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Immunogenicity of Fractional Doses of Tetravalent A/C/Y/W135 Meningococcal Polysaccharide Vaccine: Results from a Randomized Non-Inferiority Controlled Trial in Uganda.
No full textBACKGROUND: Neisseria meningitidis serogroup A is the main causative pathogen of meningitis epidemics in sub-Saharan Africa. In recent years, serogroup W135 has also been the cause of epidemics. Mass vaccination campaigns with polysaccharide vaccines are key elements in controlling these epidemics. Facing global vaccine shortage, we explored the use of fractional doses of a licensed A/C/Y/W135 polysaccharide meningococcal vaccine. METHODS AND FINDINGS: We conducted a randomized, non-inferiority trial in 750 healthy volunteers 2-19 years old in Mbarara, Uganda, to compare the immune response of the full dose of the vaccine versus fractional doses (1/5 or 1/10). Safety and tolerability data were collected for all subjects during the 4 weeks following the injection. Pre- and post-vaccination sera were analyzed by measuring serum bactericidal activity (SBA) with baby rabbit complement. A responder was defined as a subject with a >/=4-fold increase in SBA against a target strain from each serogroup and SBA titer >/=128. For serogroup W135, 94% and 97% of the vaccinees in the 1/5- and 1/10-dose arms, respectively, were responders, versus 94% in the full-dose arm; for serogroup A, 92% and 88% were responders, respectively, versus 95%. Non-inferiority was demonstrated between the full dose and both fractional doses in SBA seroresponse against serogroups W135 and Y, in total population analysis. Non-inferiority was shown between the full and 1/5 doses for serogroup A in the population non-immune prior to vaccination. Non-inferiority was not shown for any of the fractionate doses for serogroup C. Safety and tolerability data were favourable, as observed in other studies. CONCLUSIONS: While the advent of conjugate A vaccine is anticipated to largely contribute to control serogroup A outbreaks in Africa, the scale-up of its production will not cover the entire "Meningitis Belt" target population for at least the next 3 to 5 years. In view of the current shortage of meningococcal vaccines for Africa, the use of 1/5 fractional doses should be considered as an alternative in mass vaccination campaigns. TRIAL REGISTRATION: ClinicalTrials.gov NCT00271479
All bachelors are unmarried men (p < 0.05)
No full textPre-printThis paper adds to the list of criticisms against null hypothesis significance testing (NHST).\ud
I argue that when researchers do not analyze the conceptual relations among their variables, they may fail to distinguish between logical implications and empirical relations. It does not make sense to use significance testing on hypotheses involving conceptually related phenomena. The widespread lack of conceptual clarification also leads to very small effect sizes in psychology because it causes study participants to understand the stimulus material in different ways . Therefore they answer in an inconsistent way. Researchers show an extremely low degree of ambition when they seek to show that psychological phenomena differ from chance, or when they try to disprove a hypothesis claiming that a psychological phenomenon does not exist. I see significance testing as a poor solution to the problem of tiny effect sizes in psychology. I recommend that psychological researchers be more explicit both about their main hypotheses and their auxiliary hypotheses. As examples, I analyse all quantitative articles in Issue 1, 2005 of the Journal of Health Psychology
Oppsummering av landsomfattende tilsyn i 2007 med kommunale helse- og sosialtjenester til voksne med psykiske lidelser
No full textNORSK SAMMENDRAG:\ud
Det ble i 2007 gjennomført et landsomfattende tilsyn med helse- og sosialtjenester til voksne med psykiske lidelser. Tilsynet omfattet 68 kommuner (og bydeler) i hele landet. Tilsynet har undersøkt om tjenestene er tilstrekkelige og tilgjengelige for alle som trenger dem, om tilbud er tilpasset den enkeltes behov, ønsker og forutsetninger, og om ulike deltjenester har samordnet sine tilbud og samarbeider slik at tilbudet framstår helhetlig. \ud
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Etter Statens helsetilsyns vurdering, er det i dette landsomfattende tilsynet avdekket svikt i en del av kommunene som kan få meget alvorlige konsekvenser for tjenestemottakerne. Følgene av ufullstendig utredning eller mangelfull samhandling kan være at tilbud glipper og at tjenesten ikke dekker de faktiske behovene verken i innhold eller omfang – og slik at tilbudet i sum ikke blir faglig forsvarlig. \ud
