Clean Technologies and Environmental Policy

Circular economy: Is there anything new in this concept?

An environmentally sustainable manufacturing network model under an international ecosystem Abstract There is a growing consensus that the increase in greenhouse gases results in unfavorable changes to the Earth's climate and is responsible for global warming. Due to this ecological imbalance, governments are under growing pressure to enact strict legislation to control these emissions in their respective countries. Consumers also demand eco-friendly products and are moving toward firms that are socially and environmentally responsible. Therefore, industries are facing increased pressure to adopt sustainable production approaches. This paper demonstrates how a mixed integer linear program can be used to optimize the balance of overall cost and carbon emissions in the production, storage, and distribution of products in a regulatory environment that includes a cap and trade policy. The model is computationally tested for fifteen case instances of different sizes. The main contributions of the proposed model are (a) to link the emission parameters to various decision variables to support the decision making related to carbon costs and carbon emissions, (b) to address international trade issues by considering international parameters such as imports, exports, and government subsidies and perform a country-specific analysis for carbon emissions, and (c) to identify the extent to which the operational adjustment can be used as an alternative to the costly investment in carbon reduction technologies to reduce emissions. Graphical abstract Proposed MILP model framework

Air pollution prediction by using an artificial neural network model Abstract Air pollutants impact public health, socioeconomics, politics, agriculture, and the environment. The objective of this study was to evaluate the ability of an artificial neural network (ANN) algorithm to predict hourly criteria air pollutant concentrations and two air quality indices, air quality index (AQI) and air quality health index (AQHI), for Ahvaz, Iran, over one full year (August 2009–August 2010). Ahvaz is known to be one of the most polluted cities in the world, mainly owing to dust storms. The applied algorithm involved nine factors in the input stage (five meteorological parameters, pollutant concentrations 3 and 6 h in advance, time, and date), 30 neurons in the hidden phase, and finally one output in last level. When comparing performance between using 5% and 10% of data for validation and testing, the more reliable results were from using 5% of data for these two stages. For all six criteria pollutants examined (O3, NO2, PM10, PM2.5, SO2, and CO) across four sites, the correlation coefficient (R) and root-mean square error (RMSE) values when comparing predictions and measurements were 0.87 and 59.9, respectively. When comparing modeled and measured AQI and AQHI, R2 was significant for three sites through AQHI, while AQI was significant only at one site. This study demonstrates that ANN has applicability to cities such as Ahvaz to forecast air quality with the purpose of preventing health effects. We conclude that authorities of urban air quality, practitioners, and decision makers can apply ANN to estimate spatial–temporal profile of pollutants and air quality indices. Further research is recommended to compare the efficiency and potency of ANN with numerical, computational, and statistical models to enable managers to select an appropriate toolkit for better decision making in field of urban air quality. Graphical abstract

Tidal current energy potential assessment in the Avilés Port using a three-dimensional CFD method Abstract Tidal energy is considered as an energy resource of maximum interest in both technical and research fields due to its largely unexploited energy potential. The use of hydrokinetic microturbines is now an attractive option with reduced environmental impact. The first step to evaluate the feasibility of a hydrokinetic microturbines installation is to perform a study of the velocity field characteristics and therefore the energy potential available. Up to now, different numerical models, of one, two and three spatial dimensions have been applied to evaluate the tidal potential in large areas. Due to the high computational resources needed, they include simplifications, like avoiding a precise study of the velocity in the vertical dimension, resulting in incomplete estimations of the available kinetic energy. To complete these estimations, the research presented sets out a methodology to evaluate the current effects, velocity profiles and the energy potential derived from tide movements in an estuary or port by solving the full Navier–Stokes equations. It also considers the water–air interface in the numerical scheme. The methodology is based, firstly, on the definition of a three-dimensional geometrical model of the geographical area of study, and then, the complete model is meshed with finite volumes, where the full three-dimensional Unsteady Navier–Stokes equations are solved. The methodology was applied and validated with a three-dimensional water–air numerical model of the port of Avilés (Spain). In conclusion, water surface elevations, averaged speed cycles, velocity profiles as a function of depth and tidal power and energy data have been obtained without the usual simplifications, which will mean an evaluation more accurate when assessing the implementation of a power generation system. Graphic abstract

Renewable energy supply and carbon capture: capturing all the carbon dioxide at zero cost Abstract Climate change is likely to be (and is) more serious and likely to proceed much more rapidly than was previously thought. This article surveys and evaluates the technology of processing carbon dioxide and hydrogen into sustainable synthetic carbohydrate fuels and the related economics in relation to a particular route, the capture of carbon dioxide from the flue gas stream of gas burning power stations, provided the gaseous fuel is of biogenic origin. Biogenic methane is renewable and can, after combustion into carbon dioxide, via carbon capture be further processed into a range of carbohydrate fuels, or alternatively captured for final storage under carbon capture and store (CCS). It is proposed that the air intake of a power station be replaced by cooled flue gases consisting mainly of carbon dioxide, enriched with oxygen obtained by electrolysis of water. The co-produced hydrogen can then be processed further into more easily transportable and storable forms of fuel. This implies that a gas-fired power station is not so much a means of producing energy, but rather of producing pure carbon dioxide. The capture process as such is the same as the one which arises if the purpose is carbon capture and use or CCS in which case capture of CO2 from the combustion of methane from biogenic origin amounts to negative emissions. The indirect route of supplying and using energy via the production of carbohydrate fuels requires much more primary energy than the direct use of electricity does. For this reason, use of that indirect route is efficient for aviation, where the direct route of electric power is impractical. For shipping, there also is the alternative of the implicit transport of hydrogen as part of ammonia. It is assumed that the use of biogenic methane followed by processing of the captured carbon dioxide into synthetic hydrocarbon fuels is in combination with volcanic carbon hydroxide, sufficient to meet the demand for hydrocarbon fuels. Capture of carbon dioxide from biogenic methane can also be applied in the context of CCS.

Opportunities and challenges of natural gas development and utilization in China Abstract In the background that the China government robustly advocates low carbon and green energy, China has turned to focus on natural gas, both production and consumption of which are soaring high these days and the role of which is gradually prominent in energy sources. But it also faces many problems. With the rapid development of natural gas in China, it has gradually formed a system of natural gas industry chain. With the aims to help promote more healthy and sustainable development of natural gas industry in the future, it is very valuable to think deeply about the past development process. This paper reviews and analyzes China's natural gas resources, pipeline layout, and industry development status. Based on China's specific conditions and resource characteristics, it analyzes China's future natural gas development opportunities. Simultaneously, the analysis shows China's natural gas production will reach 236.5 billion cubic meters by 2030 and the proportion of natural gas in the primary energy structure will reach about 15% in 2030. But in terms of current natural gas production, the supply gap is very large. Moreover, the dependence on foreign natural gas imports has continued to increase in recent years. Thus, China should continue to improve its natural gas layout and utilization system, increase investment in domestic natural gas exploration and development, strengthen core technology research, and improve its relevant laws and regulations in order to better maintain the rapid development of natural gas. Graphical abstract

Photocatalytic decomposition of VOCs by AC–TiO 2 and EG–TiO 2 nanocomposites Abstract In this study, TiO2 nanoparticles (NPs)-based catalysts were prepared for the photocatalytic removal of toluene as a model VOC from air under UV light. Expanded graphite (EG) and activated carbon (AC) as two sustainable supports were employed for immobilization of TiO2 NPs by sol–gel technique. In this approach, substrates were added to TiO2 sol–gel and heated up to 60 °C followed by calcination process at 400 °C to afford, EG/TiO2 and AC/TiO2. The studies show that much better results ensued for AC–TiO2 because of higher surface area, good nanoparticle distribution, and lower pore width. The products were characterized by X-ray diffraction, scanning electron microscope, energy dispersive X-ray, as well as N2 adsorption/desorption. Graphical abstract

