Contingency Test Research Articles

Cost-effectiveness of cell-free DNA in maternal blood testing for prenatal detection of trisomy 21, 18 and 13: a systematic review.

The aim of this paper was to conduct a systematic review of the cost-effectiveness of the analysis of cell-free DNA in maternal blood, often called the non-invasive prenatal test (NIPT), in the prenatal screening of trisomy in chromosomes 21, 18 and 13. MEDLINE, MEDLINE in process, EMBASE, and Cochrane Library were searched in April 2017. We selected: (1) economic evaluations that estimated the costs and detected cases of trisomy 21, 18 or 13; (2) comparisons of prenatal screening with NIPT (universal or contingent strategies) and the usual screening without NIPT, (3) in pregnant women with any risk of foetal anomalies. Studies were reviewed by two researchers. Data were extracted, the methodological quality was assessed and a narrative synthesis was prepared. In total, 12 studies were included, four of them performed in Europe. Three studies evaluated NIPT as a contingent test, three studies evaluated a universal NIPT, and six studies evaluated both. The results are heterogeneous, especially for the contingent NIPT where the results range from NIPT being dominant to a dominated strategy. Universal NIPT was found to be more effective but also costlier than the usual screening, with very high incremental cost-effectiveness ratios. One advantage of screening with NIPT is lower invasive procedure-related foetal losses than with usual screening. In conclusion, the cost-effectiveness of contingent NIPT is uncertain according to several studies, while the universal NIPT is not cost-effective currently.

Consumers´ purchasing preferences towards organic food in Slovakia

Submitted paper deals with the consumers´ purchasing preferences towards organic food in Slovakia, pointing at the situation on the organic food market in Slovakia finding the consumers' preferences when buying organic food. The results of the questionnaire survey identified the preferences and opinions of respondents about organic food. Paper analyses the questionnaire survey by 227 respondents concerning the purchasing preferences towards organic food in Slovakia. In order to achieve given aim and to ensure deeper analysis of the results, there had been stated 3 assumptions and 5 hypothesis. As the results of the survey proved, 65% of respondents buy organic food, of which 39% of respondents buy organic food at least once a week. Up to 98% of respondents have already met the concept of organic food and know what it means. 37 % of respondents buy mostly organic fruit and vegetables, 18% of respondents buy the most the meat and meat products in organic quality and 13% of respondents prefer dairy products in organic quality. The most preferred place to buy organic food are specialized stores (36 %),to buy organic food directly from the producer is the most popular way for 29 % of respondents, hypermarket and supermarkets are favorite place to buy organic food for 19% of respondents, and 12% of respondents buy organic food mostly in farmers´ markets. Only 4% of respondents prefer another way to buy organic food. Quality of organic food and not using the pesticides is the most important criteria for buying organic food (36%). Price has also really strong influence on purchasing decision, when 34% of respondents are the most affected by the price when purchasing organic food. Package is considered as the least important criteria when buying organic food by 72% of respondents. On the basis of provided results of our survey and formulated hypothesis which were evaluated by Chi-square goodness of fit test, Chi square test of the square contingency and Kolmogorov-Smirnov test. Based on research can be concluded that there is a difference in preferences of respondents. In Slovakia exists the dependence between the consumers´ preferences towards organic food and conventional food product and there are strong preferences for buying the organic food.

Sequential combined test, second trimester maternal serum markers, and circulating fetal cells to select women for invasive prenatal diagnosis.

