed significant geographical clustering with regional spread of IncHI2 plasmids in Europe and IncI2 in Asia. These findings point towards promiscuous spread of the mcr-1 gene by efficient horizontal gene transfer dominated by a limited number of plasmid incompatibility types.
Summary Background International travel contributes to the dissemination of antimicrobial resistance. We investigated the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae ...(ESBL-E) during international travel, with a focus on predictive factors for acquisition, duration of colonisation, and probability of onward transmission. Methods Within the prospective, multicentre COMBAT study, 2001 Dutch travellers and 215 non-travelling household members were enrolled. Faecal samples and questionnaires on demographics, illnesses, and behaviour were collected before travel and immediately and 1, 3, 6, and 12 months after return. Samples were screened for the presence of ESBL-E. In post-travel samples, ESBL genes were sequenced and PCR with specific primers for plasmid-encoded β-lactamase enzymes TEM, SHV, and CTX-M group 1, 2, 8, 9, and 25 was used to confirm the presence of ESBL genes in follow-up samples. Multivariable regression analyses and mathematical modelling were used to identify predictors for acquisition and sustained carriage, and to determine household transmission rates. This study is registered with ClinicalTrials.gov , number NCT01676974. Findings 633 (34·3%) of 1847 travellers who were ESBL negative before travel and had available samples after return had acquired ESBL-E during international travel (95% CI 32·1–36·5), with the highest number of acquisitions being among those who travelled to southern Asia in 136 of 181 (75·1%, 95% CI 68·4–80·9). Important predictors for acquisition of ESBL-E were antibiotic use during travel (adjusted odds ratio 2·69, 95% CI 1·79–4·05), traveller's diarrhoea that persisted after return (2·31, 1·42–3·76), and pre-existing chronic bowel disease (2·10, 1·13–3·90). The median duration of colonisation after travel was 30 days (95% CI 29–33). 65 (11·3%) of 577 remained colonised at 12 months. CTX-M enzyme group 9 ESBLs were associated with a significantly increased risk of sustained carriage (median duration 75 days, 95% CI 48–102, p=0·0001). Onward transmission was found in 13 (7·7%) of 168 household members. The probability of transmitting ESBL-E to another household member was 12% (95% CI 5–18). Interpretation Acquisition and spread of ESBL-E during and after international travel was substantial and worrisome. Travellers to areas with a high risk of ESBL-E acquisition should be viewed as potential carriers of ESBL-E for up to 12 months after return. Funding Netherlands Organisation for Health Research and Development (ZonMw).
Supplying adequate human nutrition within ecosystem carrying capacities is a key element in the global environmental sustainability challenge. Life cycle assessment (LCA) has been used effectively to ...evaluate the environmental impacts of food production value chains and to identify opportunities for targeted improvement strategies. Dietary choices and resulting consumption patterns are the drivers of production, however, and a consumption-oriented life cycle perspective is useful in understanding the environmental implications of diet choices. This review identifies 32 studies that use an LCA framework to evaluate the environmental impact of diets or meals. It highlights the state of the art, emerging methodological trends and current challenges and limitations to such diet-level LCA studies. A wide range of bases for analysis and comparison (i.e., functional units) have been employed in LCAs of foods and diet; we conceptually map appropriate functional unit choices to research aims and scope and argue for a need to move in the direction of a more sophisticated and comprehensive nutritional basis in order to link nutritional health and environmental objectives. Nutritional quality indices are reviewed as potential approaches, but refinement through ongoing collaborative research between environmental and nutritional sciences is necessary. Additional research needs include development of regionally specific life cycle inventory databases for food and agriculture and expansion of the scope of assessments beyond the current focus on greenhouse gas emissions.
Ponatinib has potent activity against native and mutant BCR-ABL1, including BCR-ABL1T315I. The pivotal phase 2 Ponatinib Ph+ ALL and CML Evaluation (PACE) trial evaluated efficacy and safety of ...ponatinib at a starting dose of 45 mg once daily in 449 patients with chronic myeloid leukemia (CML) or Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) resistant/intolerant to dasatinib or nilotinib, or with BCR-ABL1T315I. This analysis focuses on chronic-phase CML (CP-CML) patients (n = 270) with 56.8-month median follow-up. Among 267 evaluable patients, 60%, 40%, and 24% achieved major cytogenetic response (MCyR), major molecular response (MMR), and 4.5-log molecular response, respectively. The probability of maintaining MCyR for 5 years was 82% among responders. Dose reductions were implemented in October 2013 to decrease the risk of arterial occlusive events (AOEs); ≥90% of CP-CML patients who had achieved MCyR or MMR maintained response 40 months after elective dose reductions. Estimated 5-year overall survival was 73%. In CP-CML patients, the most common treatment-emergent adverse events were rash (47%), abdominal pain (46%), thrombocytopenia (46%), headache (43%), dry skin (42%), and constipation (41%). The cumulative incidence of AOEs in CP-CML patients increased over time to 31%, while the exposure-adjusted incidence of new AOEs (15.8 and 4.9 per 100 patient-years in years 1 and 5, respectively) did not increase over time. These final PACE results demonstrate ponatinib provides durable and clinically meaningful responses, irrespective of dose reductions, in this population of heavily pretreated CP-CML patients. This trial was registered at www.clinicaltrials.gov as #NCT01207440.
•Ponatinib continued to provide deep, durable responses in heavily pretreated patients with CP-CML.•Tolerability was acceptable in this heavily pretreated population with 5 years of follow-up.
Display omitted
PDF