Understanding driving patterns of carbon emissions from the transport sector in China: evidence from an analysis of panel models Abstract China's transport industry has made rapid progress, which has led to a great amount of carbon emissions. However, it is still unclear how carbon emissions from the transport sector are punctuated by shifts in underlying factors. This paper aims to examine the process of China's carbon emissions from the transport sector as well as its major driving forces at the provincial level during the period of 2000 to 2015. We first estimate the carbon emissions from the transport sector at the provincial level based on the fuel and electricity consumption using a top-down method. We find that the carbon emission per capita is steadily increasing across the country, especially in the provinces of Chongqing and Inner Mongolia. However, the carbon emission intensity is decreasing in most provinces, except in Yunnan, Qinghai, Chongqing, Zhejiang, Heilongjiang, Jilin, Inner Mongolia, Henan and Anhui. We then quantify the effect of socioeconomic factors and their regional variations on carbon emissions using a panel model. The results show that the development of secondary industry is the most significant variable for carbon intensity at both the national and regional levels, while the effects of the other variables vary across regions. Among these factors, population density is the main factor of the increasing carbon emissions per capita from the transport sector for both the whole country and the western region, whereas the consumption level per capita of residents and the development of tertiary industry are the primary drivers of per capita carbon emissions for the eastern and central regions. Graphical abstract

Gasification of waste tires in a circulating fixed-bed reactor within the scope of waste to energy Abstract Thermochemical decomposition of waste tires was evaluated in order to produce solid and gaseous products within the aim of waste-to-energy concept. Pyrolysis and gasification occur in an "oxygen-starved" environment to "thermally degrade" organic wastes. Waste tires form a large volume of a landfill space that may lead to serious environmental issues and management complexities. Proximate and ultimate analyses reported that approximately 80% carbon in waste tire can be converted to different solid, liquid and gaseous forms for energy gain. Pyrolysis and gasification experiments were carried out in a circulating fixed-bed reactor with cyclone separator at varying temperatures between 600 and 800 °C. Dried air (0.05–0.5 L/min) and pure oxygen (0.01–0.015 L/min) were fed to gasification reactor as partially oxidizing agents. Pyrolysis gasification (PyroGasification—PG) was conducted to produce "syngas" which mainly contains carbon monoxide and hydrogen. One and 4 h of cooking time for the first-step pyrolysis were applied in a nitrogen-rich medium before gasification to enrich carbon amount in fuel. A syngas rich in H2, CH4 and CO with a high calorific value of almost 4900 kcal/m3 was obtained in gasification experiments performed with 0.05 L/min of dried air. Volumetric percentages of hydrogen and methane in syngas were around 35% and 40%, respectively. More than 65% mass and 80% volume reductions which are very important for waste management hierarchy and minimization were achieved by gasification of waste tires. Graphical abstract

Quaternary ammonium-functionalized rice straw hydrochar as efficient adsorbents for methyl orange removal from aqueous solution Abstract In this study, a series of quaternary ammonium-modified hydrochars was fabricated using rice straw as raw material. The physicochemical properties of the hydrochars before and after modification were characterized by FTIR, XPS and CHN element analysis, and an adsorption mechanism was proposed. Results showed the quaternary ammonium groups were successfully grafted onto the hydrochar. The modified hydrochar showed favorable capacity for methyl orange (MO) elimination from aqueous solution with a maximum value of 849 mg/g, which was an order of magnitude higher than that of pristine hydrochar (49 mg/g). Besides, the MO adsorption of all the adsorbents fitted well with the pseudo-second-order and Langmuir models, and the adsorption process was exothermal. Analysis of the adsorption mechanism showed that the decontamination process was primarily controlled by electrostatic attractions and ion exchange. Graphical abstract Utilization of rice straw to produce quaternary ammonium-functionalized hydrochars for the efficient removal of methyl orange.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Apoptosis

Letter to the editor regarding article, "Role of glycogen synthase kinase following myocardial infarction and ischemia–reperfusion"

Role of glycogen synthase kinase following myocardial infarction and ischemia–reperfusion

17-Aminogeldanamycin selectively diminishes IRE1α-XBP1s pathway activity and cooperatively induces apoptosis with MEK1/2 and BRAF V600E inhibitors in melanoma cells of different genetic subtypes Abstract Outcomes of melanoma patient treatment remain unsatisfactory despite accessibility of oncoprotein-targeting drugs and immunotherapy. Here, we reported that 17-aminogeldanamycin more potently activated caspase-3/7 in BRAFV600E melanoma cells than geldanamycin, another inhibitor of heat shock protein 90 (HSP90). 17-aminogeldanamycin alleviated self-triggered compensatory increase in HSP70 mRNA level and induced endoplasmic reticulum (ER) stress, which was followed by selective diminution of cytoprotective IRE1α-XBP1s pathway activity of unfolded protein response (UPR), inhibition of ERK1/2 activity and induction of apoptosis. Concomitantly, ATF6/p50 level and expression of PERK-dependent genes, CHOP and BIM, remained unaltered. This might result from an inframe deletion in EIF2AK3 leading to a PERKL21del variant revealed by whole-exome sequencing in melanoma cell lines. 17-aminogeldanamycin exhibited similar activity in NRASQ61R melanoma cells that harbored a heterozygous inactivating variant of NAD(P)H:quinone oxidoreductase 1 (NQO1P187S). In addition, 17-aminogeldanamycin acted cooperatively with trametinib (an inhibitor of MEK1/2) and vemurafenib (an inhibitor of BRAFV600E) in induction of apoptosis in melanoma cell lines as evidenced by in-cell caspase-3/7 activation and PARP cleavage that occurred earlier compared with either drug used alone. As trametinib and vemurafenib did not significantly affect HSP70 and GRP78 transcript levels, cooperation of MEK/BRAFV600E inhibitors and 17-aminogeldanamycin might result from a concurrent inhibition of the RAS/RAF/MEK/ERK cascade and IRE1α-dependent signaling, and cell-intrinsic ER homeostasis can determine the extent of the drug cooperation. Our study indicates that 17-aminogeldanamycin takes several advantages compared with other HSP90-targeting compounds, and can complement activity of BRAF/MEK inhibitors in melanoma cells of different genetic subtypes.

Copper-imidazo[1,2- a ]pyridines induce intrinsic apoptosis and modulate the expression of mutated p53, haem-oxygenase-1 and apoptotic inhibitory proteins in HT-29 colorectal cancer cells Abstract Metastatic colorectal cancer responds poorly to treatment and is a leading cause of cancer related deaths. Worldwide, chemotherapy of metastatic colorectal cancer remains plagued by poor efficacy, development of resistance and serious adverse effects. Copper-imidazo[1,2-a]pyridines were previously shown by our group to be selectively active against several cancer cell lines, with three complexes, JD46(27), JD47(29), and JD88(21), showing IC50 values between 0.8 and 1.8 μM against HT-29 cells. Here, we report that treatment with the copper complexes resulted in fragmented nuclei suggestive of apoptotic cell death, which was confirmed by increased annexin V binding and caspase-3/7 activity. The copper complexes caused a loss of mitochondrial membrane potential and increased caspase-9 activity. The absence of caspase-8 activity indicated activation of the intrinsic pathway. Proteomic analysis revealed that copper-imidazo[1,2-a]pyridines decreased the expression of phosphorylated forms of p53 [phospho-p53(S15), phospho-p53(S46) and phospho-p53(S392)]. The expression of inhibitor of apoptosis proteins, XIAP, cIAP1, livin, and the antiapoptotic proteins, Bcl-2 and Bcl-x, was decreased. HO/HMOX/HSP32, expression was notably increased, which suggested the accumulation of reactive oxygen species. Increased expression of TRAIL-R2/DR5 death receptor indicated the possible dual activation of both the extrinsic and intrinsic apoptotic pathways; however, caspase-8 activation could not be demonstrated. In conclusion, the copper-imidazo[1,2-a]pyridines were effective inducers of apoptotic cell death at low micromolar concentrations and changed the expression levels of proteins important for cell survival and cell death. These copper complexes may be useful tools to better understand the complexity of signalling networks in cancer cell death in response to cell stress.