From January 1st 2013 to August 31st 2016, 24408 pregnant women received the first trimester Combined test and contingently offered second trimester maternal serum screening to identify those women who would most benefit from invasive prenatal diagnosis (IPD). The screening was based on first trimester cut-offs of ≥1:30 (IPD indicated), 1:31 to 1:899 (second trimester screening indicated) and ≤1:900 (no further action), and a second trimester cut-off of ≥1:250. From January 2014, analysis of fetal cells from peripheral maternal blood was also offered to women with positive screening results. For fetal Down syndrome, the overall detection rate was 96.8% for a false-positive rate of 2.8% resulting in an odds of being affected given a positive result (OAPR) of 1:11, equivalent to a positive predictive value (PPV) of 8.1%. Additional chromosome abnormalities were also identified resulting in an OAPR for any chromosome abnormality of 1:6.6 (PPV 11.9%). For a sub-set of cases with positive contingent test results, FISH analysis of circulating fetal cells in maternal circulation identified 7 abnormal and 39 as normal cases with 100% specificity and 100% sensitivity. We conclude that contingent screening using conventional Combined and second trimester screening tests is effective but can potentially be considerably enhanced through the addition of fetal cell analysis.

A Study of the Natural History of Vitreomacular Traction Syndrome by OCT

To examine the natural history of vitreomacular traction syndrome (VMTS) in the absence of other ocular comorbidities. Retrospective clinical case series. A total of 183 eyes of 159 patients diagnosed with VMTS with no other ocular comorbidity. Patients with VMTS were identified from an OCT database at Moorfields Eye Hospital, London. Sequential OCT scans and patient notes were reviewed over a minimum period of 6 months. Data collected included patient demographics, best-corrected visual acuity, and OCT features of vitreomacular adhesion. Contingency tests and binary logistic modeling were used to identify baseline predictors of stability and progression. The rates of spontaneous resolution (defined by release of traction), progression to full-thickness macular hole, and surgical intervention were analyzed. Presenting visual acuity was 0.3±0.3 logMAR units. The mean length of follow-up was 17.4±12.1 months. During this period, VMTS persisted in 60% and resolved in 20% (occurring on average at 15 months). Of the remainder, 12% developed a macular hole and 8% elected to proceed with surgery for symptoms. Focal adhesion <1500 μm was present in 87%. A premacular membrane with macular pucker (PMM) was present in 20%. With persistent VMTS, vision and central foveal thickness remained unchanged. The relative risk of resolution increased in those cases with better presenting visual acuities, lesser foveal thicknesses, and no associated PMMs; vision significantly improved in those cases with resolution. VMTS persists in the majority of patients but despite this, visual acuities did not deteriorate significantly over the study period unless patients developed a full-thickness macular hole or required surgical intervention for symptoms. Resolution spontaneously occurred in 20%, with an improvement in vision.

An NRG Oncology/GOG study of molecular classification for risk prediction in endometrioid endometrial cancer

ObjectivesThe purpose of this study was to assess the prognostic significance of a simplified, clinically accessible classification system for endometrioid endometrial cancers combining Lynch syndrome screening and molecular risk stratification. MethodsTumors from NRG/GOG GOG210 were evaluated for mismatch repair defects (MSI, MMR IHC, and MLH1 methylation), POLE mutations, and loss of heterozygosity. TP53 was evaluated in a subset of cases. Tumors were assigned to four molecular classes. Relationships between molecular classes and clinicopathologic variables were assessed using contingency tests and Cox proportional methods. ResultsMolecular classification was successful for 982 tumors. Based on the NCI consensus MSI panel assessing MSI and loss of heterozygosity combined with POLE testing, 49% of tumors were classified copy number stable (CNS), 39% MMR deficient, 8% copy number altered (CNA) and 4% POLE mutant. Cancer-specific mortality occurred in 5% of patients with CNS tumors; 2.6% with POLE tumors; 7.6% with MMR deficient tumors and 19% with CNA tumors. The CNA group had worse progression-free (HR 2.31, 95%CI 1.53–3.49) and cancer-specific survival (HR 3.95; 95%CI 2.10–7.44). The POLE group had improved outcomes, but the differences were not statistically significant. CNA class remained significant for cancer-specific survival (HR 2.11; 95%CI 1.04–4.26) in multivariable analysis. The CNA molecular class was associated with TP53 mutation and expression status. ConclusionsA simple molecular classification for endometrioid endometrial cancers that can be easily combined with Lynch syndrome screening provides important prognostic information. These findings support prospective clinical validation and further studies on the predictive value of a simplified molecular classification system.