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Kommunenes kanskje største utfordring synes å være å styre tjenestetilbudet på en slik måte at de til tross for fragmentert organisering, at det er ulike lovverk som styrer ulike tjenester og at det er mange yrkesgrupper involvert – likevel sikrer at tjenester ytes i samsvar med regelverkskravene til helse- og sosialtjenestene. \ud
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Men vi stiller også spørsmål om regelverket på området gir for lite konkrete anvisninger, og at det derfor er vanskelig for kommunene å forvalte. Vi etterlyser bedre veiledning til kommunene om hvilke tjenester de skal yte til mennesker med psykiske lidelser, og hva innholdet i disse tjenestene skal være.SUMMARY IN ENGLISH:\ud
In 2007 the Norwegian Board of Health Supervision in the Counties and the County Governors carried out countrywide supervision of health and social services for adults with mental disorders. This involved 68 municipalities and urban districts throughout the country. The aim was to investigate whether services are adequate and available for all the people who need them, whether services are adapted to the individual needs of the clients, and whether the different services are coordinated so that the total service is comprehensive.\ud
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According to our assessment, supervision revealed deficiencies in services in some of the municipalities, which can have serious consequences for clients. The result of inadequate assessment of clients and inadequate team work can be that clients’ needs are not met. Deficiencies can relate to both the range of services offered and the content of the services. The result may be that the services do not meet statutory requirements. \ud
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These services are characterized by fragmentary organization, different legislation regulating different services, and the involvement of many different types of professionals. Because of this, it is challenging for the municipalities to provide services that meet the requirements laid down in health and social legislation.\ud
However, it may be that the legislation in this area is not specific enough, and that this makes it difficult for the municipalities to interpret the legislation. We suggest that the municipalities may need clearer guidelines about which services they are required to provide for people with mental disorders, and about the content of these services
Hva nå? Evaluering av prøveordning med sprøyterom
No full textNORSK SAMMENDRAG: Oslo kommune åpnet sprøyterom 1. februar 2005, etter at Stortinget i desember 2004 vedtok en midlertidig lov om en prøveordning med sprøyterom. Forskerne Astrid Skretting og Hilgunn Olsen ved SIRUS har på oppdrag av Helse- og omsorgsdepartementet evaluert prøveordningen.\ud
I de første to driftsårene var det 383 brukere av sprøyteromsordningen. Av disse brukte 2/3 tilbudet i gjennomsnitt to ganger eller mindre per måned, mens bare 10 prosent brukte tilbudet mer enn seks ganger per måned. Det ble i gjennomsnitt satt 24 injeksjoner per dag.\ud
- Et viktig formål med ordningen var å vurdere effekten av straffrihet for en brukerdose heroin. Politiet har støttet lojalt opp om ordningen, så dette må sies å ha fungert, sier Astrid Skretting.\ud
- En annen målsetting var å bidra til økt verdighet for tungt belastede heroinmisbrukere. I den grad det er mulig å måle dette, må en kunne si at sprøyteromsordningen har bidratt til økt verdighet både på et allment og et individuelt nivå. Den gir et signal om anerkjennelse av hjelpebehov til alle sprøytemisbrukere. For den enkelte bruker kan den konkrete hjelpen som gis og måten de blir møtt på, sies å bidra til økt verdighet. Målsettingen om helse- og sosialfaglig oppfølging er derimot i begrenset grad oppfylt. Vi har ikke grunnlag for å si om prøveordningen har bidratt til færre overdoser eller overdosedødsfall, sier Skretting.\ud
Brukerne gir uttrykk for stor tilfredshet med tilbudet. De oppgir trygghet for politi og vektere når de injiserer, og at de lærer å injisere slik at de får mindre skader, som grunner til at de oppsøker sprøyterommet.\ud
Evalueringen peker på en rekke dilemmaer det må tas stilling til ved en eventuell permanent sprøyteromsordning: Skal det bare være tillatt å injisere heroin eller bør det også gis adgang til å røyke heroin, som innebærer mindre risiko for skader og overdoser? Skal det ikke tillates å injisere andre narkotiske stoffer enn heroin, så lenge det er få rene heroinmisbrukere i Norge? Kan en sprøyteromsordning tolkes som et signal om at samfunnet aksepterer bruk av narkotika? Er sprøyterom en riktig bruk av samfunnets ressurser og hvor langt skal samfunnet strekke seg for å imøtekomme rusmiddelmisbrukeres behov for ulike tjenester?\ud
Oslo kommune og Sosial- og helsedirektoratet får i rapporten kritikk for at sprøyterommet ble åpnet uten nødvendige forberedelser. Mangelfull opplæring av personalgruppa og lokaler som ikke tilfredsstilte kravene i forskriften, førte til store belastninger for de ansatte.\ud
