Reconstructing landscape evolution in the Lower Khuzestan plain (SW Iran): integrating imagery, historical and sedimentary archives

During the late Holocene, an avulsion-controlled Karun megafan developed in the Lower Khuzestan plain. Based on the interpretation of satellite data, at least three different Karun channels were detected. A chronological framework is provided by archaeological sites and textual sources. The presence of extensive irrigation systems highlights the important role of human activity in the development of the plain. In addition, there is clear evidence of human actions (construction and destruction of dams) which caused repeated avulsions in the lower reaches of the present-day Karun. Similar impacts may have contributed to other channel shifts in historical times

Characteristics of direct human impacts on the rivers Karun and Dez in lowland south-west Iran and their interactions with earth surface movements

Two of the primary external factors influencing the variability of major river systems, over river reach scales, are human activities and tectonics. Based on the rivers Karun and Dez in south-west Iran, this paper presents an analysis of the geomorphological responses of these major rivers to ancient human modifications and tectonics. Direct human modifications can be distinguished by both modern constructions and ancient remnants of former constructions that can leave a subtle legacy in a suite of river characteristics. For example, the ruins of major dams are characterised by a legacy of channel widening to 100's up to c. 1000 m within upstream zones that can stretch to channel distances of many kilometres upstream of former dam sites, whilst the legacy of major, ancient, anthropogenic river channel straightening can also be distinguished by very low channel sinuosities over long lengths of the river course. Tectonic movements in the region are mainly associated with young and emerging folds with NW–SE and N–S trends and with a long structural lineament oriented E–W. These earth surface movements can be shown to interact with both modern and ancient human impacts over similar timescales, with the types of modification and earth surface motion being distinguishable. This paper examines the geomorphological evidence and outlines the processes involved in the evolution of these interactions through time. The analysis shows how interactions between earth surface movements and major dams are slight, especially after ancient dam collapse. By contrast, interactions between earth surface movements and major anthropogenic river channel straightening are shown to be a key factor in the persistence of long, near-straight river courses. Additionally, it is suggested that artificial river development, with very limited river channel lateral migration, may promote incision across an active fold at unusually long distances from the fold “core” and may promote markedly increased sinuosity across a structural lineament

Organisatiekracht in bewonersinitiatieven:ondersteuning en activering van bewonersgroepen, in het kader van het Actieprogramma Sociale Vitaliteit van het Woon- en Leefbaarheidsplan Eemsdelta Leeft!

In het kader van het Actieprogramma Sociale Vitaliteit (WLP Eemsdelta leeft!) hebben sociaalwerkers van twee welzijnsorganisaties (ASWA - Appingedam en SW&D, Delfzijl) bewonersgroepen in drie gemeenten (Delfzijl, Appingedam en Loppersum) ondersteund voor de ontwikkeling van hun organisatiekracht ten behoeve van initiatieven voor leefbaarheid in het dorp, de buurt of de straat. De focus lag op de bewoners - hoe ontwikkelen zij zich, de sociaalwerkers - hoe sluiten zij aan bij de bewoners en de gemeentelijke contactpersonen - hoe faciliterend zijn zij? Uit het begeleidende onderzoek dat een activerend karakter had bleek vooral dat de bewoners hun organisatiekracht hoog inschatten, terwijl in de praktijk bleek dat de groepen (deels) uiteen vielen of hun doelen niet bereikten. Sociaalwerkers moeten dan ook meer aandacht besteden aan bronnen en oorzaken voor conflicten om de continuiteit in de groep te waarborgen. Gemeentelijke medewerkers bleken voor bewonersgroepen vaak onbereikbaar of onvoldoende behulpzaam. In de periode van het activerend onderzoek zijn de verbeterpunten ter harte genomen, in die zin heeft het activerend onderzoek gewerkt. De vragenlijst waarmee de organisatiekracht van bewoners is onderzocht is beschikbaar en als bijlage aan het rapport toegevoegd

The effect of PD-L1 testing on the cost-effectiveness and economic impact of immune checkpoint inhibitors for the second-line treatment of NSCLC

Background: Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab, pembrolizumab, and atezolizumab with and without the use of PD-L1 testing for patient selection. Design: We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line immunotherapy versus docetaxel. The model used outcomes data from randomized clinical trials (RCTs) and drug acquisition costs from the United States. Thereafter, we used epidemiologic data to estimate the economic impact of the treatment. Results: We included four RCTs (2 with nivolumab, 1 with pembrolizumab, and 1 with atezolizumab). The incremental quality-adjusted life year (QALY) for nivolumab was 0.417 among squamous tumors and 0.287 among non-squamous tumors and the incremental cost-effectiveness ratio (ICER) were $155 605 and$187 685, respectively. The QALY gain in the base case for atezolizumab was 0.354 and the ICER was $215 802. Compared with treating all patients, the selection of patients by PD-L1 expression improved incremental QALY by up to 183$98 421. Patient selection also reduced the budget impact of immunotherapy. Conclusion: The use of PD-L1 expression as a biomarker increases cost-effectiveness of immunotherapy but also diminishes the number of potential life-years saved.info:eu-repo/semantics/publishedVersio