Emergency planning and business continuity: why blood services must plan for both. How the EBA working group (WG) is assisting blood services

BackgroundIn 2016, the Executive of the European Blood Alliance (EBA) decided to explore whether there was sufficient interest amongst member countries on whether they saw value in the re‐establishment of a Working Group on contingency planning. A survey of members was carried out and as there was sufficient interest a Working Group (WG) was established. The question then was how could the work of the WG add value to member countries in their contingency planning process? We set out to establish this.MethodMembers of the WG decided that there were three areas where the WG should concentrate on and these were as follows: (1) share lessons learnt during past contingencies and response to major disasters, (2) exchange contingency plans and (3) test run of contingency plans. As a first step, it was decided that we would share our existing contingency plans and when these were shared the WG undertook to carry out a gap analysis. It became evident that the state of contingency planning varied across countries. It is vitally important that each BTS ensures that their critical functions of manufacturing, testing and supply management have contingency arrangements in place whether that is within the country or with an international partner. However, having them in place is not enough they must be tested on a regular basis to ensure that they work. It was important that the WG formulated formal terms of reference to inform its work and also to set out clear deliverables. Draft Terms of Reference (ToR) were drawn up and sent to the Board of the EBA for approval in line with the normal procedure for WGs. These have been approved by the Board and are as follows: To share and leverage the knowledge of EBA members so all can move towards best practice (e.g. ISO 22301) To share experience, documentation, risk and other relevant materials and identify common training needs and opportunities. To identify opportunities for mutual aid in business continuity and emergency planning processes, consumables and the provision of services and products and develop these into agreed heads of agreement in bilateral or multilateral mutual aid arrangements. To create routes and mechanisms of communication on business continuity and emergency planning issues between EBA members, and to maintain a forum for discussion on these matters (e.g. EBA newsletter, EBAse). To engage in and lead the conversation on business continuity and emergency planning with the Commission and Competent Authorities to ensure a workable and consistent approach across EBA member states. OutcomeThe work of the group will deliver a better understanding of contingency planning with tangible examples and case studies which demonstrate how these plans have been activated and the lessons learnt from the events that required their activation. Some of the lessons learnt to date are that (1) there can never be too much communication on the contingency arrangements and there must be deputies in place for the main functional leads in the plan because inevitably the event occurs at a weekend where the nominated people are not always available, (2) the carrying out of a desktop exercise can be very useful and can expose any shortcomings in the contingency plan in a safe environment and (3) communication between the BTS and their contingency partner must ensure that any changes by either party are communicated so that any impact is worked through. The work of the WG is continuing.

Locust displacing winds in eastern Australia reassessed with observations from an insect monitoring radar.

Based on previous investigations, adult Australian plague locusts are believed to migrate on warm nights (with evening temperatures >25°C), provided daytime flight is suppressed by surface winds greater than the locusts' flight speed, which has been shown to be 3.1ms-1. Moreover, adult locusts are believed to undertake briefer 'dispersal' flights on nights with evening temperature >20°C. To reassess the utility of these conditions for forecasting locust flight, contingency tests were conducted comparing the nights selected on these bases (predicted nights) for the months of November, January, and March and the nights when locust migration were detected with an insect monitoring radar (actual nights) over a 7-year period. In addition, the wind direction distributions and mean wind directions on all predicted nights and actual nights were compared. Observations at around 395m above ground level (AGL), the height at which radar observations have shown that the greatest number of locusts fly, were used to determine the actual nights. Tests and comparisons were also made for a second height, 990m AGL, as this was used in the previous investigation. Our analysis shows that the proposed criteria are successful from predicting migratory flight only in March, when the surface temperature is effective as a predicting factor. Surface wind speed has no predicting power. It is suggested that a strong daytime surface wind speed requirement should not be considered and other meteorological variables need to be added to the requirement of a warm surface temperature around dusk for the predictions to have much utility.

