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In an observational prospective study, feasibility and outcomes of a dedicated multidisciplinary rehabilitation program (HNR) for head and neck cancer (HNC) patients were evaluated. HRQoL was assessed before and after HNR with EORTC C30 and H&N-35 QoL questionnaires in 52 consecutive patients. Initial HRQoL scores were compared with EORTC reference scores for HNC patients and post-HNR with those available for the general healthy population. Distress was assessed before and after HNR with the distress thermometer (DT). At completion of HNR with a mean duration of 7 months, overall HRQoL was significantly improved (p < 0.001). Role, Emotional, and Social function scales and most EORTC C30 and H&N35 symptom scale items showed a statistically significant (p < 0.01) and clinically relevant improvement. Mean distress score before HNR was above the cutoff value of 5, suggesting the need for referral to rehabilitation. After completing HNR, distress decreased significantly to 3.0 (p < 0.001). HRQoL pretreatment was poorer than that of the EORTC reference HNC population, whereas at the completion of the HNR program, the HRQoL was comparable to that of the general population reference level. We conclude that a dedicated multidisciplinary HNR program is feasible and suggest that it has a positive impact on HRQoL. The multidisciplinary approach may have added value over mono-disciplinary interventions. However, our results should be judged cautiously due to the observational nature of the study.

Objectives: Data from a vaccine trial and from post-vaccine surveillance in the United Kingdom have suggested that the bivalent HPV-16/18 vaccine offers cross-protection against HPV-6/11 and protection against anogenital warts (AGW). We studied the effect of the bivalent vaccine on genital HPV-6/11 positivity and AGW in the Netherlands.Methods: We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional study among 16- to 24-year-old sexually transmitted infection (STI) clinic attendants. Vaginal self-swabs were analyzed for type specific HPV and AGW were diagnosed at the STI-clinic. Prevalence of HPV-6 and/or HPV-11 and AGW were compared between self-reported vaccinated and unvaccinated women by log-binomial regression analysis, adjusted for demographics and risk behavior.Results: Of the 1198 women included, 56% reported to be vaccinated at least once. Relative to unvaccinated women, the adjusted prevalence ratio (PR) for HPV-6/11 was 1.03 (95% confidence interval [CI] 0.74-1.43) for women vaccinated at least once. The crude PR for AGW was 0.67 (95% CI 0.22-2.07) for women vaccinated at least once. Adjustment did not change these results.Conclusions: We observed no cross-protective effect of the bivalent vaccine on genital HPV-6/11 positivity and a non-significant partially protective effect on AGW. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association.

To manage environmental problems in an adequate way, it is essential to take different spatial scales into consideration. As a tool for decision making, it would be beneficial if valuation methods take spatial scales into account as well. In this article, we review the valuation literature with regard to the spatial scales of environmental public goods and services to which the contingent valuation method, hedonic pricing method, and travel cost method have been applied in the past. We classified 117 environmental case studies to the local, landscape/watershed, regional, and global scales. These case studies cover a broad range of environmental goods and services, such as green space in a city, air quality, rivers, natural areas, and a stable climate system. Additionally, we took into account the year of publication of the case studies. Our results show that the majority of the environmental case studies are related to the local and landscape/watershed scales. However, the number of case studies on the regional and global scales has been increasing in recent years. This article argues that such a change in spatial scale calls for a debate on scaling issues in the field of environmental valuation.

Current economic instruments aimed at climate change mitigation focus on CO2 emissions only, but the Kyoto Protocol refers to other greenhouse gases (GHG) as well as CO2. These are CH4, N2O, HFCs, PFCs and SF6. Taxation of multiple greenhouse gases improves the cost-effectiveness of climate change mitigation. It is not yet clear, however, what the effect is of multigas taxation on the distribution of the tax burden across income groups. This paper examines and compares distributional effects of a CO2 tax and a comprehensive tax that covers all six GHG of the Kyoto Protocol. The study concentrates on the Netherlands in the year 2000. We established tax rates on the basis of marginal abatement cost curves and the Dutch policy target. The distributional effects have been determined by means of environmentally extended input−output analysis and data on consumer expenditures. Our results show that taxation of multiple GHG improves not only the cost-effectiveness of climate change mitigation, but also distributes the tax burden more equally across income groups as compared to a CO2 tax. These findings are relevant for the debate on the role of non-CO2 GHG in climate change mitigation.

An infant with moderate muscular hypotonia and congenital lactic acidosis died suddenly at the age of 3 months. Autopsy revealed no abnormalities responsible for this unexpected death. Measurement of mitochondrial enzymes involved in energy production indicated a severely decreased total pyruvate dehydrogenase complex (PDHC) activity in muscle tissue (0.23 nmoles x min-1 x mg protein-1, control range 2.8-8.7) and moderately decreased PDHC activity in fibroblasts (0.27 nmoles x min-1 x mg protein-1, control range 0.37-2.32). The activity of the first component E1 (pyruvate dehydrogenase) in muscle tissue was 10 times lower than that of controls (0.008 nmoles x min-1 x mg protein-1, control range 0.10-0.25). The activities of dihydrolipoyl dehydrogenase (E3) and various other mitochondrial enzymes were normal. Immunochemical analysis in skeletal muscle tissue and fibroblasts demonstrated a decrease in the amount of the alpha and beta subunits of E1. The features of this patient are compared with those of other patients reported in the literature with immunochemically confirmed combined E1 alpha and beta deficiency.

Lewis,1 using dogs and cats, was able to demonstrate that the minute output of the heart was decreased about 20% when the auricles were caused to fibrillate by faradic stimulation. He made the observation also that the more rapid the ventricular rate, the greater the decrease in minute volume.Eyster and Swarthout,2 in similar experiments on dogs, were able to produce a decrease in minute volume of from 15-79% when the auricles were caused to fibrillate. The ventricular rate in their experiments was increased after fibrillation was induced so that the actual decrease in minute volume cannot be entirely attributed to the fibrillation of the auricles.Smith, Walker and Alt3 found that the minute volume increased approximately 30% when normal rhythm was restored by quinidine in cases of auricular fibrillation which had been previously compensated by digitalis. Realizing that in mitral stenosis auricular contraction plays an appreciable role in the filling of the left ventricle, we used only mitral stenosis cas...

Physicians must keep well abreast of current developments in drug therapy to provide adequate and proper treatment of cardiac conditions. From his own experience, the author reviews the use of digitalis, rhythm-regulatory drugs, coronary dilators, cardiac stimulants, diuretics, antihypertensive agents and anticoagulants. He cautions that older therapeutic agents should not be discarded until the newer ones have been proved effective.

Excerpt The proteins of the blood plasma being hydrophilic colloids in solution must exert an osmotic pressure. This osmotic pressure measures the momentum of the impacts made by the colloid partic...

Excerpt Numerous investigators have produced edema by a reduction of the plasma proteins. The reduction of the plasma proteins by repeated bleedings is called plasmapheresis. Leiter1,2and Barker an...