Flooding and heavy rainfall have been associated with waterborne infectious disease outbreaks, however, it is unclear to which extent they pose a risk for public health. Here, risks of infection from ...exposure to urban floodwater were assessed using quantitative microbial risk assessment (QMRA). To that aim, urban floodwaters were sampled in the Netherlands during 23 events in 2011 and 2012. The water contained Campylobacter jejuni (prevalence 61%, range 14- >103 MPN/l), Giardia spp. (35%, 0.1–142 cysts/l), Cryptosporidium (30%, 0.1–9.8 oocysts/l), noroviruses (29%, 102–104 pdu/l) and enteroviruses (35%, 103–104 pdu/l). Exposure data collected by questionnaire, revealed that children swallowed 1.7 ml (mean, 95% Confidence Interval 0–4.6 ml) per exposure event and adults swallowed 0.016 ml (mean, 95% CI 0–0.068 ml) due to hand-mouth contact. The mean risk of infection per event for children, who were exposed to floodwater originating from combined sewers, storm sewers and rainfall generated surface runoff was 33%, 23% and 3.5%, respectively, and for adults it was 3.9%, 0.58% and 0.039%. The annual risk of infection was calculated to compare flooding from different urban drainage systems. An exposure frequency of once every 10 years to flooding originating from combined sewers resulted in an annual risk of infection of 8%, which was equal to the risk of infection of flooding originating from rainfall generated surface runoff 2.3 times per year. However, these annual infection risks will increase with a higher frequency of urban flooding due to heavy rainfall as foreseen in climate change projections.
•Urban flooding was measured for enteric pathogens to assess risks for public health.•Health risks were quantified for flooding of different urban drainage systems.•The annual risk of infection for flooding originating from combined sewers was 8%.
Food insecurity is a growing concern due to man-made conflicts, climate change, and economic downturns. Forecasting the state of food insecurity is essential to be able to trigger early actions, for ...example, by humanitarian actors. To measure the actual state of food insecurity, expert and consensus-based approaches and surveys are currently used. Both require substantial manpower, time, and budget. This paper introduces an extreme gradient-boosting machine learning model to forecast monthly transitions in the state of food security in Ethiopia, at a spatial granularity of livelihood zones, and for lead times of one to 12 months, using open-source data. The transition in the state of food security, hereafter referred to as predictand, is represented by the Integrated Food Security Phase Classification Data. From 19 categories of datasets, 130 variables were derived and used as predictors of the transition in the state of food security. The predictors represent changes in climate and land, market, conflict, infrastructure, demographics and livelihood zone characteristics. The most relevant predictors are found to be food security history and surface soil moisture. Overall, the model performs best for forecasting Deteriorations and Improvements in the state of food security compared to the baselines. The proposed method performs (F1 macro score) at least twice as well as the best baseline (a dummy classifier) for a Deterioration. The model performs better when forecasting long-term (7 months; F1 macro average = 0.61) compared to short-term (3 months; F1 macro average = 0.51). Combining machine learning, Integrated Phase Classification (IPC) ratings from monitoring systems, and open data can add value to existing consensus-based forecasting approaches as this combination provides longer lead times and more regular updates. Our approach can also be transferred to other countries as most of the data on the predictors are openly available from global data repositories.
Display omitted
•Forecasting food insecurity is essential to be able to trigger early actions for example, by humanitarian actors.•Forecast monthly transitions in food security in Ethiopia using supervised machine learning and open data.•The transferrable model performs better when forecasting long term (7 months) compared to short time (3 months).•Combining machine learning and open data can add value to existing consensus-based forecasting approaches.
Background
Socioeconomic status (SES) has been associated with early mortality in cancer patients. However, the association between SES and outcome in colorectal cancer patients is largely unknown. ...The aim of this study was to investigate whether SES is associated with short- and long-term outcome in patients undergoing curative surgery for colorectal cancer.