Matrix metalloproteinase 9 induces keratinocyte apoptosis through FasL/Fas pathway in diabetic wound Abstract Apoptosis is a mechanism to remove unwanted cells in the tissue. In diabetic wound, which is characterized by delayed healing process, excessive apoptosis is documented and plays a crucial role. Matrix metalloproteinase 9 (MMP9), which is elevated in non-healed diabetic wound, is necessary for healing process but its abnormality resulted in a delayed healing. The classical function of MMP9 is the degradation of extracellular matrix (ECM). However, there is some literature evidence that MMP9 triggers cell apoptosis. Whether the excessive MMP9 contributes to epidermis cell apoptosis in delayed healing diabetic wound and the underlying mechanisms is not clear. In this study, we aimed to explore whether MMP9 induced keratinocyte apoptosis and investigate the plausible mechanisms. Our in vitro study showed that advanced glycation end products (AGEs) induced keratinocyte apoptosis and enhanced MMP9 level. Besides, MMP9, both intra-cellular expressions and extra-cellular supplement, promoted cell apoptosis. Further, MMP9 resulted in an increased expression of FasL, other than Fas and p53. These findings identified a novel effect that MMP9 exerted in delayed diabetic wound healing, owing to a pro-apoptotic effect on keratinocyte, which was mediated by an increase of FasL expression. This study increases understanding of elevated MMP9 which is involved in diabetic wound repair and offers some insights into novel future therapies.

Berberine mitigates IL-21/IL-21R mediated autophagic influx in fibroblast-like synoviocytes and regulates Th17/Treg imbalance in rheumatoid arthritis Abstract In our previous study, we explored the therapeutic effect of berberine (BBR) against IL-21/IL-21R mediated inflammatory proliferation of adjuvant-induced arthritic fibroblast-like synoviocytes (AA-FLS) through the PI3K/Akt pathway. The current study was designed to explore the therapeutic potential of BBR (15–45 µM) against IL-21/IL-21R mediated autophagy in AA-FLS mediated through PI3K/Akt signaling and Th17/Treg imbalance. Upon IL-21 stimulation, AA-FLS expressed elevated levels of autophagy-related 5 (Atg5), Beclin-1 and LC3-phosphatidylethanolamine conjugate 3-II (LC3-II) through the utilization of p62 and inhibition of C/EBP homologous protein (CHOP). BBR (15–45 µM) inhibited autophagy in AA-FLS cells mediated through PI3K/Akt signaling via suppressing autophagic elements, p62 sequestration and induction of CHOP in a dose-dependent manner. Moreover, IL-21 promoted the uncontrolled proliferation of AA-FLS through induction of B cell lymphoma-2 (Bcl-2) and diminished expression of Bcl-2 associated X protein (BAX) via PI3K/Akt signaling. BBR inhibited the proliferation of AA-FLS via promoting apoptosis through increased expression of BAX and diminished Bcl-2 transcription factor levels. Furthermore, T cells stimulated with IL-21 induced CD4+ CD196+ Th17 cells proliferation through RORγt activation mediated in a PI3K/Akt dependent manner. BBR inhibited the proliferation of Th17 cells through downregulation of RORγt in a concentration-dependent manner. BBR also promoted the differentiation of CD4+ CD25+ Treg cells through induction of forkhead box P3 (Foxp3) activation via aryl hydrocarbon receptor (AhR) and upregulation of cytochrome P450 family 1, subfamily A, polypeptide 1 (CYP1A1). Collectively, we conclude that BBR might attenuate AA-FLS proliferation through inhibition of IL-21/IL-21R dependent autophagy and regulates the Th17/Treg imbalance in RA.

CNOT3 contributes to cisplatin resistance in lung cancer through inhibiting RIPK3 expression Abstract Chemotherapeutic resistance always results in poor clinical outcomes of cancer patients and its intricate mechanisms are large obstacles in overcoming drug resistance. CCR4-NOT transcription complex subunit 3 (CNOT3), a post-translational regulator, is suggested to be involved in cancer development and progression. However, its role in chemotherapeutic resistance is not well understood. In this study, after screening the CNOT3mRNA in a cancer microarray database called Oncomine and examining the expression levels of CNOT3 mRNA in normal tissues and lung cancer tissues, we found that CNOT3 was up-regulated in lung cancer tissues. Besides, its high-expression was associated with poor prognosis of lung cancer patients. We also found higher expression level of CNOT3 and lower expression level of receptor-interacting protein kinase 3 (RIPK3) in cisplatin-resistant A549 (A549/DDP) cells, and knocking down CNOT3 expression could sensitize A549/DDP cells to cisplatin-induced apoptosis. We demonstrated that CNOT3 depletion up-regulated the expression level of RIPK3 and the enhanced apoptosis was mediated by the elevated RIPK3 to further trigger Caspase 8 activation. Taken together, our results reveal a role of CNOT3 in cisplatin resistance of lung cancer and provide a potential target for lung cancer therapy.

Recombinant human lactoferrin induces apoptosis, disruption of F-actin structure and cell cycle arrest with selective cytotoxicity on human triple negative breast cancer cells Abstract Breast cancer is the most frequently diagnosed cancer among women worldwide. Here, recombinant human lactoferrin (rhLf) expressed in Pichia pastoris was tested for its potential cytotoxic activity on a panel of six human breast cancer cell lines. The rhLf cytotoxic effect was determined via a live-cell HTS imaging assay. Also, confocal microscopy and flow cytometry protocols were employed to investigate the rhLf mode of action. The rhLf revealed an effective CC50 of 91.4 and 109.46 µg/ml on non-metastatic and metastatic MDA-MB-231 cells, with favorable selective cytotoxicity index values, 11.68 and 13.99, respectively. Moreover, rhLf displayed satisfactory SCI values on four additional cell lines, MDA-MB-468, HCC70, MCF-7 and T-47D (1.55–3.34). Also, rhLf provoked plasma membrane blebbing, chromatin condensation and cell shrinkage in MDA-MB-231 cells, being all three apoptosis-related morphological changes. Also, rhLf was able to shrink the microfilaments, forming a punctuated cytoplasmic pattern in both the MDA-MB-231 and Hs-27 cells, as visualized in confocal photomicrographs. Moreover, performing flow cytometric analysis, rhLf provoked significant phosphatidylserine externalization, cell cycle arrest in the S phase and apoptosis-induced DNA fragmentation in MDA-MB-231 cells. Hence, rhLf possesses selective cytotoxicity on breast cancer cells. Also, rhLf caused apoptosis-associated morphologic changes, disruption of F-actin cytoskeleton organization, phosphatidylserine externalization, DNA fragmentation, and arrest of the cell cycle progression on triple-negative breast cancer MDA-MB-231 cells. Overall results suggest that rhLf is using the apoptosis pathway as its mechanism to inflict cell death. Findings warranty further evaluation of rhLf as a potential anti-breast cancer drug option.

Endothelin-1-mediated cerebral ischemia in mice: early cellular events and the role of caspase-3 Abstract Over the past 30 years a number of animal models of cerebral ischemic injury have been developed. Middle cerebral artery occlusion (MCAO) in particular reproduces both ischemic and reperfusion elements and is widely utilized as a model of ischemic stroke in rodents. However substantial variability exists in this model even in clonal inbred mice due to stochastic elements of the cerebral vasculature. Models such as MCAO thus exhibit significant irreducible variabilities with respect to their zone of injury as well as inducing a sizable volume of injury to the cerebrum with damage to sub-cortical structures, conditions not typically seen for the majority of human clinical strokes. An alternative model utilizes endothelin-1 application focally to cerebral vasculature, resulting in an ischemic reperfusion injury which more closely mimics that seen in human clinical stroke. In order to further define this model we demonstrate that intra-cortical administration of ET-1 results in a highly reproducible pattern of tissue injury which is limited to the cerebral cortex, characterizing the early cellular and molecular events which occur during the first 24 h post-injury. In addition we demonstrate that caspase-3 is both necessary and sufficient to regulate a majority of cortical cell death observed during this period. The enhanced survival effects seen upon genetic deletion of caspase-3 appear to arise as a result of direct modification of cell autonomous PCD signaling as opposed to secondary effectors such as granulocyte infiltration or microglia activation. Taken together these findings detail the early mechanistic features regulating endothelin-1-mediated ischemic injury.