Beet curly top virus Strains Associated with Sugar Beet in Idaho, Oregon, and a Western U.S. Collection.

Curly top of sugar beet is a serious, yield-limiting disease in semiarid production areas caused by Beet curly top virus (BCTV) and transmitted by the beet leafhopper. One of the primary means of control for BCTV in sugar beet is host resistance but effectiveness of resistance can vary among BCTV strains. Strain prevalence among BCTV populations was last investigated in Idaho and Oregon during a 2006-to-2007 collection but changes in disease severity suggested a need for reevaluation. Therefore, 406 leaf samples symptomatic for curly top were collected from sugar beet plants in commercial sugar beet fields in Idaho and Oregon from 2012 to 2015. DNA was isolated and BCTV strain composition was investigated based on polymerase chain reaction assays with strain-specific primers for the Severe (Svr) and California/Logan (CA/Logan) strains and primers that amplified a group of Worland (Wor)-like strains. The BCTV strain distribution averaged 2% Svr, 30% CA/Logan, and 87% Wor-like (16% had mixed infections), which differed from the previously published 2006-to-2007 collection (87% Svr, 7% CA/Logan, and 60% Wor-like; 59% mixed infections) based on a contingency test (P < 0.0001). Whole-genome sequencing (GenBank accessions KT276895 to KT276920 and KX867015 to KX867057) with overlapping primers found that the Wor-like strains included Wor, Colorado and a previously undescribed strain designated Kimberly1. Results confirm a shift from Svr being one of the dominant BCTV strains in commercial sugar beet fields in 2006 to 2007 to becoming undetectable at times during recent years.

Hubungan Waktu Pemberian MP-ASI Dini dengan Kejadian Diare Pada Bayi Usia 0-12 Bulan di Desa Jaddih Kecamatan Socah Kabupaten Bangkalan

The companion food of breast milk is extra food to baby after six months. The feeding of companion to baby is very influential of diareehea. The reality still many mothers gave early companion food of breast milk to baby under six months. The purpose oh this research to know the age feeding of companion food of breast milk with the diarrhea case to baby of 1-2 months in Jaddih village Socah Bangkalan. The type oh this research is analytic, the design of this research is cross sectional. The pepulation of this research is all of mothers who have baby the old of 0-12 months is 190 og people. The sample of this research using simple random sampling is 129 of people. The independent variable is early feeding of companion food. The dependent of variable is diarrhea case. The colleting methods of the datausing questionnaire.The analyze of this research using coefficient contingency thes is p= 0,05. The result of this research is the most a part of mother gave early companion food of breast milk to baby (87,6%) and the most a part of baby have experience of diarrhea (77,5%). The result of the coefficient contingency test get the value p=0,0001. There are a relationship between the feeding of aerly companion food of breast milk with diarrhea case to baby 0-12 months in Jaddih Village Socah Bangkalan. The conclusion of this research is there relationship between the feeding of early companion food of breast milk with diarrhea case to baby of age 0-12 months.

Can common serum biomarkers predict complicated appendicitis in children?

As appendicitis in children can be managed differently according to the severity of the disease, we investigated whether commonly used serum biomarkers on admission could distinguish between simple and complicated appendicitis. Admission white blood cell (WBC), neutrophil (NEU), and C-reactive protein (CRP) levels were analysed by ROC curve, and Kruskal-Wallis and contingency tests. Patients were divided according to age and histology [normal appendix (NA), simple appendicitis (SA), complicated appendicitis (CA)]. Of 1197 children (NA=186, SA=685, CA=326), 7% were <5years, 55% 5-12, 38% 13-17. CA patients had higher CRP and WBC levels than NA and SA (p<0.0001). NEU levels were lower in NA compared to SA or CA (p<0.0001), but were similar between SA and CA (p=0.6). CA patients had higher CRP and WBC levels than SA patients in 5-12- (p<0.0001) and 13-17-year groups (p=0.0075, p=0.005), but not in <5-year group (p=0.72, p=0.81). We found CRP >40mg/L in 58% CA and 37% SA (p<0.0001), and WBC >15×109/L in 58% CA and 43% SA (p<0.0001). Admission CRP and WBC levels may help the clinician predict complicated appendicitis in children older than 5years of age. Early distinction of appendicitis severity using these tests may guide caregivers in the preoperative decision-making process.

