Serum glial fibrillary acidic protein and disability progression in progressive multiple sclerosis

OBJECTIVE

Progression prediction is a significant unmet need in people with progressive multiple sclerosis (pwPMS). Studies on glial fibrillary acidic protein (GFAP) have either been limited to single center with relapsing MS or were based solely on Expanded Disability Status Scale (EDSS), which limits its generalizability to state-of-the-art clinical settings and trials applying combined outcome parameters.

METHODS

Serum GFAP and NfL (neurofilament light chain) were investigated in EmBioProMS participants with primary (PP) or secondary progressive MS. Six months confirmed disability progression (CDP) was defined using combined outcome parameters (EDSS, timed-25-foot walk test (T25FW), and nine-hole-peg-test (9HPT)).

RESULTS

243 subjects (135 PPMS, 108 SPMS, age 55.5, IQR [49.7-61.2], 135 female, median follow-up: 29.3 months [17.9-40.9]) were included. NfL (age-) and GFAP (age- and sex-) adjusted Z scores were higher in pwPMS compared to HC (p < 0.001 for both). 111 (32.8%) CDP events were diagnosed in participants with ≥3 visits (n = 169). GFAP Z score >3 was associated with higher risk for CDP in participants with low NfL Z score (i.e., ≤1.0) (HR: 2.38 [1.12-5.08], p = 0.025). In PPMS, GFAP Z score >3 was associated with higher risk for CDP (HR: 2.88 [1.21-6.84], p = 0.016). Risk was further increased in PPMS subjects with high GFAP when NfL is low (HR: 4.31 [1.53-12.13], p = 0.006).

INTERPRETATION

Blood GFAP may help identify pwPPMS at risk of progression. Combination of high GFAP and low NfL levels could distinguish non-active pwPMS with particularly high progression risk.

Patient-reported outcome parameters and disability worsening in progressive multiple sclerosis

OBJECTIVES

Detection and prediction of disability progression is a significant unmet need in people with progressive multiple sclerosis (PwPMS). Government and health agencies have deemed the use of patient-reported outcomes measurements (PROMs) in clinical practice and clinical trials a major strategic priority. Nevertheless, data documenting the clinical utility of PROMs in neurological diseases is scarce. This study evaluates if assessment of PROMs could track progression in PwPMS.

METHODS

Emerging blood Biomarkers in Progressive Multiple Sclerosis (EmBioProMS) investigated PROMs (Beck depression inventory-II (BDI-II), multiple sclerosis impact scale-29 (MSIS-29), fatigue scale for motor and cognition (FSMC)) in PwPMS (primary [PPMS] and secondary progressive MS [SPMS]). PROMs were evaluated longitudinally and compared between participants with disability progression (at baseline; retrospective evidence of disability progression (EDP), and during follow up (FU); prospective evidence of confirmed disability progression (CDP)) and those without progression. In an independent cohort of placebo participants of the phase III ORATORIO trial in PPMS, the diagnostic and prognostic value of another PROMs score (36-Item Short Form Survey [SF-36]) regarding CDP was evaluated.

RESULTS

EmBioProMS participants with EDP in the two years prior to inclusion (n = 136/227), or who suffered from CDP during FU (number of events= 88) had worse BDI-II, MSIS-29, and FSMC scores compared to PwPMS without progression. In addition, baseline MSIS29physical above 70th, 80th, and 90th percentiles predicted future CDP/ progression independent of relapse activity in EmBioProMS PPMS participants (HR of 3.7, 6.9, 6.7, p = 0.002, <0.001, and 0.001, respectively). In the placebo arm of ORATORIO (n = 137), the physical component score (PCS) of SF-36 worsened at week 120 compared to baseline, in cases who experienced progression over the preceding trial period (P = 0.018). Worse PCS at baseline was associated with higher hazard ratios of disability accumulation over the subsequent 120 weeks (HR: 2.01 [30th-], 2.11 [20th-], and 2.8 [10th percentile], P = 0.007, 0.012 and 0.005, respectively).