Evalueringen gir ingen anbefaling om prøveordningen bør gjøres permanent. Den påpeker imidlertid at en eventuell permanent sprøyteromsordning må stille krav til kommunene som ønsker å etablere et slikt tilbud. Lokalene må være hensiktsmessige og ivareta de ansattes sikkerhet. De ansattes opplæring og arbeidsforhold må også ivaretas på en bedre måte enn i prøveordningen.ENGLISH SUMMARY: A proposal to pilot a public injecting room was put before the Norwegian parliament (Stortinget) for the first time in 1999. The idea went back and forth between different governments and parliaments. The Director General of Public Prosecutions warned legislators that before a supervised injecting room could be established, the law would have to be amended. A provisional act sanctioning the pilot scheme was adopted by parliament (Drug Injection Rooms Act),25 together with a set of regulations in December of 2004. SIRUS was asked to evaluate the scheme.\ud
Oslo City Council was authorized by the Directorate for Health and Social Affairs to pilot the supervised injecting centre. Oslo City Council opened the centre, located in the centre of Oslo, on February 1, 2005.\ud
A specific group of injectors was singled out as the centre target group, “heavy heroin users aged 18 and over”. The objectives of the scheme were:\ud
• to assess the effect of impunity for possession and use of drugs in a certain area defined elsewhere:\ud
• to help heavy drug users build a sense of self-esteem (dignity);\ud
• to facilitate contact between the social and health services and drug users;\ud
• to prevent the spread of infectious diseases; and\ud
• reduce overdose rates and overdose fatalities\ud
Two years later, 409 persons had registered as clients of the centre, of whom 383 used the facility on one or more occasions. Of these 383, 71 per cent were male and 29 per cent female; 23 per cent were 30 or younger, 41 per cent 31–40 and 37 per cent 40 or above.\ud
In these two years, 17,226 injections were administered, that is, an average of 24 injections every day. There is wide variation in the frequency with which registered clients used the facility. Only 10 per cent used the centre more than six times per month. Two thirds used it only once or twice per month after registering as clients.\ud
Injection doses of 0.2–0.25 grams were reported by 80 per cent of the clients. The drug was predominantly injected into the arm (64 per cent), followed by groin (19 per cent), leg (15 per cent) and neck (2 per cent).\ud
Clients reported safety as their primary reason for using the facility. Other important reasons included the sense of security at the facility, learning how to inject more safely, supervision in the event of an overdose, and knowledge that they could administer the drug without worrying about the police or security guards moving them on.\ud
The clients of the injecting centre express in the main satisfaction with the facilities provided. Virtually none have any complaints about advice on how to inject, how they were treated by staff or about the equipment provided. They would like to see opening hours extended, and an opportunity to inject pills with the heroin.\ud
The police have given their full support during the trial. Impunity has undoubtedly worked insofar as it, in legal terms, is actually possible to run the injecting facility, despite the inability of staff to satisfy themselves that clients are only bringing one heroin dose onto the premises. Impunity has had an unintended side effect however, in that possession of small quantities of heroin is decriminalised even further in the centre of Oslo.\ud
Insofar as it is possible to operationalize the concept of dignity, it could be said that the injecting room has had a positive effect on the dignity of the group in question. The pilot scheme has enhanced the dignity of drug users in a wider sense, by acknowledging the need to inject drugs in as risk free an environment as possible. The courteous manner of the staff has also been beneficial in that sense as well.\ud
Healthcare and welfare counselling have been provided in 8 per cent of all visits. This care depends, however, on adequate staffing. Suitable premises where staff and clients can talk privately would improve the centre’s ability to provide care.\ud
Given the limited data it is difficult to say whether the scheme reduced infection or contamination rates. Clients are obliged to follow strict rules of hygiene, however. They are also given practical advice on the best way of administering an injection, with least risk of developing physical problems such as inflammation and abscesses. Injection training was given in 13 per cent of all injection visits, and to 81 per cent of the clients on one or more occasions. One would expect clients to practice what they learned when they inject outside the facility. Clients became more aware of the need for good standards of hygiene, they said.\ud