Gevolgen van een moeilijke kippenjeugd

Kippengeluk wordt al bepaald in het ei. Een kuiken dat op de juiste temperatuur is uitgebroed is gezonder en waarschijnlijk ook minder angstig dan soortgenoten die het in het ei te heet of te koud hebben gehad. Ook de eerste levensweken van een kip blijken van grote invloed op de latere gezondheidstoestand van het die

Addition of cetuximab to first-line chemotherapy in patients with advanced non-small-cell lung cancer: a cost-utility analysis

Background: Adding cetuximab to standard chemotherapy results in a moderate increase of overall survival in patients with advanced non-small-cell lung cancer (NSCLC), but the cost-effectiveness is unknown. Materials and methods: A Markov model was constructed based on the results of the First-Line ErbituX in lung cancer randomized trial, adding cetuximab to cisplatin-vinorelbine first-line chemotherapy in patients with advanced NSCLC. The primary outcome was the incremental cost-effectiveness ratio (ICER) of adding cetuximab, expressed as cost per quality-adjusted life year (QALY) gained, and relative to a willingness-to-pay threshold of €60 000/QALY. The impact of cetuximab intermittent dosing schedules on the ICER was also evaluated. Results: Adding cetuximab to standard chemotherapy leads to a gain of 0.07 QALYs per patient at an additional cost of €26 088. The ICER for adding cetuximab to chemotherapy was €376 205 per QALY gained. Intermittent cetuximab dosing schedules resulted in ICERs per QALY gained between €31 300 and €83 100, under the assumption of equal efficacy. Conclusions: From a health economic perspective, the addition of cetuximab to standard first-line chemotherapy in patients with epidermal growth factor receptor-expressing advanced NSCLC cannot be recommended to date, due to a high ICER compared with other health care interventions. Treatment schedules resulting in more favorable cost-utility ratios should be evaluate

Early detection of Alzheimer's disease using the Cambridge Cognitive Examination (CAMCOG)

Dementia screening instruments, such as the Cambridge Cognitive Examination (CAMCOG), measure a variety of cognitive functions. However, memory impairment generally is the first sign of Alzheimer's disease (AD). It seems logical, therefore, to use only memory-related items for the early detection of AD. We divided the CAMCOG into a memory section and a non-memory section, and tested the hypothesis that the memory section predicts AD better than the non-memory section. We also provide normative data for both sections. Normal subjects (N = 169) and patients with incident AD (i.e. satisfying AD criteria between 1 and 3 years from baseline: N = 25) were participants in the Amsterdam Study of the Elderly (AMSTEL), a population-based longitudinal study on cognitive decline and dementia. Patients with prevalent AD (i.e. satisfying AD criteria at baseline: N = 155) were either recruited in a memory clinic or came from AMSTEL. Normal subjects were cognitively intact at baseline and remained so for at least 3 years. The CAMCOG was administered to all subjects. AD was diagnosed by DSM-III-R criteria. Logistic regression analysis showed that the memory section was related to prevalent AD, whereas in multivariate analysis the non-memory section was not (after correction for the memory score and demographic characteristics). A similar analysis showed that the memory section predicted incident AD, as did a higher score on the non-memory section. The MMSE did not predict incident AD better than age alone. For the early detection of AD it is best to use the memory and non-memory sections separately instead of the total CAMCOG scor

Trastuzumab beyond progression: a cost-utility analysis

Background: The continuation of trastuzumab beyond progression in combination with capecitabine as secondary chemotherapy for HER2-positive metastatic breast cancer (MBC) prolongs progression-free survival without a substantial increase in toxicity. Patients and methods: A Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Information on response rates and major adverse effects was derived, and transition probabilities were estimated, based on the results of the Breast International Group 03-05 clinical trial. Direct costs were assessed from the perspective of the Swiss health care system. Results: The addition of trastuzumab to capecitabine is estimated to cost on average an additional of €33 980 and to yield a gain of 0.35 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio of €98 329/QALYs gained. Probabilistic sensitivity analysis showed that the willingness-to-pay threshold of €60 000/QALY was reached in 12% of cases. Conclusion: The addition of trastuzumab to capecitabine in MBC patients is more expensive than what is typically regarded as cost-effective but falls within the value ranges found for established regimens in the treatment of MB

Structural properties of crumpled cream layers

The cream layer is a complex heterogeneous material of biological origin which forms spontaneously at the air-milk interface. Here, it is studied the crumpling of a single cream layer packing under its own weight at room temperature in three-dimensional space. The structure obtained in these circumstances has low volume fraction and anomalous fractal dimensions. Direct means and noninvasive NMR imaging technique are used to investigate the internal and external structure of these systems.Comment: 9 pages, 4 figures, accepted in J. Phys. D: Appl. Phy