Diagnostic performance and costs of contingent screening models for trisomy 21 incorporating non‐invasive prenatal testing

Contingent screening for trisomy 21 using non-invasive prenatal testing has the potential to reduce invasive diagnostic testing and increase the detection of trisomy 21. To describe the diagnostic and economic performance of prenatal screening models for trisomy 21 that use non-invasive prenatal testing as a contingent screen across a range of combined first trimester screening risk cut-offs from a public health system perspective. Using a hypothetical cohort of 300000 pregnancies, we modelled the outcomes of 25 contingent non-invasive prenatal testing screening models and compared these to conventional screening, offering women with a high-risk (1>300) combined first trimester screening result an invasive test. The 25 models used a range of risk cut-offs. High-risk women were offered invasive testing. Intermediate-risk women were offered non-invasive prenatal testing. We report the cost of each model, detection rate, costs per diagnosis, invasive tests per diagnosis and the number of fetal losses per diagnosis. The cost per prenatal diagnosis of trisomy 21 using the conventional model was $51876 compared to the contingent models which varied from $49309-66686. The number of diagnoses and cost per diagnosis increased as the intermediate-risk threshold was lowered. Results were sensitive to trisomy 21 incidence, uptake of testing and cost of non-invasive prenatal testing. Contingent non-invasive prenatal testing models using more sensitive combined first trimester screening risk cut-offs than conventional screening improved the detection rate of trisomy 21, reduced procedure-related fetal loss and could potentially be provided at a lower cost per diagnosis than conventional screening.

Management of relationship between customer satisfaction and services in hotel industry in Prishtina

Nowadays, when companies more and more are oriented towards the customer, it is important to make a research on customer satisfaction. This paper will describe the management of relationship between customer satisfaction and services in hotel industry in Pristina.In the first part of the paper, review of the literature of different authors, from books and scientific publications. From the literature we achieved to understand customer relationship management, customer satisfaction and relationship between services and customer satisfaction. The literature review helped us to successfully carry out research for understanding the relationship between customer satisfaction and services in hotel industry.The second part of the paper includes research conducted by collecting data through self-administered questionnaire. The survey was conducted in five hotels in Pristina, where respondents through the questionnaire have expressed satisfaction with the services of the hotel. The collected data are presented through different tables, amounting to an analysis of the reliability of variables, the correlation between them and testing hypotheses through multivariate regression and contingency test. From the findings, we concluded that the tangible aspect of the hotel services, the seriousness aspect of the hotel services, the responsiveness aspect of the hotel services and the empathy aspect of the hotel services have a significant relation with customer satisfaction. But, the demographic variables did not have any significant relation with the level of customer satisfaction with services.Finally, from the obtained results it was possible to draw conclusions and recommendations for future researchers in this area.

First trimester contingent screening for trisomies 21,18,13: is this model cost efficient and feasible in public health system?

Purpose: To evaluate the effectiveness of three different first trimester screening models for trisomies 21, 18 and 13, in terms of detection rate, invasive test rate and final costs.Material and methods: We analyzed the distribution of risk for trisomies 21, 18 and 13 in a population of 20,831 singleton pregnancies based on maternal age, fetal heart rate, nuchal translucency, free beta human chorionic gonadotropin and pregnancy-associated plasma protein A (Combined test). On the basis of our data, we estimated the performance and cost of screening for trisomies using three different models at specific cutoffs: Combined test; Cell free DNA test and Contingent screening test.Results: Using Combined test, DR for major trisomies was estimated to be 94.92%, invasive test rate was 6.3%. cfDNA would result in a DR of 97.92%, with an invasive test rate of 3.64%. Contingent screening approach would result in an overall DR of 97.82, with a rate for invasive procedure of 1.36% and a final cost lower than other screening policies (2,338,433 euro vs 5,796,060 of cfDNA and 2,385,473 of Combined test).Conclusions: Contingent screening test could be a cost-efficient and feasible first trimester screening test for aneuploidies in public health system.

