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Setting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals’ lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals.
Proton beam therapy (PBT) offers compelling advantages in physical dose distribution compared to photon therapy. There are increasing numbers of gantry-based proton facilities worldwide but no such facilities exist in Canada. To access PBT, Canadian patients must travel abroad for treatment at high cost. In the face of limited access, this report seeks to provide recommendations for the selection of patients most likely to benefit from PBT and suggests an out-of-country referral process. METHODS: A systematic literature search for studies between January 1990 and May 2014 evaluating clinical outcomes after PBT. A draft report was developed through review of evidence, externally reviewed, and approved by the Alberta Health Services Cancer Care Proton Therapy Guidelines steering committee. RESULTS: Proton therapy is often used to treat tumours close to radiosensitive tissues, and children at risk of developing significant late effects of radiation therapy (RT). Local control rates with PBT appear similar to or, in some cases, higher than photon RT in uncontrolled and retrospective studies. Randomized trials comparing equivalent doses of PBT and photon RT are not available. SUMMARY: Referral for PBT is recommended for patients being treated with curative intent, with an expectation for long-term survival, and who are able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents occurring in patients with greatest risk of long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head and neck, breast, lung, gastrointestinal tract, and pelvic cancers including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.
Observations show that glaciers around the world are in retreat and losing mass. Internationally coordinated for over a century, glacier monitoring activities provide an unprecedented dataset of glacier observations from ground, air and space. Glacier studies generally select specific parts of these datasets to obtain optimal assessments of the mass-balance data relating to the impact that glaciers exercise on global sea-level fluctuations or on regional runoff. In this study we provide an overview and analysis of the main observational datasets compiled by the World Glacier Monitoring Service (WGMS). The dataset on glacier front variations (∼42 000 since 1600) delivers clear evidence that centennial glacier retreat is a global phenomenon. Intermittent readvance periods at regional and decadal scale are normally restricted to a subsample of glaciers and have not come close to achieving the maximum positions of the Little Ice Age (or Holocene). Glaciological and geodetic observations (∼5200 since 1850) show that the rates of early 21st-century mass loss are without precedent on a global scale, at least for the time period observed and probably also for recorded history, as indicated also in reconstructions from written and illustrated documents. This strong imbalance implies that glaciers in many regions will very likely suffer further ice loss, even if climate remains stable.
Dietary interventions with flavan-3-ols have shown beneficial effects on vascular function. The translation of these findings into the context of the health of the general public requires detailed information on habitual dietary intake. However, only limited data are currently available for European populations. Therefore, in the present study, we assessed the habitual intake of flavan-3-ol monomers, proanthocyanidins (PA) and theaflavins in the European Union (EU) and determined their main food sources using the EFSA (European Food Safety Authority) Comprehensive European Food Consumption Database. Data for adults aged 18–64 years were available from fourteen European countries, and intake was determined using the FLAVIOLA Flavanol Food Composition Database, developed for the present study and based on the latest US Department of Agriculture and Phenol-Explorer databases. The mean habitual intake of flavan-3-ol monomers, theaflavins and PA ranged from 181 mg/d (Czech Republic) to 793 mg/d (Ireland). The highest intakes of flavan-3-ol monomers and theaflavins were observed in Ireland (191/505 mg/d) and the lowest intakes in Spain (24/9 mg/d). In contrast, the daily intake of PA was highest in Spain (175 mg/d) and lowest in The Netherlands (96 mg/d). Main sources were tea (62 %), pome fruits (11 %), berries (3 %) and cocoa products (3 %). Tea was the major single contributor to monomer intake (75 %), followed by pome fruits (6 %). Pome fruits were also the main source of PA (28 %). The present study provides important data on the population-based intake of flavanols in the EU and demonstrates that dietary intake amounts for flavan-3-ol monomers, PA and theaflavins vary significantly across European countries. The average habitual intake of flavan-3-ols is considerably below the amounts used in most dietary intervention studies.
A conspicuous silicified microfossil, Frankbaronia polyspora n. gen. n. sp., occurs in plant litter and as an inhabitant of microbial mats from the Lower Devonian Rhynie chert, Aberdeenshire, Scotland. Specimens are elongate-cylindrical, oval, or spherical, thin-walled, and may possess conical or column-like surface projections. Most specimens occur isolated, some are arranged in pairs or short chains. Each specimen contains several small spheres, each in turn with a (sub)centric opaque inclusion. Immature specimens indicate that ontogenesis in this fossil includes the formation of a single centric body of opaque material that subsequently is apportioned among the developing small spheres. Frankbaronia polyspora is quite similar in size and morphology to the oogonia containing oospores seen in certain extant members of the Peronosporomycetes. The Rhynie chert is known to contain the oldest fossil evidence of the Peronosporomycetes but only a single form (Hassiella monospora) has previously been documented. The discovery of a second putative representative of this group of organisms proves that this paleoecosystem is still an important source of new information on the paleodiversity of microbial life.
Japanese knotweed, Sakhalin knotweed, and their hybrid, Bohemian knotweed, are invasive across much of the United States. Monocultures formed by these species threaten natural riparian areas, and effective methods of control are being sought. Injection of herbicide is a relatively new control technique with no known published results. Bohemian knotweed was injected with four treatment dosages: 1 ml (0.03 oz) (0.48 g ae) (0.017 oz ae), 3 ml (0.10 oz) (1.44 g ae) (0.05 oz ae), or 5 ml (0.17 oz) (2.4 g ae) (0.08 oz ae) of undiluted glyphosate (suggested application), and 5 ml (0.17 oz) of a glyphosate : water mix (1 : 1, by vol) (1.2 g ae) (0.04 oz ae). Injections were tested at two heights on the plants: low node, 0.2 m (0.66 ft) (L) or chest height node, 1.0 to 1.3 m (3.3 to 4.3 ft) (M). After 1 mo, average percent injury was greater than 90%, and analysis showed no effect of injection location on the stem and no difference between the suggested 5-ml (0.17 oz) glyphosate application and 3-ml (0.10 oz) application. Nine months after treatment there was a reduction in knotweed height and density, though vigorous regrowth was evident within plots. Although the injection method results in the short-term dieback of injected stems, drawbacks to its use in certain scenarios should be considered when developing an integrated management plan for knotweed control.
Scrapie is an ovine sub-acute transmissible spongiform encephalopathy (TSE) caused by unconventional transmissible agents. In several species, TSE are associated to major endocrinopathy, such as hyperinsulinemia and hypercorticism (Carp et al, 1990, Gayrard et al, 2000). Cachexia is commonly observed in the clinical phase of the prion disease. Our objective was to investigate if scrapie is associated to alterations of GH axis, leptin, insulin and metabolic parameters. In addition, central adrenergic system being affected in TSE (Braun et al, 1999), we investigated a possible alteration of α2-adrenergic control of GH axis associated to the prion disease.