CONCLUSIONS

PROMs could provide additional, practical, cost-efficient, and remotely accessible insight about disability progression in PMS through standardized, structured, and quantifiable patient feedback.

NNLO QCD predictions for Z-boson production in association with a charm jet within the LHCb fiducial region

We compute next-to-next-to-leading order (NNLO) QCD corrections to neutral vector boson production in association with a charm jet at the LHC. This process is studied in the forward kinematics at s = 13  TeV, which may provide valuable constraints on the intrinsic charm component of the proton. A comparison is performed between fixed order and NLO predictions matched to a parton shower showing mutual compatibility within the respective uncertainties. NNLO corrections typically lead to a reduction of theoretical uncertainties by a factor of two and the perturbative convergence is further improved through the introduction of a theory-inspired constraint on the transverse momentum of the vector boson plus jet system. A comparison between these predictions with data will require an alignment of a flavour-tagging procedure in theory and experiment that is infrared and collinear safe.

NNLO interpolation grids for jet production at the LHC

Fast interpolation-grid frameworks facilitate an efficient and flexible evaluation of higher-order predictions for any choice of parton distribution functions or value of the strong coupling α s . They constitute an essential tool for the extraction of parton distribution functions and Standard Model parameters, as well as studies of the dependence of cross sections on the renormalisation and factorisation scales. The APPLfast project provides a generic interface between the parton-level Monte Carlo generator and both the APPLgrid and the fastNLO libraries for the grid interpolation. The extension of the project to include hadron-hadron collider processes at next-to-next-to-leading order in perturbative QCD is presented, together with an application for jet production at the LHC.

Fully Differential Higgs Boson Production to Third Order in QCD

We present the first fully differential predictions for the production cross section of a Higgs boson via the gluon fusion mechanism at next-to-next-to-next-to-leading order (N^{3}LO) in QCD perturbation theory. Differential distributions are shown for the two-photon final state produced by the decay of the Higgs boson for a realistic set of fiducial cuts. The N^{3}LO corrections exhibit complex features and are in part larger than the inclusive N^{3}LO corrections to the production cross section. Overall, we observe that the inclusion of the N^{3}LO QCD corrections significantly reduces the perturbative uncertainties and leads to a stabilization of the perturbative expansion.

Possible causes of aberrations in adverse grouping behavior of dairy cows: A field study

In the Dutch national surveillance system, an increasing number of reports were received in the summer of 2017 from farmers about unusual behavior of their cows. The cows were grouping during the day in summer in one part of the barn and did not move for several hours, which, according to the farmers, led to reduced food and water intake and lying time and resulted in decreased milk production and increased risk of lameness. Many farmers perceived magnetic fields from, for instance, high-voltage lines, automated milking systems, or solar panels as possible causes for the behavior of their cows. Our aim for the study was to study potential factors such as magnetic fields and other factors such as barn climate and insect burden for adverse grouping behavior of dairy cows in the barn. For each case herd, 2 control herds were selected in the same postal area code. A case was a herd in which cattle grouped at least on 7 occasions in a month for several hours. In a control herd, the cows were in the barn during the same time period as in the matching case herd but did not show adverse grouping behavior. A questionnaire was administered by telephone in 31 case herds and 62 control herds. The questionnaire gathered information on behavior of the cows and potential risk factors. In addition, data on the distance of the herd to high-voltage lines was obtained. From a total of 74 variables, all variables with a P-value ≤0.10 were included in full multivariable logistic regression model. Backward selection was carried out at P ≤ 0.10. The grouping behavior of the cows started in most herds in June, was seen only during the day, and lasted mostly 6 to 8 h, with cows often grouped in the northern part of the barn. Identified risk factors appeared to be recently constructed barns, measured stray voltage in barns, and presence of fans in barns. Given the cross-sectional design of the case-control study, causality for these risk factors leading to adverse behavior of the cows could not be proven. Dissemination of the results to farmers hopefully results in measures that can prevent the unusual grouping behavior of cows.