0.6 per cent of injections resulted in an overdose, and 18 per cent of clients experienced an overdose while at the injecting room. None of these incidents were fatal. There is no evidence that the scheme has caused a general reduction in overdose rates or overdose fatalities. To avoid risk of overdose, there would have to be sufficient capacity to supervise most of the injections administered in the city.\ud
Staff turnover has been high. After an initial period of enthusiasm, poor physical and psycho-social working conditions resulted in high levels of sick leave absence and resignations. Many members of staff felt at risk and that responsibility for preventing overdoses was too onerous. It was also exhausting having to observe at close quarters clients’ self-destructive behaviour. They felt let down by their employer, and have had limited access to professional advice and counselling.\ud
Oslo City Council and Alcohol and Drug Addiction Service started the scheme without the necessary preparations, according to the staff. Personnel training was inadequate. The Directorate for Health and Social Affairs is blamed for giving the City authorities the green light. The Directorate should have realized that the premises were below the standards required in the regulations, and that personnel lacked appropriate training.\ud
If the scheme becomes a permanent fixture, more suitable premises must be found. The injecting room must be large enough to allow a certain amount of space between staff and injecting clients. The facility must have two exits, and an effective ventilation system. Opening hours should cater to the needs of the clients. Care of staff must be given high priority. More should be done to ensure as safe an environment as possible for staff. This includes not only the architectural layout of the facility, but the psycho-social aspects of working conditions. Consideration should be given, if the facility becomes a permanent service, to locate it in a “health centre“ for drug users.\ud
Supervised injecting rooms come with their own set of paradoxes/dilemmas\ud
Several issues need to be addressed:\ud
• Since injecting heroin is more likely to result in an overdose than smoking it, it could be seen as a paradox that the Norwegian trial only allows the drug to be injected.\ud
• As long as the number of exclusive heroin users in Norway is so low, it could be a paradox that the only drug clients may inject is heroin .\ud
• It could also be a paradox that the injecting facility may in fact be contributing to the perpetuation of drug abuse.\ud
• An injecting facility will find it difficult to cope with clients suffering from mental illness and aggressive behaviour. It could therefore be a dilemma that the people most in need of a drug injecting facility may have to be kept out.\ud
• Administering an injection in the neck or groin is more likely to cause physical injury than in the arm. Whether a future injecting facility centre should allow clients to administer injections in the neck or groin is therefore something of a dilemma.\ud
• A desire to keep drug addicts off the streets could be an argument in favour of an injecting facility, but it might put the health aspect in the shade.\ud
• By running an injecting facility, the authorities may indirectly be seen as condoning drug use.\ud
• The Health Personnel Act requires staff in an public injecting room to notify the child welfare authorities when clients are caring for children, the social services if clients are pregnant, and the police if clients have been driving while impaired by drugs/alcohol. This may create a dilemma for staff, because by notifying the authorities they risk alienating the client.\ud
• As long as the public injecting room is a scarce “commodity”, there is no guarantee that users with the greatest need will be admitted. Whether the “first come, first served” principle should be applied, or other criteria, is yet another dilemma.\ud
• And is it wise to spend public resources on an injecting centre, and how far should society go in attending to the various types of assistance needed by drug users
Oppsummeringsrapport etter tilsyn med smitteisolering ved 10 helseforetak i 2006
No full textNORSK SAMMENDRAG: Helsetilsynet og Arbeidstilsynet gjennomførte høsten 2006 tilsyn med kontaktsmitte- og luftsmitteisoleringen ved ti helseforetak. Dette ble gjort som ledd i videreføringen av kampanjen ”God Vakt” og som oppfølging av ”Handlingsplan for å forebygge sykehusinfeksjoner 2004 – 2006.”\ud