Cellular responses of BRCA1 -defective HCC1937 breast cancer cells induced by the antimetastasis ruthenium(II) arene compound RAPTA-T Abstract An organometallic ruthenium(II) arene compound, Ru(η6-toluene)(PTA)Cl2 (PTA = 1,3,5-triaza-7-phosphaadamantane), termed RAPTA-T, exerts promising antimetastatic properties. In this study, the effects of RAPTA-T on BRCA1-defective HCC1937 breast cancer cells have been investigated, and compared to its effects on BRCA1-competent MCF-7 breast cancer cells. RAPTA-T showed a very low cytotoxicity against both tested cells. Ruthenium is found mostly in the cytoplasmic compartment of both cells. Flow cytometric analysis reveals that the compound arrests the growth of both cells by triggering the G2/M phase that led to the induction of apoptosis. At equimolar concentrations, RAPTA-T causes much more cellular BRCA1 damage in HCC1937 than in MCF-7 cells, suppressing the expression of BRCA1 mRNA in both cell lines with the subsequent down-regulation of the BRCA1 protein. Interestingly, RAPTA-T exhibits an approximately fivefold greater ability to suppress the expression of the BRCA1 protein in HCC1937 than in MCF-7 cells. These data provide insights into the molecular mechanisms by which RAPTA-T exerts its effects on BRCA1-associated breast cancer cells.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Urologie in der Praxis

Editorial

Erratum zu: Alternative Therapieoptionen zur TUR‑P beim benignen Prostatasyndrom Erratum zu: Urol. Prax. 2019 https://doi.org/10.1007/s41973-019-0043-1 Die Originalversion dieses Beitrags enthält bedauerlicherweise einige Fehler: S. 1, linke Spalte, Zeile 1 ff: Anstelle von „Kaum eine urologische Erkrankung verfügt über so unterschiedliche Behandlungsoptionen wie die benigne …

Éditorial

Mikrohämaturie – Abklärung wann und wie oft? Zusammenfassung Die Mikrohämaturie ist ein häufiger (Zufalls)befund und bedarf immer einer Abklärung. Ursächlich ist ein breites Spektrum an nephrologischen und urologischen Erkrankungen, wobei bei ungefähr 80 % der Betroffenen keine Ursache gefunden werden kann. Die Basisdiagnostik beinhaltet eine Anamnese, körperlicher Untersuchung, einen mikroskopisch differenzierten Urinstatus sowie Sonographie von Harnblase und Nieren. Im Falle einer symptomatischen Mikrohämaturie sollte die Ursache behandelt werden. Bei asymptomatischer Mikrohämaturie kann mittels mikroskopisch differenzierten Urinsediment zwischen einer glomerulären und nichtglomerulären Ursache unterschieden werden. Bei Verdacht einer glomerulären Genese bedarf es einer weiteren nephrologischen Abklärung, bei einer nichtglomerulären Mikrohämaturie sollten Patienten auf Grund von bestehenden Risikofaktoren für Harnwegsneoplasien (Tabakrauchen, Chemikalien-Exposition und Alter) eine risikoadaptierte Diagnostik erhalten. Bei bestehenden Risikofaktoren sollte eine komplette Diagnostik gefahren werden, wohingegen bei jungen oder Patienten ohne Risikofaktoren eine Zystoskopie, Spülzytologie und Sonografie ausreicht, da eine Neoplasie des oberen Harntraktes in diesem Fall als äußerst selten gilt (<1 %). Insgesamt besteht jedoch trotz hoher Mikrohämaturie-Prävalenz kein einheitlicher Algorithmus über eine gerechte Abklärung.

Prostatakarzinom-Highlights vom ASCO-GU

Die Urotherapeutin: Ein neues Berufsbild in der Urologie Zusammenfassung Die Urotherapie umfasst die Diagnostik, Behandlung und Betreuung von Menschen mit funktionellen oder organisch bedingten Störungen der Harnblase. Seit 2017 berät das Kantonsspital Winterthur urologisch abgeklärte Frauen und Männer, die Probleme und Fragen im Bereich der Blase und Prostata haben. So konnten 2018 bereits 73 Beratungen von diplomiertem Pflegefachpersonal mit der Weiterbildung in der Urotherapie durchgeführt werden. In enger Zusammenarbeit mit dem Urologen und dem Hausarzt ist es gemeinsam das Ziel, Patienten ganzheitlich und nach neuesten medizinischen Erkenntnissen zu behandeln.

Blickdiagnose Makrohämaturie

Nebennierentumoren Zusammenfassung Nebenniereninzidentalome sind insgesamt seltene Befunde, welche je nach initialem Befund (Hounsfield-Einheiten, Größe) weitergehende Abklärungen brauchen oder nicht. Bei einer Größe <4 cm und <10 Hounsfield-Einheiten in der nativen Computertomographie (CT) ist eine weitergehende Abklärung oder Nachsorge nicht notwendig. Alle anderen Befunde brauchen eine weitergehende Abklärung, welche je nach klinischer Präsentation auch die Abklärung der endokrinologischen Aktivität beinhaltet. Patienten sollten einem Dexamethasone-Supressionstest, einer Metanephrin- und Katecholaminbestimmung im Plasma oder Urin und Patienten mit einer arteriellen Hypertonie einem Aldosteron-Renin-Quotienten unterzogen werden. Ist die Bildgebung nicht konklusiv, ist eine weitergehende Abklärung mittels Kontrastmittel-CT, Magnetresonanztomographie oder PET-CT zu erwägen. Anhand der dann vorliegenden Untersuchungsresultate sollte die weitere Behandlung/Therapie an einem interdisziplinären Tumorboard besprochen und festgelegt werden.

News-Screen Urologie

Sonde vésicale: comment la gérer en pratique médicale courante Résumé Une part considérable des prises en charge urologiques fonctionnelles et/ou oncologiques nécessitent un drainage urinaire vésical, le plus souvent via une sonde transurétrale, pour permettre la vidange vésicale et/ou faciliter la cicatrisation. Les complications rencontrées tel que le mal-positionnement de la sonde, l'obstruction de la lumière de la sonde et les infections urinaires, amènent le patient à consulter et nécessitent des connaissances de base sur l'indication de la pose de sonde transurétrale et de son entretien quotidien.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Air Quality, Atmosphere & Health

Whether to wear a pollution filter

Development of air quality forecasting system in Macedonia, based on WRF-Chem model Abstract Urban air quality is composed of a complex interaction of factors associated with anthropogenic emissions, atmospheric circulation, and geographic factors; also, most of the urban pollution presents aerosols and trace gases toxic to human health and responsible for damaged flora, fauna, and materials. The air quality system based on the state-of-the-art Weather Research and Forecasting model coupled with chemistry (WRF-Chem) has been configured and designed for Macedonia. An extensive set of experiments have been performed with different model settings to forecast simultaneously the weather and air pollution over Macedonia. For the present work, a numerical simulation of extreme pollution episode over the urban area in Skopje has been simulated using 1-km WRF-Chem model and a newly developed set of urban mobile emissions. The modeled results implied that the model is very sensitive to the initial meteorological conditions, grid spacing, and mobile emissions. The results are validated against available observations for meteorological fields and pollutant concentrations. While the model forecasts with coarser horizontal grid resolution well fit with the hourly values of some air quality monitoring stations, these experiments tend to underpredict the peak level of about 1250 μg/m3 evidenced at the air quality station "Karpos." A WRF-Chem 5-km simulation shows increased PM10 concentrations with a peak value of about 1325 μg/m3 a few hours before the evidenced extreme concentration while 2.5-km grid run indicates the initial accumulation of air pollution with relatively high concentration with peak PM10 on 5 February 2017 at 0100 UTC. The 1-km model configuration well captures the PM10distribution over Skopje valley and the location and timing of the maximum measured air pollution. The verification analysis indicates that the best performance in the sense of the correlation coefficient is achieved with the 5-km WRF-Chem v.3.91 forecast. Numerical simulations with coarser grid resolution show less confidence and lower CC. The results suggest that model initialization and initial data using a mobile source emission provide a better quantitative assessment of extreme air pollution in urban areas. Overall, the present case study shows that the WRF-Chem model has an acceptable performance for meteorological variables as well as PM10concentration over Skopje. This study provides a general overview of WRF-Chem simulations and can serve as a reference for future air quality modeling studies.