Beta-synuclein in cerebrospinal fluid as an early diagnostic marker of Alzheimer's disease

OBJECTIVE

Synaptic loss plays a major role in Alzheimer's disease (AD). However so far no neurochemical marker for synaptic loss has been introduced into clinical routine. By mass spectrometry beta-synuclein was established as a candidate marker. We now aimed to set up a novel ELISA for beta-synuclein for evaluation of its potential as a diagnostic and predictive marker for AD.

METHODS

We analysed in total 393 patients from four specialised centres. The diagnostic groups comprised: AD (n=151), behavioural variant frontotemporal dementia (bvFTD, n=18), Parkinson syndrome (n=46), Creutzfeldt-Jakob disease (CJD, n=23), amyotrophic lateral sclerosis (ALS, n=29), disease control (n=66) and 60 non-neurodegenerative control patients. Results were compared with core AD biomarkers (total tau, phospho-tau and amyloid-β peptide 1-42). Additionally, coexistence of beta-synuclein with vesicular glutamate transporter 1 (VGLUT1) was determined and beta-synuclein levels were quantified in brain homogenates.

RESULTS

Beta-synuclein levels quantified with the newly established ELISA correlated strongly with antibody-free quantitative mass spectrometry data (r=0.92 (95% CI: 0.89 to 0.94), p<0.0001). Cerebrospinal fluid (CSF) beta-synuclein levels were increased in AD-mild cognitive impairment (p<0.0001), AD dementia (p<0.0001) and CJD (p<0.0001), but not in bvFTD, Parkinson syndrome or ALS. Furthermore, beta-synuclein was localised in VGLUT1-positive glutamatergic synapses, and its expression was significantly reduced in brain tissue from patients with AD (p<0.01).

CONCLUSION

We successfully established a sensitive and robust ELISA for the measurement of brain-enriched beta-synuclein, which we could show is localised in glutamatergic synapses. We confirmed previous, mass spectrometry-based observations of increased beta-synuclein levels in CSF of patients with AD and CJD supporting its potential use as a marker of synaptic degeneration.

Predictions for Z-Boson Production in Association with a b-Jet at O(α_{s}^{3})

Precise predictions are provided for the production of a Z boson and a b-jet in hadron-hadron collisions within the framework of perturbative QCD, at O(α_{s}^{3}). To obtain these predictions, we perform the first calculation of a hadronic scattering process involving the direct production of a flavored jet at next-to-next-to-leading-order accuracy in massless QCD and extend techniques to also account for the impact of finite heavy-quark mass effects. The predictions are compared to CMS data obtained in pp collisions at a center-of-mass energy of 8 TeV, which are the most precise data from run I of the LHC for this process, where a good description of the data is achieved. To allow this comparison, we have performed an unfolding of the data, which overcomes the long-standing issue that the experimental and theoretical definitions of jet flavor are incompatible.

Explorative study of emerging blood biomarkers in progressive multiple sclerosis (EmBioProMS): Design of a prospective observational multicentre pilot study

Background

Defining clinical and subclinical progression in multiple sclerosis (MS) is challenging. Patient history, expanded disability status scale (EDSS), and magnetic resonance imaging (MRI) all have shortcomings and may underestimate disease dynamics. Emerging serum biomarkers such as glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) proved useful in many cross-sectional studies. However, longitudinal data on patients with progressive MS is scarce.

Objectives

To assess whether the serum biomarkers GFAP and NfL might differentiate between patients with progressive vs. non-progressive disease stages and predict the disease course according to the Lublin criteria.

Methods

EmBioProMS is a pilot, observational, prospective, multicentric study funded by the German Multiple Sclerosis Society (DMSG). 200 patients with MS according to the 2017 McDonald criteria and history of relapse-independent progression at any time (progressive MS, PMS), younger than 65 years, and with EDSS ≤ 6.5 will be recruited in 6 centres in Germany. At baseline, month 6, and 18, medical history, EDSS, Nine-Hole-Peg-Test (9-HPT), Timed-25-Foot-Walk-Test (T-25FW), Symbol-Digit-Modalities-Test (SDMT), serum GFAP, and NfL, MRI (at least baseline and month 18) and optional optical coherence tomography (OCT) will be performed. Disease progression before and during the study is defined by confirmed EDSS progression, increase by ≥ 20% in 9-HPT or T-25FW time.