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Ved tilsynet avdekket Helsetilsynet at organiseringen av smittevernpersonellet ved flere helseforetak ikke var i samsvar med myndighetskravene. Personellressursene avsatt til smittevernarbeid var heller ikke tilstrekkelig over alt. I halvparten av helseforetakene var antallet og fordelingen av isolat betydelig lavere enn ønskelig. I tillegg var ikke alle isolatene i samsvar med Isoleringsveilederens anbefalinger. Ikke alle helseforetakene sikret at arbeidstakerne gjennomgikk nødvendige undersøkelser for MRSA og tuberkulose. Det var mangler ved vedlikehold, oppdatering og etterlevelse av infeksjonskontrollprogrammet ved noen helseforetak.\ud
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Arbeidstilsynet konkluderte med at smittevernarbeidet ikke var tilstrekkelig prioritert i de fleste av helseforetakene. Det var laget systemer for smittevernet ut fra smittevernloven, mens arbeidsmiljølovens forskrifter syntes mindre kjent. Avvikssystemene fungerte heller ikke optimalt flere steder. Toppledelsens oppbakking og kontroll av smittevernarbeidet virket ofte mangelfull. Ved flere av helseforetakene påpekte Arbeidstilsynet at det var utilstrekkelig med smittevernpersonell. Systematiske risiko- og sårbarhetsanalyser manglet de fleste steder. Rutiner for vaksinering sikret ikke at alle med behov fikk tilbud. Smittevernopplæringen gikk stort sett inn i annen opplæring. De fleste steder fikk ikke de ansatte smittevernundervisning før de ble satt i arbeid med smitterisiko. Elektroniske infeksjonskontrollprogram ble av mange oppfattet som vanskelig tilgjengelig. Ved ett helseforetak hadde ikke verneombudet praktisk mulighet til å ivareta sine lovpålagte oppgaver. Et annet helseforetak hadde ikke oppdaterte prosedyrer for HMS.SUMMARY IN ENGLISH: The Norwegian Board of Health Supervision and the Norwegian Labour Inspection Authority\ud
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In the autumn of 2006, the Norwegian Board of Health Supervision and the Norwegian Labour Inspection Authority carried out supervision of isolation of contact infection and air-borne infection at ten health trusts. This was carried out as part of the Labour Inspection Authority’s campaign Be on your Guard (God Vakt) and as a follow-up of the Norwegian Government’s Plan of Action for the Prevention of Hospital Infections 2004-2006. \ud
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Supervision showed that organization of personnel responsible for control of infection at several of the health trusts was not in accordance with the requirements laid down by the authorities. Also, personnel resources allocated to control of infection were not always sufficient. In half of the health trusts, the number of isolation units was considerably lower than was desirable. In addition, not all isolation units were run in accordance with the recommendation in the Guidelines for Isolation Units. Not all the health trusts ensured that all staff had been tested for MRSA (Methicillin-resistant Staphylococcus aureus) and tuberculosis. Some of the health trusts did not adequately ensure that the infection control programme was followed, maintained and updated.\ud
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The Norwegian Labour Inspection Authority concluded that work with control of infection was not given adequate priority by most of the health trusts. Systems for control of infection were developed according to the Communicable Diseases Control Act, but the regulations in the Working Environment Act seemed to be less well known. Also, the systems for dealing with nonconformities were inadequate in many places. Not all the top leaders supported and controlled work with control of infection adequately. At several of the health trusts, the Norwegian Labour Inspection Authority pointed out that it is not sufficient just to have personnel with responsibility for control of infection. Systematic risk and vulnerability analyses were not carried out in most places. Routines for vaccination did not ensure that everyone who needed to be vaccinated were offered this. Training in control of infection was largely incorporated in training in other areas. In most places, the staff had not been given training in control of infection before they began to work in situations where there was a risk of infection. Many of the staff regarded access to electronic infection control programmes as difficult. In one health trust, the health and safety officer did not have the possibility to carry out his duties in accordance with statutory requirements. In another health trust, there were no updated procedures for work with health and safety
Foresattes vurderinger av tilbudet ved barne- og ungdomspsykiatriske poliklinikker i 2006 Resultater fra en nasjonal undersøkelse
No full textNORSK SAMMENDRAG: Høsten 2006 gjennomførte Nasjonalt kunnskapssenter for helsetjenesten en\ud
spørreundersøkelse blant foresatte til barn og ungdom som mottar et tilbud fra barneog\ud