Air quality impacts of open-plan cooking in tiny substandard homes in Hong Kong Abstract This study investigated the air quality impacts of open-plan cooking in subdivided units (SDUs), which is a type of substandard housing in Hong Kong. About 210,000 persons (2.9% of the population) currently live in such tiny and poorly ventilated dwellings. With a median floor area of merely 9.3 m2 (100 ft2), most SDUs do not have space for a partitioned kitchen to contain the air pollutants generated by cooking, posing a serious indoor air quality issue that affects all members living in the SDU. The CO, CO2, PM10, PM2.5 and VOC concentrations in seven SDUs were monitored for 72 h to capture the emissions from their routine cooking activities. All SDUs used induction or electric cookers and 32 cooking events were recorded. Under natural ventilation, the mean PM10 and PM2.5 concentrations during cooking were 36 and 20 μg/m3, which were 136% and 82% higher than the pre-cooking levels respectively. Their mean maximum concentrations reached 1644 and 749 μg/m3 respectively. The mean PM10 concentration exceeded the local guideline (excellent class) by 1.82 times. However, cooking activities did not contribute to substantial changes in CO, CO2 and VOC concentrations. When the air conditioner was turned on to relieve the heat from cooking, it took 90 min for air pollution to return to pre-cooking levels after a cooking event because of poor ventilation, which significantly increased the occupants' exposure to the cloistered air pollutants. Lacking a partitioned kitchen and effective ventilation in SDUs may pose chronic health threats to their occupants, particularly children.

Climatological evaluation in a Central Anatolian city and indirect effects of climatological variation on air quality Abstract Climate is defined as the statistics of weather over a long period of time. Climate has a dynamic structure, and climate change is caused either by natural or anthropogenic effects. Meteorological parameters are routinely recorded by national weather stations. In this study, climate variability was analyzed in a mid-populated city in the middle of the Anatolian Peninsula. Humidity, temperature, precipitation, open surface evaporation, and solar radiation records over 57-year period from 1960 to 2016 were considered. The increase in temperature and solar radiation was obvious. The increase rates were 0.05 °C and 0.62 W/m2 for temperature and solar radiation, respectively. Relative humidity showed a declining trend from 64 to 53%. This study also aimed to evaluate the climate change of planetary boundary layer development, which influences air quality level. AERMET, which is the AERMOD meteorological preprocessor was exploited in order to simulate the planetary boundary layer height, and twice daily upper air soundings, wind speed, wind direction, ambient temperature, and cloud cover have been used as minimum required parameters. The complete meteorological data available were between 2006 and 2016; for that reason, the boundary layer was calculated for 11 years. The determined average boundary layer height was 1018 m in 2006 and was reduced to 889 m in 2016.

Air quality at two stations (Gdynia and Rumia) located in the region of Gulf of Gdansk during periods of intensive smog in Poland Abstract The study was conducted to establish whether an extremely high concentration of aerosols occurred in the region of the Gulf of Gdansk at the very end of 2016, and if so which factors determined it. This period was notable in terms of intensity of smog episodes across the rest of Poland. The main goal was to consider pollution sources affecting two nearby stations in the area, which is usually characterised by better air quality than other parts of the country. To achieve this, concentrations of PM1 and PM2.5 were studied in Gdynia and PM10 concentration was measured in Rumia from 22 December 2016 to 22 January 2017. Concentrations of OC, EC, PAHs and major ions were also examined in order to indicate the origin of pollutants. The average daily concentration ranged 6.0–50.0 μg·m−3 for PM1 and 8.3–61.9 μg·m−3 for PM2.5 in Gdynia, and 8.6–71.9 μg·m−3 for PM10 in Rumia. High concentrations of PM1 and PM2.5, classified as values higher than 25 μg·m−3, were noted 4 times. The 24-h limit value of PM10 was exceeded 3 times. Even though the highest aerosol concentration obtained in our results exceeded the limit value by 150%, it was nevertheless lower than in other Polish regions at the same time. This was due to dissimilar meteorological conditions, heavy snowfall and the landfall of Hurricane Barbara. However, high PAH concentrations in aerosols measured in Gdynia and Rumia indicate poor air conditions despite there being a relatively low average concentration of PM at the same time.

Passive sampling as a feasible tool for mapping and model evaluation of the spatial distribution of nitrogen oxides in the city of Curitiba, Brazil Abstract Nitrogen oxides (NOx) are important pollutants that affect air quality in urban areas and are associated with harmful effects in human health. These compounds are emitted by combustion process especially vehicles. The main aim of this paper is to assess the concentrations of NOx in the atmosphere of Curitiba by using Ogawa samplers and dispersion models. The determination of compounds in 11 places was performed by using a simple colorimetric reaction and spectrophotometry. A comparison between the Ogawa samplers and the reference chemiluminescence analyzer showed good agreement and repeatability of the method used. Two-week sampling campaigns were performed at 11 stations from July 29 to August 12, and from August 15 to 29, 2016. The results showed the highest concentrations in places with high traffic vehicular and at street level (121 μg m−3 for NOx, 47.9 μg m−3 for NO2, and 48 μg m−3 for NO) as compared to the roof level that can be attributed to the impact of local traffic passing the street canyon. The similarity of monitored and modeled NOx concentrations (17 out of 26 pointwise comparisons within ± 25%) gives confidence in the emission inventory and the model simulations, allowing a conclusion of the source contributions.

Air quality assessment of the Tobacco Heating System 2.2 under simulated residential conditions Abstract Despite the growing popularity of new alternatives to traditional tobacco products, there is still limited evidence on their indoor effect in particular in residential spaces as specific environments where enforcement of air quality standards is difficult. Hence, the impact of the Tobacco Heating System 2.2 (THS, marketed as IQOS®) on indoor air quality was assessed under controlled experimental conditions using ventilation representative of residential buildings with natural ventilation. Smoking of cigarettes (Marlboro Gold®) at the same ventilation conditions and consumption rates was used as positive control. Before each THS 2.2 or Marlboro Gold session, a background session with the same volunteers as for the product-use session was held. In the high-load simulated residential environment, out of the 24 measured airborne constituents, only the increase of the indoor concentrations of nicotine, acetaldehyde, and glycerin above the background was attributable to the use of THS 2.2. The quantified concentrations of these three airborne compounds were significantly below the harmful levels defined in the air quality guidelines. Smoking Marlboro Gold resulted in much greater increases in the concentrations of all measured indoor air constituents, except for glycerin, and the indoor concentrations of several constituents exceeded the exposure levels set forth by cognizant authorities. Based on these data, it is reasonable to conclude that the use of THS 2.2 in environments where norms for indoor exposure in terms of adequate ventilation are respected does not adversely affect the overall indoor air quality.