Conclusions

This longitudinal multicentre study will reveal to what extent the prediction of disease progression in patients with PMS will be improved by the analysis of serum biomarkers in conjunction with routine clinical data and neuroimaging measures.

Optical coherence tomography-based assessment of retinal vascular pathology in cerebral small vessel disease

Background

Cerebral small vessel disease (CSVD) is a disorder of brain vasculature that causes various structural changes in the brain parenchyma, and is associated with various clinical symptoms such as cognitive impairment and gait disorders. Structural changes of brain arterioles cannot be visualized with routine imaging techniques in vivo. However, optical coherence tomography (OCT) is thought to be a “window to the brain”. Thus, retinal vessel parameters may correlate with CSVD characteristic brain lesions and cerebrospinal fluid biomarkers (CSF) of the neuropathological processes in CSVD like endothelial damage, microglial activation and neuroaxonal damage.

Methods

We applied OCT-based assessment of retinal vessels, magnetic resonance imaging (MRI), and CSF biomarker analysis in a monocentric prospective cohort of 24 patients with sporadic CSVD related stroke and cognitive impairment. MRI lesions were defined according to the STandards for ReportIng Vascular changes on nEuroimaging (STRIVE). Biomarkers were assessed using commercially available ELISA kits. Owing to the unavailability of an age-matched control-group lacking MRI-characteristics of CSVD, we compared the retinal vessel parameters in CSVD patients (73.8 ± 8.5 years) with a younger group of healthy controls (51.0 ± 16.0 years) by using an age- and sex-adjusted multiple linear regression analysis model.

Results

Among the parameters measured with OCT, the Wall to Lumen Ratio (WLR) but not Mean Wall Thickness (MWT) of the superior branch of the retinal artery correlated significantly with the volume of white matter hyperintensities on MRI (r_s = − 0.5) and with CSF-levels of Chitinase 3 like 1 protein (r_s = − 0.6), zona occludens 1 protein (r_s = − 0.5) and GFAP (r_s = − 0.4). MWT and WLR were higher in CSVD than in controls (28.9 μm vs. 23.9 μm, p = 0.001 and 0.32 vs. 0.25, p = 0.001).

Conclusions

In this exploratory study, WLR correlated with the volume of white matter hyperintensities, and markers of vascular integrity, microglial activation, and neuroaxonal damage in CSVD. Further prospective studies should clarify whether retinal vessel parameters and CSF biomarkers may serve to monitor the natural course and treatment effects in clinical studies on CSVD.

Second-order QCD corrections to event shape distributions in deep inelastic scattering

We compute the next-to-next-to-leading order (NNLO) QCD corrections to event shape distributions and their mean values in deep inelastic lepton-nucleon scattering. The magnitude and shape of the corrections varies considerably between different variables. The corrections reduce the renormalization and factorization scale uncertainty of the predictions. Using a dispersive model to describe non-perturbative power corrections, we compare the NNLO QCD predictions with data from the H1 and ZEUS experiments. The newly derived corrections improve the theory description of the distributions and of their mean values.

Calculations for deep inelastic scattering using fast interpolation grid techniques at NNLO in QCD and the extraction of α s from HERA data

The extension of interpolation-grid frameworks for perturbative QCD calculations at next-to-next-to-leading order (NNLO) is presented for deep inelastic scattering (DIS) processes. A fast and flexible evaluation of higher-order predictions for any a posteriori choice of parton distribution functions (PDFs) or value of the strong coupling constant is essential in iterative fitting procedures to extract PDFs and Standard Model parameters as well as for a detailed study of the scale dependence. The APPLfast project, described here, provides a generic interface between the parton-level Monte Carlo program NNLOjet and both the APPLgrid and fastNLO libraries for the production of interpolation grids at NNLO accuracy. Details of the interface for DIS processes are presented together with the required interpolation grids at NNLO, which are made available. They cover numerous inclusive jet measurements by the H1 and ZEUS experiments at HERA. An extraction of the strong coupling constant is performed as an application of the use of such grids and a best-fit value of α s ( M Z ) = 0.1170 ( 15 ) exp ( 25 ) th is obtained using the HERA inclusive jet cross section data.