Methods
Patients who underwent curative surgery in the region of Rotterdam for stage I–III colorectal cancer between January 2007 and July 2014 were included. Gross household income and survival status were obtained from a national registry provided by Statistics Netherlands Centraal Bureau voor de Statistiek. Patients were assigned percentiles according to the national income distribution. Logistic regression and Cox proportional hazard regression were performed to assess the association of SES with 30-day postoperative complications, overall survival and cancer-specific survival, adjusted for known prognosticators.
Results
For 965 of the 975 eligible patients (99%), gross household income could be retrieved. Patients with a lower SES more often had diabetes, more often underwent an open surgical procedure, and had more comorbidities. In addition, patients with a lower SES were less likely to receive (neo) adjuvant treatment. Lower SES was independently associated with an increased risk of postoperative complications (Odds ratio per percent increase 0.99, 95%CI 0.99–0.998,
p
= 0.004) and lower cancer-specific mortality (Hazard ratio per percent increase 0.99, 95%CI 0.98–0.99,
p
= 0.009).
Conclusion
This study shows that lower SES is associated with increased risk of postoperative complications, and poor cancer-specific survival in patients undergoing surgery for stage I–III colorectal cancer after correcting for known prognosticators.
Achilles tendon disorders, like Achilles tendinopathy, are very common among athletes. In the general population, however, knowledge about the incidence of Achilles tendinopathy is lacking. Design ...Cross-sectional study.
In a cohort of 57.725 persons registered in primary care, the number of patients visiting the general practitioner (GP) with diagnosis of mid-portion Achilles tendon problems was counted using computerised registration networks of GPs in 2009. Subsequently, the authors assessed associations of these rates with demographic characteristics.
The incidence rate of Achilles tendinopathy is 1.85 per 1,000 Dutch GP registered patients. In the adult population (21-60 years), the incidence rate is 2.35 per 1,000. In 35% of the cases, a relationship with sports activity was recorded.
This is the first report on incidence rates of mid-portion Achilles tendinopathy in general practice. With an incidence of 1.85 per 1,000 registered persons, Achilles tendinopathy is frequently seen by GPs. The actual incidence might even be higher due to study limitations. More research on the frequency of this injury is required.
This article introduces the Causal Attitude Network (CAN) model, which conceptualizes attitudes as networks consisting of evaluative reactions and interactions between these reactions. Relevant ...evaluative reactions include beliefs, feelings, and behaviors toward the attitude object. Interactions between these reactions arise through direct causal influences (e.g., the belief that snakes are dangerous causes fear of snakes) and mechanisms that support evaluative consistency between related contents of evaluative reactions (e.g., people tend to align their belief that snakes are useful with their belief that snakes help maintain ecological balance). In the CAN model, the structure of attitude networks conforms to a small-world structure: evaluative reactions that are similar to each other form tight clusters, which are connected by a sparser set of "shortcuts" between them. We argue that the CAN model provides a realistic formalized measurement model of attitudes and therefore fills a crucial gap in the attitude literature. Furthermore, the CAN model provides testable predictions for the structure of attitudes and how they develop, remain stable, and change over time. Attitude strength is conceptualized in terms of the connectivity of attitude networks and we show that this provides a parsimonious account of the differences between strong and weak attitudes. We discuss the CAN model in relation to possible extensions, implication for the assessment of attitudes, and possibilities for further study.
A regional atmospheric climate model with multi-layer snow module (RACMO2) is forced at the lateral boundaries by global climate model (GCM) data to assess the future climate and surface mass balance ...(SMB) of the Antarctic ice sheet (AIS). Two different GCMs (ECHAM5 until 2100 and HadCM3 until 2200) and two different emission scenarios (A1B and E1) are used as forcing to capture a realistic range in future climate states. Simulated ice sheet averaged 2 m air temperature (T
2m
) increases (1.8–3.0 K in 2100 and 2.4–5.3 K in 2200), simultaneously and with the same magnitude as GCM simulated T
2m
. The SMB and its components increase in magnitude, as they are directly influenced by the temperature increase. Changes in atmospheric circulation around Antarctica play a minor role in future SMB changes. During the next two centuries, the projected increase in liquid water flux from rainfall and snowmelt, together 60–200 Gt year
−1
, will mostly refreeze in the snow pack, so runoff remains small (10–40 Gt year
−1
). Sublimation increases by 25–50 %, but remains an order of magnitude smaller than snowfall. The increase in snowfall mainly determines future changes in SMB on the AIS: 6–16 % in 2100 and 8–25 % in 2200. Without any ice dynamical response, this would result in an eustatic sea level drop of 20–43 mm in 2100 and 73–163 mm in 2200, compared to the twentieth century. Averaged over the AIS, a strong relation between
SMB and
of 98 ± 5 Gt w.e. year
−1
K
−1
is found.