Complex analysis focused on influence of biodiesel and its mixture on regulated and unregulated emissions of motor vehicles with the aim to protect air quality and environment Abstract The main task of this study is to perform a complex analysis dealing with influence of biodiesel and its mixture on regulated and unregulated gaseous emissions of diesel engine, which is installed in a motorcar as a driving unit determined for standard road traffic. As a real technical platform intended for realisation of the required experiments, a motor vehicle equipped with the TDI engine was chosen because just this kind of engine was directly affected by the affair "dieselgate". This type of piston combustion engine is widely used in the traffic, together with negative impacts on the air quality. Various diesel fuel mixtures, which represented the applied experimental fuels, were created by mixing of the ultra-low sulphur diesel fuel (ULSDF) with the biodiesel, using different mixture ratios. The individual experiments were performed during a 13-mode test cycle especially developed for the diesel engine in such a way, so that it was possible to identify influence of the engine loading and engine speed on the regulated and unregulated gaseous emissions of the given TDI diesel engine. It is possible to say according to the obtained results that a higher portion of the biodiesel in the fuel mixture reduces the amount of the hydrocarbons (HC), carbon monoxide (CO) and particulate matters (PM) in the gaseous emissions, but it increases volume of the nitrogen oxides (NOX). A higher portion of the biodiesel causes a growth of the formaldehyde emissions and acetaldehyde emissions in the case of unregulated diesel engine emissions. The same trend is also typical for the 1,3-butadiene, propene and ethene. The biodiesel additive increases emissions of benzene; however, it reduces emissions of the toluene and xylene within the aromatic substance emissions. The obtained results confirm a fact that all the gaseous emissions are influenced by the engine operational regimes, especially by the engine loading status.

Assessment of particulate matter, metals of toxicological concentration, and health risk around a mining area, Odisha, India Abstract In this study, trace element concentrations in PM10 and suspended particulate matter (SPM) have been investigated for their distribution, enrichment factor, and health impacts in Ganjam, Odisha. We investigated the presence of metals in air particulates to appraise the levels of the metals in the workplace of mine. The spatial variation of metals of toxicological around mining and residential areas were also studied. PM10 levels in mining and residential area were found to be in the range of 30–59 and 12–54 μg m−3, respectively, with an average value of 45 ± 12 and 32 ± 12 μg m−3, respectively, throughout the year and well within the prescribed NAAQS. SPM and PM10 concentrations were observed minimum in the rainy season because of precipitation and maximum in the winter season. The annual average concentration of Pb is higher in the SPM as compared to PM10in the residential area and within 10% of the national ambient air quality standard of 500 ng m−3. Human health risk in the mining areas is 1.1 times higher than the risk for the nearby residential areas. Carcinogenic risk assessment illustrated that there is no potential danger to the populace in the investigation studied.

A hybrid framework for forecasting PM2.5 concentrations using multi-step deterministic and probabilistic strategy Abstract PM2.5 concentration forecasting can provide powerful assistance to avoid health and economy loss. Recent research studies have proven that the PM2.5 concentration series is significantly non-stationary and does not obey standard distribution. In this study, a hybrid framework is proposed to solve the above difficulties. The proposed hybrid model consists of five algorithms: wavelet packet decomposition (WPD), gradient boost regression tree (GBRT), linear programming boosting (LPBoost), multi-layer perceptron (MLP), and Dirichlet process mixture model (DPMM). A hybrid preprocessing method WPD-GBRT is firstly applied to extract multi-resolution exogenous features, the LPBoost algorithm can assemble MLPs to achieve better forecasting performance, and the DPMM algorithm is finally built to model complex distribution of PM2.5 concentrations adaptively. Four pollutant data with different time intervals collected from Tangshan are utilized for data simulation. The results indicate the proposed model has excellent forecasting performance. In 1-h interval data, the index of agreement (IA) of the proposed model is 0.9490 and the coverage width-based criterion (CWC) with 99% confidence level is 0.3370.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Immigrant and Minority Health

Correction to: The Effects of Hispanic Immigrant Mother's Resiliency on Children's Dietary Adjustment The original version of this article unfortunately contained errors in Affiliation 3, Acknowledgement, Table 1 and in the text under Methods section. Also, a Co-corresponding author has to be included in the article.

Cardiovascular Disease Screening Among Immigrants from Eight World Regions Abstract Inequalities between native-born and foreign-born individuals in screening rates for a variety of conditions have been well-documented in literature on immigrant health. A preponderance of this research focuses on the Latin American case and on cancer-specific screening. This study seeks to expand knowledge of such preventative-health screening differences by analyzing screening rates for blood sugar, blood pressure, and serum cholesterol among nine groups overall and (for immigrants) at various stages of US residency. Using nationally representative data from the National Health Interview Survey, we find that immigrants from eight geographic regions receive preventative care at lower rates than US-born Whites and that preventative screening is generally higher after 15 years than during the first 4 years of residency in the United States. Importantly, our data also show that screening patterns and trends vary based on region of origin and outcome. These findings improve our understanding of immigrant health and health care use in the United States.

Exploring the 'Patient Experience' of Individuals with Limited English Proficiency: A Scoping Review Abstract Individuals with limited English proficiency (LEP) face barriers to safe and high-quality health care. 'Patient-experience' is increasingly viewed as an important component of health care quality. However, the impact of language proficiency on 'patient-experience' is not well-described. This scoping review mapped the literature on the patient experience of individuals with LEP. We reviewed sixty qualitative and mixed-methods studies from EMBASE and MEDLINE published between 2007 and 2017. We identified four major themes: (1) Communication, language barriers, and health literacy, (2) Relationships with health care professionals, (3) Discrimination and intersection with other dimensions of identity, and (4) Cultural safety. We also identified factors that may improve LEP patient experience, including: mitigating language barriers through interpretation or language-concordant providers, offering translated patient resources, and educating health care professionals about cultural safety.

Oral Health Status of Refugee Children in Montreal Abstract This study aimed to assess the oral health status of refugee children in comparison with that of Canadian children. In addition, we investigated the extent to which demographic factors are associated with caries experience in this population. Children with a confirmed refugee status and Canadian children (control group) matched for age and sex composed the study population. A comprehensive review of dental charts was completed to assess children's demographic data, caries experience, oral hygiene and gingival health status. The majority of refugee children had never seen a dentist before their arrival to Canada. Refugee children had significant higher dmft/DMFT scores than Canadian children (7.29 ± 5.1 and 4.47 ± 5, respectively; p < 0.0001). Furthermore, individual factors, such as refugee status (OR = 5.08; 95% CI = 2.31–11.1) and child age (OR = 2.17; 95% CI = 1.04–4.51) were significantly associated with caries experience. Access to appropriate dental care to refugee children should be a key priority for health care providers and policy makers.

Cumulative Stress and Trauma from the Migration Process as Barriers to HIV Testing: A Qualitative Study of Latino Immigrants Abstract Immigrants are at increased risk for late HIV testing; however, there is limited understanding of how migration to the United States shapes HIV testing behaviors. This study examined the relationship between the migration process and HIV testing among Latino immigrants. Semi-structured, in-depth interviews were conducted in March and April 2017 with 34 Latino immigrants in New York City. Grounded theory guided analysis of the qualitative data. Results indicated that Latino immigrants experienced cumulative stress and trauma throughout the migration process that contributed to significant emotional and psychological consequences. Stress and trauma accumulated from the migration process posed barriers to HIV testing as Latino immigrants sought to avoid activities perceived as stressful, including learning one's HIV status. Targeted interventions that ameliorate the stressful effects of migration may facilitate preventive health behaviors among Latino immigrants.