Triple Differential Dijet Cross Section at the LHC

The measurement of the triple-differential dijet production cross section as a function of the average transverse momentum p_{T,avg}, half the rapidity separation y^{*}, and the boost y_{b} of the two leading jets in the event enables a kinematical scan of the underlying parton momentum distributions. We compute for the first time the second-order perturbative QCD corrections to this triple-differential dijet cross section, at leading color in all partonic channels, thereby enabling precision studies with LHC dijet data. A detailed comparison with experimental CMS 8 TeV data is performed, demonstrating how the shape of this differential cross section probes the parton densities in different kinematical ranges.

Vector boson production in association with a jet at forward rapidities

Final states with a vector boson and a hadronic jet allow one to infer the Born-level kinematics of the underlying hard scattering process, thereby probing the partonic structure of the colliding protons. At forward rapidities, the parton collisions are highly asymmetric and resolve the parton distributions at very large or very small momentum fractions, where they are less well constrained by other processes. Using theory predictions accurate to next-to-next-to-leading order (NNLO) in QCD for both W ± and Z production in association with a jet at large rapidities at the LHC, we perform a detailed phenomenological analysis of recent LHC measurements. The increased theory precision allows us to clearly identify specific kinematical regions where the description of the data is insufficient. By constructing ratios and asymmetries of these cross sections, we aim to identify possible origins of the deviations, and highlight the potential impact of the data on improved determinations of parton distributions.

Dijet production in diffractive deep-inelastic scattering in next-to-next-to-leading order QCD

Hard processes in diffractive deep-inelastic scattering can be described by a factorisation into parton-level subprocesses and diffractive parton distributions. In this framework, cross sections for inclusive dijet production in diffractive deep-inelastic electron-proton scattering (DIS) are computed to next-to-next-to-leading order (NNLO) QCD accuracy and compared to a comprehensive selection of data. Predictions for the total cross sections, 40 single-differential and four double-differential distributions for six measurements at HERA by the H1 and ZEUS collaborations are calculated. In the studied kinematical range, the NNLO corrections are found to be sizeable and positive. The NNLO predictions typically exceed the data, while the kinematical shape of the data is described better at NNLO than at next-to-leading order (NLO). A significant reduction of the scale uncertainty is achieved in comparison to NLO predictions. Our results use the currently available NLO diffractive parton distributions, and the discrepancy in normalisation highlights the need for a consistent determination of these distributions at NNLO accuracy.

Next-to-Next-to-Leading-Order QCD Corrections to the Transverse Momentum Distribution of Weak Gauge Bosons

The transverse momentum spectra of weak gauge bosons and their ratios probe the underlying dynamics and are crucial in testing our understanding of the standard model. They are an essential ingredient in precision measurements, such as the W boson mass extraction. To fully exploit the potential of the LHC data, we compute the second-order [next-to-next-to-leading-order (NNLO)] QCD corrections to the inclusive-p_{T}^{W} spectrum as well as to the ratios of spectra for W^{-}/W^{+} and Z/W. We find that the inclusion of NNLO QCD corrections considerably improves the theoretical description of the experimental CMS data and results in a substantial reduction of the residual scale uncertainties.

MOG-IgG in primary and secondary chronic progressive multiple sclerosis: a multicenter study of 200 patients and review of the literature

Background

Antibodies to human full-length myelin oligodendrocyte glycoprotein (MOG-IgG) as detected by new-generation cell-based assays have recently been described in patients presenting with acute demyelinating disease of the central nervous system, including patients previously diagnosed with multiple sclerosis (MS). However, only limited data are available on the relevance of MOG-IgG testing in patients with chronic progressive demyelinating disease. It is unclear if patients with primary progressive MS (PPMS) or secondary progressive MS (SPMS) should routinely be tested for MOG-IgG.