To evaluate whether abdominal–pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes.
Nested cohort study.
...Not applicable.
Childhood cancer survivors previously exposed to abdominal–pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer.
Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non–RT-exposed CCSs; n = 110) and general population controls (n = 110).
Uterine volume, pregnancy complications, and pregnancy outcomes.
Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6–52.8) mL for RT-exposed CCSs, 48.1 (35.7–61.8) mL for non–RT-exposed CCSs, and 61.3 (49.1–75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio OR 5.31 95% confidence interval 1.98–14.23). Surprisingly, the same was true for non–RT-exposed CCSs (OR 2.61 1.16–5.91). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 2.55–63.40, OR 9.74 1.49–63.60, and OR 15.66 1.43–171.35, respectively). Compared with non–RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 1.08–43.75).
Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
Función uterina,complicaciones del embarazo y resultados del embarazo en mujeres supervivientes de cáncer infantil
Evaluar si la radioterapia abdominal-pélvica para el cáncer infantil afecta la función uterina y aumenta el riesgo de resultados adversos y complicaciones del embarazo.
Estudio de cohorte anidado.
Este es un subestudio del estudio DCOG LATER-VEVO, un estudio retrospectivo de cohorte a nivel nacional que evalúa la fertilidad en mujeres supervivientes de cáncer infantil (SCI) en los Países Bajos. Los datos se recogieron mediante cuestionario, toma de muestras de sangre y ecografía transvaginal.
Supervivientes de cáncer infantil previamente expuestas a radioterapia abdominal-pélvica (SCI expuestas a RT) como parte de su tratamiento para el cáncer infantil.
Las SCI expuestas a radioterapia (n = 55) se ajustaron por edad y paridad a las SCI no irradiadas (SCI no expuestas a RT; n =110) y a los controles de la población general (n = 110).
volumen uterino, complicaciones del embarazo y resultados del embarazo.
Entre las participantes nuligrávidas, el volumen uterino mediano (rango intercuartil) fue de 41.4 (18.6–52.8) mL para SCI expuestas a RT, 48.1 (35.7–61.8) mL para SCI no expuestas a RT, y 61.3 (49.1– 75.5) mL para controles de población general. Las SCI expuestas a radioterapia tenían un mayor riesgo de un volumen uterino reducido (<44.3 ml) en comparación con los controles de población (odds ratio OR 5,31 intervalo de confianza del 95%: 1,98 a 14,23). Sorprendentemente, lo mismo sucedió con las SCI no expuestas a RT (OR 2.61 1.16–5.91).
Entre las participantes grávidas, las SCI expuestas a la RT tuvieron un mayor riesgo de complicaciones del embarazo, parto prematuro y un bebé con bajo peso al nacer en comparación con los controles de la población (OR 12.70 2.55–63.40, O 9.74 1.49–63.60 y OR 15.66 1.43 –171.35, respectivamente). En comparación con las SCI no expuestas a la RT, las SCI expuestas a la RT tenían un mayor riesgo de tener un bebé con bajo peso al nacer (OR 6.86 1.08-43.75).
La exposición uterina a la radioterapia durante la infancia reduce el volumen uterino en adultos y aumenta el riesgo de complicaciones del embarazo y resultados adversos del embarazo. El asesoramiento preconcepcional y el control obstétrico adecuado está justificado.
Purpose
To evaluate the impact of treatment for Hodgkin lymphoma (HL) on clinical reproductive markers and pregnancy outcomes.