Polyvictimization, Related Symptoms, and Familial and Neighborhood Contexts as Longitudinal Mediators of Racial/Ethnic Disparities in Violence Exposure Across Adolescence Abstract African American and Hispanic adolescent experience more violence exposure relative to White youth. The present study examined the mediating role of posttraumatic stress symptoms (PTSS), delinquency, earlier victimization, and familial and neighborhood factors in disparities in future victimization. The study utilized data from the National Survey of Adolescents-Replication (N = 3,312), which consists of three waves of data collected approximately 1 year apart. A series of path models, tested polyvictimization, PTSS, delinquency, familial socioeconomic factors, and neighborhood safety as mediators of disparities in new polyvictimization. All cross-lagged and autoregressive paths positively predicted past-year polyvictimization and mediated longitudinal disparities. Familial socioeconomic variables and neighborhood safety mediated initial violence exposure disparities. Overall, results indicate that prior violence exposure, related mental health symptoms, and familial and neighborhood factors account for significant portions of disparities in new violence exposure across adolescence.

A Pilot Study Evaluating Organochlorine and Organophosphate Pesticide Exposure in Children and Adolescents of Mexican Descent Residing in Hidalgo County, Texas Abstract Children and adolescents of Mexican descent residing in Hidalgo County (TX) were evaluated for exposure to organochlorine (OC) and organophosphate (OP) pesticides. A convenience sample of 60 participants enrolled in our pilot study. The lipid-adjusted serum concentrations of nine OC metabolites and creatinine-adjusted urinary concentrations of six OP metabolites were measured and compared with data from the Centers for Disease Control and Prevention's Fourth Report on Human Exposure to Environmental Chemicals. Descriptive statistics were used to summarize the concentration levels for each metabolite. Study participants were aged 5–18 years. For most of the OC and OP metabolites, our findings showed that participants had concentration levels within the distributional range of the national data. However, notable outlying levels (greater than the 95th percentile in the Fourth Report) were identified for the following OC metabolites: gamma-hexachlorocyclohexane, p,p′-dichlorodiphenyldichloroethene, and p,p′-dichlorodiphenyltrichloroethane. Among the children aged 5–11 years, one child had an outlying value for the OP metabolite: dimethylphosphate. Our findings on the levels of OC and OP pesticide exposure enhances the credibility of national estimates, and can serve as baselines for children and adolescents of Mexican descent residing in Lower Rio Grande Valley. Furthermore, our study contributes to the lacunae of knowledge regarding environmental exposures and presses further investigation of outlying OC and OP exposure levels.

Cardiovascular Risk Factors and Events in Iranian Immigrants Versus Other Immigrants from the Middle East Abstract We report the incidence of cardiovascular events, mortality and risk factors (diabetes and hypertension) in immigrants from Iran and in non-Iranian immigrants from the Middle East. Using population-based healthcare administrative data, all immigrants from the Middle East and the non-immigrant population of Ontario, Canada as of July 2012 were identified. Baseline differences in diabetes and hypertension prevalence were compared. Outcomes were ascertained through March 2016 and included the incidence of acute coronary events, ischemic heart disease mortality, all-cause mortality, and incident diabetes and hypertension. The study population included 55,539 Iranian immigrants, 106,926 non-Iranian Middle Eastern immigrants, and 6,967,132 non-immigrants. Non-immigrants had the highest crude baseline prevalence of diabetes and hypertension. Compared to non-immigrants, Iranian and non-Iranian Middle Eastern immigrants had significantly lower incidence rate of acute coronary events, ischemic heart disease mortality and all-cause mortality. Both Iranian and non-Iranian Middle Eastern immigrants had better cardiovascular health status than non-immigrants.

Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy Abstract Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19–17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.

Acculturation and Dental Caries Among Children in Spain Abstract This study explored the relationship between different indicators of acculturation and children's caries experience. Data from 313 children attending the Dental Clinic of the European University of Madrid were analysed. Acculturation was measured via generational status, age at arrival, length of residence and language spoken at home. The association between each indicator of acculturation and caries experience was assessed in Poisson regression models adjusting for confounders. First- and second-generation migrant children had greater caries experience than Spanish-born children. These differences only persisted for first-generation migrant children after adjustment for confounders. Children who arrived in Spain before age 6 years, who lived in Spain for 10 or more years and who spoke a language other than Spanish at home had greater caries experience than Spanish-born children. Inequalities in caries experience between migrant and native children were evident (favouring the local children) and independent of family's socioeconomic circumstances.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

The Patient - Patient-Centered Outcomes Research

Correction to: Important Treatment Outcomes for Patients with Psoriatic Arthritis: A Multisite Qualitative Study The Open Access license, which previously read.

Towards Meaningful Engagement for the Patient Voice

10th Meeting "International Academy of Health Preference Research" Basel, Switzerland, 13–14 July, 2019

Validity and Reliability of a Novel Multimodal Questionnaire for the Assessment of Abdominal Symptoms in People with Cystic Fibrosis (CFAbd-Score) Abstract Background and Objective For people with cystic fibrosis, validated patient-reported outcome measures for the assessment of the complex abdominal involvement are lacking. The objective of this study was to examine whether the CFAbd-Score, a novel questionnaire consisting of 28 items, meets the essential requirements (validity and reliability) for a patient-reported outcome measure according to US Food and Drug Administration recommendations. Methods Content validity was assessed by recording the frequencies and severity of symptoms that occurred during the prior 2 weeks in patients with cystic fibrosis (n = 116; aged ≥ 6 years). Comparing the CFAbd-Score results obtained from patients with cystic fibrosis and healthy controls (n = 88), we determined known-groups validity. To explore the structure of the patient-reported outcome measure, a factor analysis was conducted. Internal consistency of the five extracted score domains was assessed using Cronbach's alpha. For test–retest reliability, a subgroup of patients (n = 43) was reevaluated and intra-class correlation coefficients were determined. Results The CFAbd-Score differentiated patients with cystic fibrosis from healthy controls with a large effect size (17.3 ± 1.1 vs. 8.0 ± 0.7 points; p < 0.001; Cohen's d = 0.85). Items, domains, and scores reflected the relevance to patients with cystic fibrosis and allowed a differentiation between subgroups of patients with cystic fibrosis (e.g., patients with and without abdominal pain, pancreatic sufficiency, and age groups). High item-domain loadings as well as good to excellent internal consistency and reproducibility (Cronbach's α = 0.70–0.92; intra-class correlation coefficient = 0.932, 95% confidence interval 0.874–0.963) indicated construct validity and reliability. Conclusions The CFAbd-Score has successfully passed through key steps of the iterative process of patient-reported outcome measure development. Prospectively, the CFAbd-Score is proposed as a patient-centered instrument for monitoring abdominal symptoms and, most interestingly, for evaluating changes in symptoms with novel treatments such as cystic fibrosis transmembrane regulator modulators. Trail Registration ClinicalTrials.gov: NCT03052283.

Health-Related Quality of Life in Patients with Adult-Onset Myotonic Dystrophy Type 1: A Systematic Review Abstract Background Adult-onset myotonic dystrophy type 1 (DM1) is a chronic, multisystem disorder that leads to disability and premature death. Objectives The objective of our study was to conduct a systematic literature review of the health-related quality of life (HRQoL) of patients with DM1. Methods We searched Embase, Web of Science, and PubMed for English language full-text articles reporting results from studies of HRQoL in patients with adult-onset DM1 published between 1 January 2000 and 21 February 2018. We excluded reviews, editorials, and studies reporting results for a sample with fewer than five patients (to allow for meaningful inference). Results The search identified 266 unique publications. Of these, 231 were excluded following title and abstract screening and 16 after full-text review, leaving 19 articles for data synthesis. We found 15 articles measuring the HRQoL of patients with adult-onset DM1 using the 36-Item Short Form Health Survey (SF-36), six using the Individualized Neuromuscular Quality of Life Questionnaire (INQoL), and one using Cantril's Ladder. Available evidence shows that patient HRQoL is impaired in DM1, mainly due to compromised physical health, but also reveals that substantial heterogeneity exists in estimates across studies. Conclusions HRQoL in adult-onset DM1 has been extensively studied using the SF-36 and the INQoL, but current estimates are inconclusive, and little is known of the impact of the disease as measured using other instruments. Our data synthesis should help characterize the patient burden of DM1 and inform future studies of HRQoL in this indication.