Objective

To evaluate the frequency of MOG-IgG among patients classified as having PPMS or SPMS based on current diagnostic criteria.

Methods

For this purpose, we retrospectively tested serum samples of 200 patients with PPMS or SPMS for MOG-IgG using cell-based assays. In addition, we performed a review of the entire English language literature on MOG-IgG published between 2011 and 2017.

Results

None of 139 PPMS and 61 SPMS patients tested was positive for MOG-IgG. Based on a review of the literature, we identified 35 further MOG-IgG tests in patients with PPMS and 55 in patients with SPMS; the only reportedly positive sample was positive just at threshold level and was tested in a non-IgG-specific assay. In total, a single borderline positive result was observed among 290 tests.

Conclusion

Our data suggest that MOG-IgG is absent or extremely rare among patients with PPMS or SPMS. Routine screening of patients with typical PPMS/SPMS for MOG-IgG seems not to be justified.

Precise predictions for V + jets dark matter backgrounds

High-energy jets recoiling against missing transverse energy (MET) are powerful probes of dark matter at the LHC. Searches based on large MET signatures require a precise control of the Z ( ν ν ¯ ) +  jet background in the signal region. This can be achieved by taking accurate data in control regions dominated by Z ( ℓ + ℓ - ) +  jet, W ( ℓ ν ) +  jet and γ +  jet production, and extrapolating to the Z ( ν ν ¯ ) +  jet background by means of precise theoretical predictions. In this context, recent advances in perturbative calculations open the door to significant sensitivity improvements in dark matter searches. In this spirit, we present a combination of state-of-the-art calculations for all relevant V +  jets processes, including throughout NNLO QCD corrections and NLO electroweak corrections supplemented by Sudakov logarithms at two loops. Predictions at parton level are provided together with detailed recommendations for their usage in experimental analyses based on the reweighting of Monte Carlo samples. Particular attention is devoted to the estimate of theoretical uncertainties in the framework of dark matter searches, where subtle aspects such as correlations across different V +  jet processes play a key role. The anticipated theoretical uncertainty in the Z ( ν ν ¯ ) +  jet background is at the few percent level up to the TeV range.

Determination of the strong coupling constant α s ( m Z ) in next-to-next-to-leading order QCD using H1 jet cross section measurements: H1 Collaboration

The strong coupling constant α s is determined from inclusive jet and dijet cross sections in neutral-current deep-inelastic ep scattering (DIS) measured at HERA by the H1 collaboration using next-to-next-to-leading order (NNLO) QCD predictions. The dependence of the NNLO predictions and of the resulting value ofα s ( m Z ) at the Z-boson mass m Z are studied as a function of the choice of the renormalisation and factorisation scales. Using inclusive jet and dijet data together, the strong coupling constant is determined to beα s ( m Z ) = 0.1157 ( 20 ) exp ( 29 ) th . Complementary,α s ( m Z ) is determined together with parton distribution functions of the proton (PDFs) from jet and inclusive DIS data measured by the H1 experiment. The valueα s ( m Z ) = 0.1142 ( 28 ) tot obtained is consistent with the determination from jet data alone. The impact of the jet data on the PDFs is studied. The running of the strong coupling is tested at different values of the renormalisation scale and the results are found to be in agreement with expectations.

Precise Predictions for Dijet Production at the LHC

We present the calculation of dijet production, doubly differential in dijet mass m_{jj} and rapidity difference |y^{*}|, at leading color in all partonic channels at next-to-next-to-leading order (NNLO) in perturbative QCD. We consider the long-standing problems associated with scale choice for dijet production at next-to-leading order (NLO) and investigate the impact of including the NNLO contribution. We find that the NNLO theory provides reliable predictions, even when using scale choices that display pathological behavior at NLO. We choose the dijet invariant mass as the theoretical scale on the grounds of perturbative convergence and residual scale variation and compare the predictions to the ATLAS 7 TeV 4.5  fb^{-1} data.