Methods
This study was embedded within the DCOG LATER-VEVO study; a ...Dutch, multicenter, retrospective cohort study between 2004 and 2014. Serum anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, antral follicle count (AFC), and self-reported (first) pregnancy outcomes were evaluated in female childhood HL survivors and controls.
Results
84 HL survivors and 798 controls were included, aged 29.6 and 32.7 years old at time of assessment. Median age at HL diagnosis was 13.4 years. Cyclophosphamide equivalent dose (CED-score) exceeded 6000 mg/m
2
in 56 women and 14 survivors received pelvic irradiation.
All clinical markers were significantly deteriorated in survivors (odds-ratio for low AMH (< p10) 10.1 95% CI 4.9; 20.6; low AFC (< p10) 4.6 95% CI 2.1; 9.9; elevated FSH (> 10 IU/l) 15.3 95% CI 5.7; 41.1, low Inhibin B (< 20 ng/l) 3.6 95% CI 1.7; 7.7, p < 0.001). Pregnancy outcomes were comparable between survivors and controls (± 80% live birth, ± 20% miscarriage). However, survivors were significantly younger at first pregnancy (27.0 years vs 29.0 years, P = 0.04). Adjusted odds-ratio for time to pregnancy > 12 months was 2.5 95% CI 1.1; 5.6 in survivors, p = 0.031. Adverse outcomes were specifically present after treatment with procarbazine and higher CED-score.
Conclusion
HL survivors appear to have an impaired ovarian reserve. However, chance to achieve pregnancy seems reassuring at a young age. Additional follow-up studies are needed to assess fertile life span and reproductive potential of HL survivors, in particular for current HL treatments that are hypothesized to be less gonadotoxic.
Straylight Effects with Aging and Lens Extraction Van Den Berg, Thomas J.T.P; Van Rijn, L.J. (René); Michael, Ralph ...
American journal of ophthalmology,
09/2007, Letnik:
144, Številka:
3
Journal Article
Recenzirano
Purpose To assess possible gains and losses in straylight values among the population to consider straylight as added benefit of lens extraction. Design In this cross-sectional design, data from a ...multicenter study on visual function in automobile drivers were analyzed. Methods On both eyes of 2,422 subjects, visual acuity (logarithm of the minimum angle of resolution logMAR in steps of 0.02 log units), straylight on the retina (psychophysical compensation comparison method), and lens opacity (slit-lamp scoring using the Lens Opacities Classification System III LOCS III system) were determined. Three groups were defined: 220 pseudophakic eyes, 3,182 noncataractous eyes (average LOCS III score, <1.5), and 134 cataractous eyes (average LOCS III score, >3.0). Results Noncataractous straylight values increases strongly with age as: log( s ) = constant + log(1 + ( age / 65)4 ), doubling by the age of 65 years, and tripling by the age of 77 years. Population standard deviation around this age norm was approximately 0.10 log units. The cataract eyes (in this active driver group) had relatively mild straylight increase. In pseudophakia, straylight values may be very good, better even than in the noncataract group. Visual acuity and straylight were found to vary quite independently. Conclusions Lens extraction holds promise not only to improve on the condition of the cataract eye, but also to improve on the age-normal eye. Lens extraction potentially reverses the strong age increase in straylight value, quite independently from visual acuity.
This study evaluates the impact of a recent upgrade in the physics package of the regional atmospheric climate model RACMO2 on the simulated surface mass balance (SMB) of the Antarctic ice sheet. The ...modelled SMB increases, in particular over the grounded ice sheet of East Antarctica (+44 Gt a–1), with a small change in West Antarctica. This mainly results from an increase in precipitation, which is explained by changes in the cloud microphysics, including a new parameterization for ice cloud supersaturation, and changes in large-scale circulation patterns, which alter topographically forced precipitation. The spatial changes in SMB are evaluated using 3234 in situ SMB observations and ice-balance velocities, and the temporal variability using GRACE satellite retrievals. The in situ observations and balance velocities show a clear improvement of the spatial representation of the SMB in the interior of East Antarctica, which has become considerably wetter. No improvements are seen for West Antarctica and the coastal regions. A comparison of model SMB temporal variability with GRACE satellite retrievals shows no significant change in performance.
PDF
