Environmental Nakba: Environmental injustice and violations of the Israeli occupation of Palestine

This report is funded in part by the European Commission. The content of the report is the exclusive responsibility of the producers and does not reflect the position of the European Commission.AmsterdamA report of the Friends of the Earth International observer mission to the West Bankdiv_PaSAlternative Information Center (AIC), 2011, 'State Comptroller Report: Industrial Zones in Judea and Samaria and the Rural Sector' http://www.alternativenews.org/english/index.php/features/economy-of-theoccupation/ 4481-west-bank-industrial-zones-endanger-lives-break-laws.html Al-Sheikh, B., 2010. IUCN Country Report 'Important Plant Areas in Palestine' B'Tselem, 2009 'Foul Play: Neglect of Wastewater Treatment in the West Bank' Korzom, May (2009), 'Walls of Racism: the colonial motives for environmental destruction in Palestine' http://www.maanctr. org/magazine/Archive/Issue14/index.htm Isaac, Jad& Hilal, Jane (2011): 'Palestinian landscape and the Israeli - Palestinian conflict', International Journal of Environmental Studies, 68:4, 413-429 Koppelman and Alshalalfeh 2012 'The Human right to Water in Palestine', Lifesource http://www.blueplanetproject.net/documents/RTW/RTW-Palestine-1.pdf Land Resource Center (LRC) 2006 'Wadi Qana polluted by Israeli settlements' http://www.poica.org/editor/case_studies/view.php?recordID=923 Masalha, Nur 2012, The Palestine Nakba, Zed books Pappe, Ilan 2006, The Ethnic Cleansing of Palestine, Oneworld Publications UNCHA 2012 'How Dispossession Happens: The Humanitarian Impact of the Takeover of Palestinian Water Springs by Israeli Settlers.', Special Focus, March 2012pub3282pu

Risk-prediction models in postmenopausal patients with symptoms of suspected ovarian cancer in the UK (ROCkeTS): a multicentre, prospective diagnostic accuracy study

Background: Multiple risk-prediction models are used in clinical practice to triage patients as being at low risk or high risk of ovarian cancer. In the ROCkeTS study, we aimed to identify the best diagnostic test for ovarian cancer in symptomatic patients, through head-to-head comparisons of risk-prediction models, in a real-world setting. Here, we report the results for the postmenopausal cohort. Methods: In this multicentre, prospective diagnostic accuracy study, we recruited newly presenting female patients aged 16–90 years with non-specific symptoms and raised CA125 or abnormal ultrasound results (or both) who had been referred via rapid access, elective clinics, or emergency presentations from 23 hospitals in the UK. Patients with normal CA125 and simple ovarian cysts of smaller than 5 cm in diameter, active non-ovarian malignancy, or previous ovarian malignancy, or those who were pregnant or declined a transvaginal scan, were ineligible. In this analysis, only postmenopausal participants were included. Participants completed a symptom questionnaire, gave a blood sample, and had transabdominal and transvaginal ultrasounds performed by International Ovarian Tumour Analysis consortium (IOTA)-certified sonographers. Index tests were Risk of Malignancy 1 (RMI1) at a threshold of 200, Risk of Malignancy Algorithm (ROMA) at multiple thresholds, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX) at thresholds of 3% and 10%, IOTA SRRisk model at thresholds of 3% and 10%, IOTA Simple Rules (malignant vs benign, or inconclusive), and CA125 at 35 IU/mL. In a post-hoc analysis, the Ovarian Adnexal and Reporting Data System (ORADS) at 10% was derived from IOTA ultrasound variables using established methods since ORADS was described after completion of recruitment. Index tests were conducted by study staff masked to the results of the reference standard. The comparator was RMI1 at the 250 threshold (the current UK National Health Service standard of care). The reference standard was surgical or biopsy tissue histology or cytology within 3 months, or a self-reported diagnosis of ovarian cancer at 12 month follow-up. The primary outcome was diagnostic accuracy at predicting primary invasive ovarian cancer versus benign or normal histology, assessed by analysing the sensitivity, specificity, C-index, area under receiver operating characteristic curve, positive and negative predictive values, and calibration plots in participants with conclusive reference standard results and available index test data. This study is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN17160843). Findings: Between July 13, 2015, and Nov 30, 2018, 1242 postmenopausal patients were recruited, of whom 215 (17%) had primary ovarian cancer. 166 participants had missing, inconclusive, or other reference standard results; therefore, data from a maximum of 1076 participants were used to assess the index tests for the primary outcome. Compared with RMI1 at 250 (sensitivity 82·9% [95% CI 76·7 to 88·0], specificity 87·4% [84·9 to 89·6]), IOTA ADNEX at 10% was more sensitive (difference of –13·9% [–20·2 to –7·6], p<0·0001) but less specific (difference of 28·5% [24·7 to 32·3], p<0·0001). ROMA at 29·9 had similar sensitivity (difference of –3·6% [–9·1 to 1·9], p=0·24) but lower specificity (difference of 5·2% [2·5 to 8·0], p=0·0001). RMI1 at 200 had similar sensitivity (difference of –2·1% [–4·7 to 0·5], p=0·13) but lower specificity (difference of 3·0% [1·7 to 4·3], p<0·0001). IOTA SRRisk model at 10% had similar sensitivity (difference of –4·3% [–11·0 to –2·3], p=0·23) but lower specificity (difference of 16·2% [12·6 to 19·8], p<0·0001). IOTA Simple Rules had similar sensitivity (difference of –1·6% [–9·3 to 6·2], p=0·82) and specificity (difference of –2·2% [–5·1 to 0·6], p=0·14). CA125 at 35 IU/mL had similar sensitivity (difference of –2·1% [–6·6 to 2·3], p=0·42) but higher specificity (difference of 6·7% [4·3 to 9·1], p<0·0001). In a post-hoc analysis, when compared with RMI1 at 250, ORADS achieved similar sensitivity (difference of –2·1%, 95% CI –8·6 to 4·3, p=0·60) and lower specificity (difference of 10·2%, 95% CI 6·8 to 13·6, p<0·0001). Interpretation: In view of its higher sensitivity than RMI1 at 250, despite some loss in specificity, we recommend that IOTA ADNEX at 10% should be considered as the new standard-of-care diagnostic in ovarian cancer for postmenopausal patients. Funding: UK National Institute of Heath Research

Organisation of a quality assurance system for animal trichinellosis diagnosis in France : results of the ring trials

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