Precise QCD Predictions for the Production of a Z Boson in Association with a Hadronic Jet

We compute the cross section and differential distributions for the production of a Z boson in association with a hadronic jet to next-to-next-to-leading order (NNLO) in perturbative QCD, including the leptonic decay of the Z boson. We present numerical results for the transverse momentum and rapidity distributions of both the Z boson and the associated jet at the LHC. We find that the NNLO corrections increase the NLO predictions by approximately 1% and significantly reduce the scale variation uncertainty.

Modelling indoor electromagnetic fields (EMF) from mobile phone base stations for epidemiological studies

Radio frequency electromagnetic fields (RF-EMF) from mobile phone base stations can be reliably modelled for outdoor locations, using 3D radio wave propagation models that consider antenna characteristics and building geometry. For exposure assessment in epidemiological studies, however, it is especially important to determine indoor exposure levels as people spend most of their time indoors. We assessed the accuracy of indoor RF-EMF model predictions, and whether information on building characteristics could increase model accuracy. We performed 15-minute spot measurements in 263 rooms in 101 primary schools and 30 private homes in Amsterdam, the Netherlands. At each measurement location, we collected information on building characteristics that can affect indoor exposure to RF-EMF, namely glazing and wall and window frame materials. Next, we modelled RF-EMF at the measurement locations with the 3D radio wave propagation model NISMap. We compared model predictions with measured values to evaluate model performance, and explored if building characteristics modified the association between modelled and measured RF-EMF using a mixed effect model. We found a Spearman correlation of 0.73 between modelled and measured total downlink RF-EMF from base stations. The average modelled and measured RF-EMF were 0.053 and 0.041mW/m(2), respectively, and the precision (standard deviation of the differences between predicted and measured values) was 0.184mW/m(2). Incorporating information on building characteristics did not improve model predictions. Although there is exposure misclassification, we conclude that it is feasible to reliably rank indoor RF-EMF from mobile phone base stations for epidemiological studies.

Prediction of residential radon exposure of the whole Swiss population: comparison of model-based predictions with measurement-based predictions

Radon plays an important role for human exposure to natural sources of ionizing radiation. The aim of this article is to compare two approaches to estimate mean radon exposure in the Swiss population: model-based predictions at individual level and measurement-based predictions based on measurements aggregated at municipality level. A nationwide model was used to predict radon levels in each household and for each individual based on the corresponding tectonic unit, building age, building type, soil texture, degree of urbanization, and floor. Measurement-based predictions were carried out within a health impact assessment on residential radon and lung cancer. Mean measured radon levels were corrected for the average floor distribution and weighted with population size of each municipality. Model-based predictions yielded a mean radon exposure of the Swiss population of 84.1 Bq/m(3) . Measurement-based predictions yielded an average exposure of 78 Bq/m(3) . This study demonstrates that the model- and the measurement-based predictions provided similar results. The advantage of the measurement-based approach is its simplicity, which is sufficient for assessing exposure distribution in a population. The model-based approach allows predicting radon levels at specific sites, which is needed in an epidemiological study, and the results do not depend on how the measurement sites have been selected.

Geospatial modelling of electromagnetic fields from mobile phone base stations

There is concern that exposure to radio frequency electromagnetic fields (RF-EMF) from mobile phone base stations might lead to adverse health effects. In order to assess potential health risks, reliable exposure assessment is necessary. Geospatial exposure modelling is a promising approach to quantify ambient exposure to RF-EMF for epidemiological studies involving large populations. We modelled RF-EMF for Amsterdam, The Netherlands by using a 3D RF-EMF model (NISMap). We subsequently compared modelled results to RF-EMF measurements in five areas with differing built-up characteristics (e.g., low-rise residential, high-rise commercial). We performed, in each area, repeated continuous measurements along a predefined ~2 km long path. This mobile monitoring approach captures the high spatial variability in electric field strengths. The modelled values were in good agreement with the measurements. We found a Spearman correlation of 0.86 for GSM900 and 0.85 for UMTS between modelled and measured values. The average measured GSM900 field strength was 0.21 V/m, and UMTS 0.09 V/m. The model underestimated the GSM900 field strengths by 0.07 V/m, and slightly overestimated the UMTS field strengths by 0.01 V/m. NISMap provides a reliable way of assessing environmental RF-EMF exposure for epidemiological studies of RF-EMF and health in urban areas.

