A previous report documented that endocrine disrupting chemicals contribute substantially to certain forms of disease and disability. In the present analysis, our main objective was to update a range of health and economic costs that can be reasonably attributed to endocrine disrupting chemical exposures in the European Union, leveraging new burden and disease cost estimates of female reproductive conditions from accompanying report. Expert panels evaluated the epidemiologic evidence, using adapted criteria from the WHO Grading of Recommendations Assessment, Development and Evaluation Working Group, and evaluated laboratory and animal evidence of endocrine disruption using definitions recently promulgated by the Danish Environmental Protection Agency. The Delphi method was used to make decisions on the strength of the data. Expert panels consensus was achieved for probable (>20%) endocrine disrupting chemical causation for IQ loss and associated intellectual disability; autism; attention deficit hyperactivity disorder; endometriosis; fibroids; childhood obesity; adult obesity; adult diabetes; cryptorchidism; male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation, and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median annual cost of €163 billion (1.28% of EU Gross Domestic Product) across 1000 simulations. We conclude that endocrine disrupting chemical exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in the hundreds of billions of Euros per year. These estimates represent only those endocrine disrupting chemicals with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.

Background

Prevalence estimates of the serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion reactions and undertook a multicenter study using active surveillance, data review, and adjudication to test this hypothesis.

Study design and methods

A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at four academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts.

Results

Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion-associated circulatory overload was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion-related acute lung injury/possible transfusion-related acute lung injury, anaphylactic, and hypotensive reactions were noted in 0.08, 0.02, and 0.02% of transfusion episodes, respectively. Minor reactions, including febrile nonhemolytic and allergic, were noted in 0.62 and 0.29% of transfusion episodes, respectively, with 30 and 50% reported to the transfusion service.

Conclusion

Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.

In the ATLAS experiment at the LHC, the output of readout hardware specific to each subdetector will be transmitted to buffers, located on custom made PCI cards ("ROBINs"). The data consist of fragments of events accepted by the first-level trigger at a maximum rate of 100 kHz. Groups of four ROBINs will be hosted in about 150 Read-Out Subsystem (ROS) PCs. Event data are forwarded on request via Gigabit Ethernet links and switches to the second-level trigger or to the Event builder. In this paper a discussion of the functionality and real-time properties of the ROS is combined with a presentation of measurement and modelling results for a testbed with a size of about 20% of the final DAQ system. Experimental results on strategies for optimizing the system performance, such as utilization of different network architectures and network transfer protocols, are presented for the testbed, together with extrapolations to the full system. ©2005 IEEE.

In the ATLAS experiment at the LHC, the output of read-out hardware specific to each subdetector will be transmitted to buffers, located on custom made PCI cards ("ROBINs"). The data consist of fragments of events accepted by the first-level trigger at a maximum rate of 100 kHz. Groups of four ROBINs will be hosted in about 150 Read-Out Subsystem (ROS) PCs. Event data are forwarded on request via Gigabit Ethernet links and switches to the second-level trigger or to the Event builder. In this paper a discussion of the functionality and real-time properties of the ROS is combined with a presentation of measurement and modelling results for a testbed with a size of about 20% of the final DAQ system. Experimental results on strategies for optimizing the system performance, such as utilization of different network architectures and network transfer protocols, are presented for the testbed, together with extrapolations to the full system. © 2006 IEEE.

The ATLAS trigger reduces the rate of interesting events to be recorded for off-line analysis in three successive levels from 40 MHz to ∼ 100 kHz, ∼ 2 kHz and ∼ 200 Hz. The high level triggers and data acquisition system are designed to profit from commodity computing and networking components to achieve the required performance. In this paper, we discuss data flow aspects of the design of the second level trigger (LVL2) and present results of performance measurements.

Background

Progressive supranuclear palsy (PSP) -Richardson's Syndrome and Corticobasal Syndrome (CBS) are the two classic clinical syndromes associated with underlying four repeat (4R) tau pathology. The PSP Rating Scale is a commonly used assessment in PSP clinical trials; there is an increasing interest in designing combined 4R tauopathy clinical trials involving both CBS and PSP.

Objectives

To determine contributions of each domain of the PSP Rating Scale to overall severity and characterize the probable sequence of clinical progression of PSP as compared to CBS.

Methods

Multicenter clinical trial and natural history study data were analyzed from 545 patients with PSP and 49 with CBS. Proportional odds models were applied to model normalized cross-sectional PSP Rating Scale, estimating the probability that a patient would experience impairment in each domain using the PSP Rating Scale total score as the index of overall disease severity.

Results

The earliest symptom domain to demonstrate impairment in PSP patients was most likely to be Ocular Motor, followed jointly by Gait/Midline and Daily Activities, then Limb Motor and Mentation, and finally Bulbar. For CBS, Limb Motor manifested first and ocular showed less probability of impairment throughout the disease spectrum. An online tool to visualize predicted disease progression was developed to predict relative disability on each subscale per overall disease severity.

Conclusion

The PSP Rating Scale captures disease severity in both PSP and CBS. Modelling how domains change in relation to one other at varying disease severities may facilitate detection of therapeutic effects in future clinical trials.