ungdomspsykiatriske poliklinikker i Norge. Totalt har 7906 foresatte svart på en\ud
rekke spørsmål om sine erfaringer med tilbudet. Undersøkelsen har en svarprosent på\ud
46 og representativiteten er tilfredsstillende. Det er utarbeidet tre rapporter fra\ud
undersøkelsen: den foreliggende rapporten med hovedresultater, en metoderapport\ud
og en rapport med institusjonsresultater.\ud
De foresatte rapporterte i hovedsak positive erfaringer med de barne- og\ud
ungdomspsykiatriske poliklinikkene. Resultatene er oppsummert i tre hovedområder\ud
som handler om behandlerne, informasjon/ medbestemmelse og utbytte. De\ud
nasjonale resultatene på disse hovedområdene varierte fra 59 for informasjon/\ud
medbestemmelse til 75 for behandlerne, på en skala fra 0 til 100, hvor 100 er best\ud
mulige resultat. Utbytte får en skår på 72.\ud
Blant emner som ikke inngikk i hovedområdene var det varierende resultat. For\ud
eksempel svarte 43 prosent av de foresatte at de ventet ganske lenge eller altfor lenge\ud
for å få et tilbud ved poliklinikken. Til sammen 65 prosent mente de hadde blitt\ud
tilbudt et passende antall timer ved poliklinikken. På spørsmål om behandlerne\ud
samarbeidet godt med andre instanser mente 47 prosent at de opplevde dette i stor\ud
eller svært stor grad.\ud
Foresatte i alle helseregioner hadde stort sett positive tilbakemeldinger, og det var\ud
små forskjeller mellom helseregionene. Helse Øst skåret signifikant bedre enn\ud
gjennomsnittet av de andre regionene på hovedområdene behandlere og informasjon/\ud
medbestemmelse. Helse Midt-Norge hadde derimot en signifikant dårligere skåre\ud
enn gjennomsnittet av de andre helseregionene på hovedområdet behandlere. Også\ud
mellom de ulike helseforetakene er det små forskjeller, og få signifikante forskjeller.\ud
Det samme mønsteret gjør seg gjeldende her som i de nasjonale resultatene;\ud
behandlerne kommer best ut i alle helseforetakene, mens\ud
informasjon/medbestemmelse får det svakeste resultatet. Hovedområdet utbytte\ud
plasserer seg mellom disse to for alle helseforetakene.\ud
På alle hovedområder var det stor spredning i resultat mellom de ulike\ud
poliklinikkene, størst spredning på informasjon/ medbestemmelse, hvor beste\ud
gjennomsnitt var 68 og dårligste 48. Det var imidlertid få signifikante forskjeller\ud
mellom poliklinikkene og landssnittet på alle de tre hovedområdene.\ud
2\ud
De foresatte rapporterer altså gode erfaringer med poliklinikkene. Best\ud
tilbakemelding får behandlerne ved poliklinikkene, mens\ud
informasjon/medbestemmelse får dårligst tilbakemelding, og er det området med\ud
størst forbedringspotensial.ENGLISH SUMMARY: During the autumn of 2006 the Norwegian Knowledge Centre for the Health\ud
Services conducted a survey of the next-of-kin of children and adolescents receiving\ud
outpatient psychiatric service. In total, 7906 next-of-kin responded to questions about\ud
their experiences with the service. The survey had a 46% response rate and\ud
representativeness was satisfactory. Three reports are available; the present report\ud
with main results, a methods report, and a report describing results by institutions.\ud
Next-of-kin report mainly positive experiences with the outpatient service. The\ud
results are aggregated in three main dimensions describing therapists, information/\ud
involvement, and outcome. On a scale from 0 to 100, where high scores are\ud
favourable, national level results varied from 59 for information/ involvement to 75\ud
for therapists. For outcome the score was 72.\ud
The results varied among topics that were not included in the dimensions. For\ud
example: 43% answered that they waited too long or far too long for the service;\ud
65% answered that the number of consultations offered were appropriate; and, 47%\ud
perceived to a large or very large extent that the co-operation between the therapists\ud
and other organisations was good.\ud
Scores were generally positive across all of the Regional Health Authorities and the\ud
differences between the regions are small. The Eastern Region scored significantly\ud
higher than the mean of the remaining regions on the therapist and information/\ud
involvement dimensions. Scores for the therapist dimension for Central Region were\ud
significantly lower than the mean of the remaining region. There were few\ud
statistically significant differences when comparisons were made at trust level.\ud
The results varied between the different outpatient clinics for all the dimensions. The\ud
largest variation was for information/ influence, with a score range from 48 to 68.\ud
However, there were few statistically significant differences between single\ud
outpatient clinics and the national mean for the three dimensions
Gene methylation profiles of normal mucosa, and benign and malignant colorectal tumors identify early onset markers.