VP36 Cost-Effectiveness Of Non-Invasive Prenatal Testing For Down Syndrome

INTRODUCTION:The analysis of cell-free fetal DNA in maternal blood, also called Non-Invasive Prenatal Testing (NIPT), represents an emerging technology and a possible alternative/complement to current prenatal screening based on biochemical and sonographic markers for Down Syndrome (DS) detection.The aim of the study was to compare the application of NIPT with the prenatal diagnosis/screening procedures currently applied in the Basque Country.METHODS:An analytical decision model was developed to assess the costs and consequences, comparing current prenatal screening, NIPT as a contingency test in high-risk cases and NIPT as a first-line screening test. An economic analysis was conducted to determine which strategy was more cost-effective. Sensitivity analyses were performed (1).RESULTS:For a population of 97,074 pregnant women in gestational week 14 and a cut-off point of 1:270, NIPT as a contingent test was not cost-effective, detecting two cases less of DS and causing a lower number of miscarriages related to invasive-testing (4 versus 23) at a slightly lower cost (EUR8,111,351 versus EUR8,901,872).For risk cut-off points of 1:500 or 1:1000 for contingent NIPT, the number of DS cases detected increased, as did the cost. It could be cost-effective compared with current prenatal screening, (EUR61,763 or EUR256,123 per extra DS case detected, respectively).Using the NIPT as a primary test detected more DS cases (296 versus 271) and caused less miscarriages (5 versus 23), at a substantially higher cost (EUR41,395,645 versus EUR8,901,872). Cost-effectiveness analysis indicated that it was more expensive and more effective.Univariant sensitivity-analysis showed that when the price of the NIPT as primary test was EUR76, it was dominant compared with current prenatal screening. It was also cost-effective compared with the NIPT as a contingent test (EUR9,869 per extra DS case detected).CONCLUSIONS:The study shows that NIPT had higher detection rates for DS in different scenarios, but the cost constitutes a limiting factor for implementation in the Basque Health System.

Validity and reliability of a novel patient reported outcome tool to evaluate post-operative dysphagia, odynophagia, and voice (DOV) disability after anterior cervical procedures.

Existing evaluative instruments for dysphagia, odynophagia, and voice disturbance are cumbersome, focus pre-dominately on dysphagia, and often require administration by a certified Speech Pathologist. This study was conducted to utilize widely accepted instruments such as the American Speech and Hearing Association's National Outcomes Measurement System (NOMS) and VAS pain scales to validate a novel, patient-reported instrument that quantifies the severity of post-operative dysphagia, odynophagia, and voice disabilities (DOV). The DOV was developed and subjected to multiple rounds of face and content validation by representative patient cohorts and a panel of clinical experts. An established, prospective clinical registry was utilized to collect pre and post-operative VAS-swallow related pain and DOV measurements for subjects with recent anterior cervical procedures (n=25 content validation, n=20 criterion validation), or recent lumbar decompressions (n=33). NOMS evaluations were performed by a certified Speech Language Pathologist on the first post-operative day after minimally invasive anterior approaches to cervical reconstruction were performed in the criterion validation cohort. Content validity: Subjects with a recent anterior cervical procedure reported a significant increase in post-operative dysphagia (pre-op: 0.13±0.35, post-op: 1.08±1.41, p=0.01), odynophagia (pre-op: 0.24±0.69, post-op: 0.84±0.90, p=0.001), and voice (pre-op: 0.10±0.41, post-op: 0.88±0.92, p=0.0004) disturbance. In contrast, subjects with a recent lumbar procedure did not demonstrate a significant increase in post-operative dysphagia, odynophagia, or voice disturbance (p>0.05).Criterion validity: Chi-squared contingency testing for independence between converted NOMS and DOV instrument scores accepted linkage between the two instruments for dysphagia X2(DF: 12, n=20, Expected: 21.03, Observed: 24.4, p: 0.02) and voice X2(DF: 6, n=20, Expected: 12.60, Observed: 21.28, p: 0.002) dimensions. Similarly, converted swallow related VAS and DOV odynophagia instruments demonstrated linkage X2(DF: 9, n=20, Expected: 16.92, Observed: 24.21, p: 0.004).Internal Reliability: Chronbach's alpha coefficient of reliability was 0.74 between all DOV survey dimensions. The DOV survey is a valid patient-reported instrument to rapidly and reliably detect post-operative swallow and voice dysfunction.

Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part II-women's perspectives.

ObjectiveTo evaluate preferences and decision‐making among high‐risk pregnant women offered a choice between Non‐Invasive Prenatal Testing (NIPT), invasive testing or no further testing.MethodsNationwide implementation study (TRIDENT) offering NIPT as contingent screening test for women at increased risk for fetal aneuploidy based on first‐trimester combined testing (>1:200) or medical history. A questionnaire was completed after counseling assessing knowledge, attitudes and participation following the Multidimensional Measure of Informed Choice.ResultsA total of 1091/1253 (87%) women completed the questionnaire. Of these, 1053 (96.5%) underwent NIPT, 37 (3.4%) invasive testing and 1 (0.1%) declined testing. 91.7% preferred NIPT because of test safety. Overall, 77.9% made an informed choice, 89.8% had sufficient knowledge and 90.5% had positive attitudes towards NIPT. Women with intermediate (odds ratio (OR) = 3.51[1.70–7.22], p < 0.001) or high educational level (OR = 4.36[2.22–8.54], p < 0.001) and women with adequate health literacy (OR = 2.60[1.36–4.95], p = 0.004) were more likely to make an informed choice. Informed choice was associated with less decisional conflict and less anxiety (p < 0.001). Intention to terminate the pregnancy for Down syndrome was higher among women undergoing invasive testing (86.5%) compared to those undergoing NIPT (58.4%) (p < 0.001).ConclusionsThe majority of women had sufficient knowledge and made an informed choice. Continuous attention for counseling is required, especially for low‐educated and less health‐literate women. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part I-clinical impact.

ObjectiveTo evaluate the clinical impact of nationwide implementation of genome‐wide non‐invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study).MethodWomen with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn‐around time and pregnancy outcome.ResultsBetween 1 April and 1 September 2014, 1413/23 232 (6%) women received a high‐risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy‐nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn‐around time was 14 days. Follow‐up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%.ConclusionIntroduction of NIPT in the Dutch National healthcare‐funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.

In vitro Effectiveness of Commercial Bacteriophage Cocktails on Diverse Extended-Spectrum Beta-Lactamase Producing Escherichia coli Strains.

The objective of this study is to determine the in vitro susceptibility of Georgian bacteriophage cocktails on multidrug resistant (MDR) extended-spectrum beta-lactamase producing Escherichia coli (ESBL-EC) isolated from patients’ blood and urine cultures. A total of 615 E. coli isolates were included in this study. Phene Plate (PhP)-typing and phylogenetic grouping were used for the typing. Antimicrobial resistance profiles and ESBL production of all isolates were confirmed according to Clinical and Laboratory Standards Institute (CLSI) criteria. The activities of four bacteriophage cocktails (Enko-phage, SES-bacteriophage, Pyo-bacteriophage, and Intesti-bacteriophage) were determined against 142 ESBL-EC using in vitro spot tests. According to this, Enko-phage were active against 87.3% of the tested strains while that ratio was 81.7% for Intesti-bacteriophage, 81.7% for Pyo-bacteriophage, and 59.2% for SES-bacteriophage cocktails. Based on the contingency tests, the phage cocktails were observed to be statistically significantly (p < 0.001) more effective on ESBL-EC strains belonging to phylogenetic groups D and B2. The employed phage cocktails were found to be affective against all tested resistant types. These results are promising especially for the infections that are caused by MDR pathogens that are difficult to treat. As this is a preliminary step to the potential clinical trials to be designed for the country, in vitro confirmation of their success on a MDR ESBL-EC collection should be accepted as an initial action, which is encouraging to consider clinical trials of phage therapy especially in countries which are not introduce phage therapy.