Fine particulate matter measurements in Swiss restaurants, cafés and bars: what is the effect of spatial separation between smoking and non-smoking areas?

We performed 124 measurements of particulate matter (PM(2.5)) in 95 hospitality venues such as restaurants, bars, cafés, and a disco, which had differing smoking regulations. We evaluated the impact of spatial separation between smoking and non-smoking areas on mean PM(2.5) concentration, taking relevant characteristics of the venue, such as the type of ventilation or the presence of additional PM(2.5) sources, into account. We differentiated five smoking environments: (i) completely smoke-free location, (ii) non-smoking room spatially separated from a smoking room, (iii) non-smoking area with a smoking area located in the same room, (iv) smoking area with a non-smoking area located in the same room, and (v) smoking location which could be either a room where smoking was allowed that was spatially separated from non-smoking room or a hospitality venue without smoking restriction. In these five groups, the geometric mean PM(2.5) levels were (i) 20.4, (ii) 43.9, (iii) 71.9, (iv) 110.4, and (v) 110.3 microg/m(3), respectively. This study showed that even if non-smoking and smoking areas were spatially separated into two rooms, geometric mean PM(2.5) levels in non-smoking rooms were considerably higher than in completely smoke-free hospitality venues.

PRACTICAL IMPLICATIONS

PM(2.5) levels are considerably increased in the non-smoking area if smoking is allowed anywhere in the same location. Even locating the smoking area in another room resulted in a more than doubling of the PM(2.5) levels in the non-smoking room compared with venues where smoking was not allowed at all. In practice, spatial separation of rooms where smoking is allowed does not prevent exposure to environmental tobacco smoke in nearby non-smoking areas.

Seelische Belastung bei Menschen mit umweltbezogenen St�rungen

Environmental illnesses raise diagnostic and therapeutic conflicts in scientific discussions and clinical practice. When a patient's health-belief model, based on environmental origins, does not match that of the expert, the therapeutic relationship can be endangered. Our study investigates this discrepancy, which has not been empirically evaluated so far. Patient (n=61) and expert disease concepts were systematically investigated. Our results indicate that in cases in which both concepts are favourable, the patient suffered minor psychiatric disorders with stable psychic structures and the symptoms were associated with medical or environmental causes. If both concepts were unfavourable, a higher proportion of psychiatric disorders with unstable psychic structures were present. In the case of incongruent concepts, the expert evaluations allow a more accurate assessment of the psychiatric diagnoses, psychic states and the psychic attribution of somatic and psychic burden.

The Alcohol Use Disorders Identification Test (AUDIT) and carbohydrate-deficient transferrin (CDT) in a routine workplace health examination

BACKGROUND

Only a few studies on workplaces have examined the Alcohol Use Disorders Identification Test (AUDIT) or carbohydrate-deficient transferrin (CDT) as screening instruments for the early identification of elevated and risky levels of alcohol consumption. The purpose of this study was to compare the performances of AUDIT, CDT, and gamma-glutamyltransferase (GGT) in a routine health examination (alcohol screening) in the workplace.

METHODS

The study, carried out over 16 months in a large workplace in the transport sector, was part of an on-going controlled study. Employees who came to the company health service for a routine health examination were offered the opportunity to undergo an alcohol screening and check their alcohol habits.

RESULTS

Of the 570 subjects who participated, 105 (18.4%) screened positive according to AUDIT, CDT, or both. Only 7.6% of the persons who screened positive did so according to both instruments. If GGT had been included as a screening instrument, the proportion of positive results would have increased to 22.0%. If we had only used AUDIT in the screening process, the proportion of positives would have fallen by nearly half.

CONCLUSIONS

The present findings suggest that AUDIT and CDT are complementary instruments for alcohol screening in a routine workplace health examination, and each has value for identifying a different segment of the risky drinking population.