No full textBACKGROUND: Multiple epigenetic and genetic changes have been reported in colorectal tumors, but few of these have clinical impact. This study aims to pinpoint epigenetic markers that can discriminate between non-malignant and malignant tissue from the large bowel, i.e. markers with diagnostic potential. The methylation status of eleven genes (ADAMTS1, CDKN2A, CRABP1, HOXA9, MAL, MGMT, MLH1, NR3C1, PTEN, RUNX3, and SCGB3A1) was determined in 154 tissue samples including normal mucosa, adenomas, and carcinomas of the colorectum. The gene-specific and widespread methylation status among the carcinomas was related to patient gender and age, and microsatellite instability status. Possible CIMP tumors were identified by comparing the methylation profile with microsatellite instability (MSI), BRAF-, KRAS-, and TP53 mutation status. RESULTS: The mean number of methylated genes per sample was 0.4 in normal colon mucosa from tumor-free individuals, 1.2 in mucosa from cancerous bowels, 2.2 in adenomas, and 3.9 in carcinomas. Widespread methylation was found in both adenomas and carcinomas. The promoters of ADAMTS1, MAL, and MGMT were frequently methylated in benign samples as well as in malignant tumors, independent of microsatellite instability. In contrast, normal mucosa samples taken from bowels without tumor were rarely methylated for the same genes. Hypermethylated CRABP1, MLH1, NR3C1, RUNX3, and SCGB3A1 were shown to be identifiers of carcinomas with microsatellite instability. In agreement with the CIMP concept, MSI and mutated BRAF were associated with samples harboring hypermethylation of several target genes. CONCLUSION: Methylated ADAMTS1, MGMT, and MAL are suitable as markers for early tumor detection
Miljøkonsekvenser og regulering av potensiell thoriumrelatert industri i Norge
No full textRapporten gir en introduksjon til fagfeltet thoriumbasert kjernekraft, drøfter potensielle\ud
miljøkonsekvenser av evt. fremtidig thoriumrelatert industri i Norge og regulering av slik\ud
virksomhet. Miljøkonsekvensene for drift av thoriumbaserte konvensjonelle reaktorer vil\ud
inkludere produksjon av radioaktivt avfall, utslipp av radioaktive stoffer til luft og vann, og\ud
reaktorene vil representere en ulykkesrisiko.The report provides a basic introduction to thoriumbased nuclear power for the non-expert, as\ud
well as a discussion on potential environmental impact from potential thoriumbased industry in\ud
Norway in the future, and regulation of such activities. Environmental impact from thoriumbased\ud
nuclear power will include production of radioactive waste, discharges of radioactive substances\ud
and the reactors will represent a potential accidental risk
Findings and recommendations from an international comparison of models and approaches for the estimation of radiological exposure to non-human biota
No full textBeresford NA et al. Findings and recommendations from an international comparison of models and approaches for the estimation of radiological exposure to non-human biota.\ud
In: International conference on radioecology and environmental radioactivity 15-20 June, 2008, in Bergen : Proceedings : Posters / Edited by Per Strand, Justin Brown and Torun Jølle / Organised by Norwegian Radiation Protection Authority and Institut de Radioprotection et de Sûreté Nucléaire, IRSN, et al. - Østerås : Norwegian Radiation Protection Authority, 2008. Bind 1: 234-23
Epidermal growth factor receptor levels are reduced in mice with targeted disruption of the protein kinase A catalytic subunit.
No full textBACKGROUND: Epidermal Growth Factor Receptor (EGFR) is a key target molecule in current treatment of several neoplastic diseases. Hence, in order to develop and improve current drugs targeting EGFR signalling, an accurate understanding of how this signalling pathway is regulated is required. It has recently been demonstrated that inhibition of cAMP-dependent protein kinase (PKA) induces a ligand-independent internalization of EGFR. Cyclic-AMP-dependent protein kinase consists of a regulatory dimer bound to two catalytic subunits. RESULTS: We have investigated the effect on EGFR levels after ablating the two catalytic subunits, Calpha and Cbeta in two different models. The first model used targeted disruption of either Calpha or Cbeta in mice whereas the second model used Calpha and Cbeta RNA interference in HeLa cells. In both models we observed a significant reduction of EGFR expression at the protein but not mRNA level. CONCLUSION: Our results suggest that PKA may represent a target that when manipulated can maintain EGFR protein levels at the single cell level as well as in intact animals