The Public Health Significance of Controlling Contaminants in Samples of Milk and Dairy

Introduction: Controlling the presence of contaminants or harmful substances in milk and dairy products provides early detection of risks since their presence, even in legally permitted concentration, increases the risk of damaging human health, especially children's health, such as allergic manifestations, and they can have potentially toxic, carcinogenic and genotoxic effects. Aim of the Study: The aim is to determine the frequency of the presence of contaminants in samples of milk and dairy products in the Republic of Srpska from 2010 to 2012 (metals, radionuclides, aflatoxins and residues of antibiotics and pesticides), and especially to point out their public health significance because of possible health risks. The aim of the paper is to emphasize the need for monitoring all the other contaminants in milk and dairy products specified in regulations. Material and Methods: The frequency of the presence of contaminants in the samples of milk and dairy products (n= 407) was determined on the basis of legally prescribed methodology of sampling, chemical analyses and preparation of expert opinion on food safety in accordance with current food regulations. Descriptive statistical indicators were used (a number of the samples, minimum and maximum concentrations). Chi square test (χ2) of contingency was used for testing the significance of differences in presence of contaminants and residues analyzed and recommended by regulations in samples of milk and dairy products. Results: The results of public health research of contaminants in samples of milk and dairy products indicate that no health defective food samples were determined at tested parameters - metals, radionuclides, aflatoxins, and residues of antibiotics and pesticides. A statistically significant number of samples examined on heavy metal content (83.29% or 339 samples) was determined comparing to the number of samples examined on the other contaminants and residues recommended by regulations in milk and dairy products (χ2=1000.776, p<0.001) Conclusion: The data obtained can serve as a basis for further analysis in the context of milk and dairy product sample monitoring. Although samples of milk and dairy products are safe, a long-term exposure to residues of harmful substances results in cumulative effect and damage health, meaning that each early detection of food risk found through continuous controls has a public health significance for preservation and promotion of population health in the Republic of Srpska.

The Seasonal and Diurnal Cycles of Refractivity and Anomalous Propagation in the Sahelian Area from Microwave Radiometric Profiling

AbstractThe Sahelian zone of West Africa is a semiarid area where strong amplitude of the seasonal and diurnal cycles of water vapor and temperature is observed. One year of continuous observation of vertical profiles of water vapor and temperature gathered from Niamey, Niger, with a profiling microwave radiometer is used to analyze the climatology of refractivity and microwave propagation regimes in the low troposphere. Seasonal and diurnal cycles of refractivity and ground-based radar anomalous propagation are emphasized. It is shown that the combined effect of water vapor and temperature vertical gradients is responsible for strong seasonal and diurnal cycles of the ducting propagation regime. Statistics of propagation regimes are given. The probability density functions of the refractivity gradient are found lognormally distributed. Three months of C-band radar data simultaneous with the profiling microwave radiometer observations have also been collected. Relations between the vertical refractivity gradient and the ground-based radar anomalous propagation echoes (APE) are illustrated and discussed. APE spatial distributions are found strongly related to the main features of the orography and topography inside the radar-observed area. Contingency tests show that the probability for APE to be linked to ducting is higher than 95%. In addition, this paper suggests that observing the refractivity vertical profiles from a microwave radiometer profiler located close to a meteorological radar provides information on whether anomalous propagation has to be considered as a potential cause of spurious signal in the measured reflectivity field.