[Screening for cancer of the colon and rectum A review on incidence, mortality, cost and benefit].

In this article the incidence and mortality for cancer of the colon and rectum in Iceland is discussed. The two most common screening methods, faecal immunochemical test (FIT) and colonoscopy are compared and an estimate of cost and benefits for the Icelandic society will be made. The incidence of cancer of the colon and rectum has been increasing in Iceland in last decades but mortality has decreased and survival improved. However, more individuals die from cancer of the colon and rectum than from both breast- and cervical cancer added together. It is likely that screening for cancer of the colon and rectum, could prevent at least 6 of the 28 deaths related to those cancers, occurring yearly in Iceland in screening age, given a screening ages of 50-74 years. The extra cost for the Icelandic community due to the implementation of screening for cancer of the colon and rectum will be acceptable due to the lower cost of simpler treatments, lower cancer incidence and reduced mortality.

Thermal associated pressure-retarded osmosis processes for energy production: A review.

Climate change is an existential threat to global environments and human life. To achieve global mean temperature rise of below 1.5 °C, increasing utilization of renewable energy and minimizing CO2 emission from fossil fuel industries have been emphasized by the United Nations. Pressure-retarded osmosis (PRO) has displayed its technical feasibility in capturing renewable energy from the salinity gradient of two streams through a semipermeable membrane. Towards achieving economic feasible PRO, process optimization, waste stream/heat utilization, and hybrid PRO processes have been attempted by theoretically modelling and experimental examination. Among these efforts, the thermal associated PRO processes have received great attention due to their improved power generation. In this paper, we aim to provide a comprehensive review on thermal associated PRO processes, focusing on the role of thermal behaviour in both stand-alone PRO and hybrid PRO processes (e.g. PRO-membrane distillation, PRO-thermosiphon, PRO-solar pond). Meanwhile, thermal associated draw solution development has been highlighted. Finally, a combination of PRO with high temperature/high pressure geothermal waste gas as draw solution is proposed and its technical and economic feasibility is discussed, especially under Icelandic scenario.

Fiscal analysis of establishment of a double-balloon enteroscopy program and reimbursement.

BACKGROUND & AIMS: As double-balloon enteroscopy (DBE) programs continue to be established, further research is needed to assess their financial impact. We evaluated actual financial outcomes and compared them with estimated return on investment (ROI) projections for DBE. METHODS: We retrospectively compared the predicted and actual financial results for outpatients referred for DBE at an academic tertiary referral center. RESULTS: The ROI analysis was based on a 5-year time frame. The analysis projected a net present value of $64,623 and an internal rate of return of 24.6%. The projected first-year volume was 52 outpatient cases; however, the actual experience was 20 outpatient cases. The predicted percent margin for these outpatient cases was 16.6%; the actual margin was 24.4%. After 37 months, 52 outpatient cases were completed, and the actual percent margin was 4.6%. Payer type had a significant influence on the financial outcomes when projected activity and actual activity were compared. CONCLUSIONS: Institutions interested in establishing a DBE program should be aware of the financial implications of program establishment, which can be evaluated in a return on investment analysis. Payer mix significantly influences DBE reimbursement and collection rates.

Pilot study using PET/CT as a novel, noninvasive assessment of disease activity in inflammatory bowel disease.

BACKGROUND: A pilot study was performed investigating the possibility that positron emission tomography (PET) activity using 18-fluorodeoxyglucose (FDG) with nearly simultaneous computerized tomography (CT) for anatomic accuracy would identify regions of active inflammation in both ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Prospective clinical data was collected in 12 patients experiencing an exacerbation of their inflammatory bowel disease; 7 with CD and 5 with UC. A PET/CT scan (GE Discovery LS PET/CT scanner) was performed in all patients. Twenty patients undergoing PET/CT because of solitary pulmonary nodules served as controls. We graded the small bowel and 4 colon regions (ascending, transverse, descending, and rectosigmoid) with PET activity scores assigned to each region based on the amount of FDG uptake using the liver as the reference organ. RESULTS: In UC patients, PET activity was seen in 13 of 24 (52%) regions. There was high (23 of 24; 95.8%) correlation between PET activity and disease activity as determined by colonoscopy, disease activity indices, and radiology. In patients with CD, PET activity was seen in 19 of 32 (59.4%) regions. Again, there was a high (26 of 32; 81.3%) correlation between PET activity and clinical disease activity. Of the 20 controls, significant PET activity (Grades 2 and 3) was seen in only 2 of 100 regions (2%). CONCLUSIONS: We found that PET activity correlated well with active inflammation in both UC and CD, suggesting that this may be a noninvasive method of identifying disease activity in patients with inflammatory bowel disease.