Patient and Oncologist Preferences for the Treatment of Adults with Advanced Soft Tissue Sarcoma: A Discrete Choice Experiment Abstract Background There has been no single standard-of-care treatment of patients with advanced/metastatic soft tissue sarcoma (STS). This study was designed to understand patient and oncologist preferences in the advanced/metastatic setting. Methods Adult patients diagnosed with STS and oncologists treating patients with STS completed discrete choice experiment surveys. Study participants chose between pairs of hypothetical treatment profiles for advanced STS characterized by varying levels of overall survival (14, 20, or 26 months), progression-free survival (3, 5, or 7 months), objective tumor response rate (12, 18, or 26%), risk of hospitalization due to side effects (12, 30, or 46%), and days/month to administer treatment (1, 2, or 4 days). A hierarchical Bayes model was used to estimate preferences and relative importance of attributes. Results Seventy-six patients (23.7% male, mean age 52.8 years) and 160 oncologists (73.8% male, mean 16.9 years in practice) completed the surveys. Among patients, overall survival had the highest relative importance (39.5%, standard deviation [SD] 18.2%), followed by response rate (21.2%, SD 10.4%), and hospitalization (19.8%, SD 12.5%). Among oncologists, overall survival had the highest relative importance (44.6%, SD 16.0%), followed by hospitalization (18.4%, SD 8.3%). Conclusions Both patients with STS and oncologists preferred a treatment that maximizes the life of patients while avoiding hospitalizations.

EQ-5D-5L is More Responsive than EQ-5D-3L to Treatment Benefit of Cataract Surgery Abstract Background It is not clear whether 5-level EQ-5D (EQ-5D-5L) utilities based on recently developed value sets are more responsive than 3-level EQ-5D (EQ-5D-3L) utilities. Objectives The study aims were to compare (1) the responsiveness of EQ-5D-5L and EQ-5D-3L utilities and (2) the responsiveness of these utilities with the Short Form–6 Dimension (SF-6D) and Health Utilities Index Mark 3 (HUI3) utilities to the treatment benefit of cataract surgery. Methods A total of 148 patients were interviewed before and after their cataract surgery using EQ-5D-3L, EQ-5D-5L, SF-6D, and HUI3. Responsiveness was assessed for all measures using the mean change (post-treatment—pre-treatment), standardized effect size (SES), standardized response mean (SRM), and F-statistic. Results Using the Singapore value sets, mean change for EQ-5D-3L and EQ-5D-5L utilities was 0.016 and 0.028, SES was 0.097 and 0.199; SRM was 0.091 and 0.196; and F-statistic was 1.2 and 5.7, respectively. Similar trends were observed using the UK/England EQ-5D value sets, although the magnitude was slightly smaller. The mean change, SES, SRM and F-statistics for SF-6D (UK value set) were 0.020, 0.234, 0.249, and 9.2, respectively. The values of mean change, SES, SRM and F-statistics for HUI3 (Canada value set) were 0.080, 0.472, 0.474, and 33.3, respectively. Conclusions The EQ-5D-5L utilities tend to be more responsive than the EQ-5D-3L utilities to treatment benefits of cataract surgery. The HUI3 utilities are more responsive than both the EQ-5D-5L and SF-6D, and SF-6D utilities may be slightly more responsive than the EQ-5D-5L for assessing patients undergoing cataract surgery.

Measuring the Burden of Schizophrenia Using Clinician and Patient-Reported Measures: An Exploratory Analysis of Construct Validity Abstract Background Various self-reported or clinician-reported (as a proxy) measures exist to quantify the burden of schizophrenia on patients. Evidence of the psychometric relationship between these measures to inform their practical use is limited. Objectives Our objective was to conduct an exploratory analysis of the construct validity of patient-reported (EQ-5D, SF-6D, WEMWBS, SQLS subscales of Psychosocial, Motivation, Symptoms) versus clinician-reported measures (PANSS, CGI-SCH, NSA-4, HoNOS-PbR) to inform future use of patient-reported measures for burden-of-illness assessment and/or economic evaluation. Methods In an adult patient population with schizophrenia, construct validity was assessed in relation to convergent and known-group validity. Convergent validity was assessed using Spearman's rank absolute correlation strength (ACS: weak ≤ 0.3, moderate = 0.3 < 0.5, strong ≥ 0.5) and graphically using locally weighted scatterplot smoothing (LOWESS) techniques. Known-group validity was assessed using Cohen's d absolute effect size (AES: small ≤ 0.5, moderate = 0.5 < 0.8, large ≥ 0.8). Floor and ceiling effects were assessed as a proxy of sensitivity in this cross-sectional study. Statistical significance was assessed at the 5% threshold level (p < 0.05). Across head-to-head assessments, the frequency of producing the strongest ACS, largest AES, and statistically significant results determined the best overall construct validity. Results Overall, 304 patients consented to the study. In relation to statistically significant results, the SF-6D most frequently exhibited the strongest ACS and largest AES against the clinician-reported measure scores (ACS range 0.084–0.436; AES range 0.043–0.746), and the SQLS Motivation subscale most frequently exhibited the weakest/smallest values (ACS range 0.009–0.157; AES range 0.002–0.397), although these results were mixed according to the clinician-reported measure used for comparative analysis (ACS range 0.009–0.529; AES range 0.002–0.934). Conclusion The SF-6D indicated the best (mostly moderate) construct validity but still missed the negative symptoms of the condition. Although further evidence is required to confirm or refute these exploratory results, compared with the EQ-5D, the SF-6D can be self-reported to better capture generic health-related quality-of-life aspects of schizophrenia for the purpose of economic evaluation. The lack of construct validity for SQLS Motivation and Symptoms subscales were hypothesized post-hoc to be representative of the complementary information elicited by the subscales not captured by the clinician-reported measures. Therefore, the SQLS can be self-reported to capture complementary (i.e., additional) information relative to clinician-reported measures.

Patient-Community Perspectives on Real-World Evidence: Enhancing Engagement, Understanding, and Trust Abstract Background Healthcare stakeholders have pronounced both enthusiasm and apprehension over the expanding use of real-world evidence (RWE). The patient community—those who benefit from new treatments but are vulnerable to potential safety risks and whose routine medical encounters are used to generate RWE—has been less vocal. Understanding patient perspectives on the use of RWE to guide clinical decision making and inform regulatory decisions and value assessments is imperative. Methods We convened a day-long, multi-stakeholder roundtable in Washington D.C., USA, on 31 July 2017 to gather patient-community views on RWE and related concerns and the communications, information and tools needed by patients to understand, trust, and use RWE. Participants included a convenience sample of National Health Council (NHC) members primarily representing patient groups as well as non-patient members with an interest in RWE. Participants were organized into small, pre-assigned groups, ensuring representativeness across stakeholders and patient leadership. Discussions, including storyboards, notes, and illustrative examples were captured and later analyzed thematically by NHC staff. Results Ten RWE themes emerged: (1) most patients were unaware of RWE and its actual or potential uses, (2) common definitions for real-world data and RWE are needed, (3) patient organizations need RWE skills and tools, (4) patient–scientist partnerships can help differentiate high-quality RWE, (5) RWE should inform decision making, (6) clinician support is needed for RWE uptake in patient decision making, (7) communications to patients should be balanced and empowering, (8) context of use impacts RWE acceptability/trust, (9) privacy/data ownership require clarity, and (10) patient-generated data are also real-world data (RWD). Conclusion Patients see great possibility in using RWE to understand how a treatment works—to find someone that "looks like me" as assurance of how a treatment might benefit them personally. Patient groups will play a critical role in helping to educate constituents on understanding, contributing to, and using RWE. To maximize patient uptake and the co-development and application of RWE, patient groups require education and tools.

Support Tools for Preference-Sensitive Decisions in Healthcare: Where Are We? Where Do We Go? How Do We Get There?

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com