Evidence-based selection on the appropriate fit cut-off point in crc screening programs in the covid pandemic

Introduction: The COVID pandemic has forced the closure of many colorectal cancer (CRC) screening programs around the world. Resuming these programs is a priority, but fewer colonoscopies may be available. Aims & Methods: The aim of the study is to develop an evidence-based tool for decision-making in CRC screening programs, based on a fecal hemoglobin immunological test (FIT), to optimize the strategy for screening a population for CRC. We retrospectively analyzed data collected at a regional CRC screening program between February/2014 and November/ 2018. We investigated two different scenarios: not modifying (scenario 1) vs. modifying the FIT cut-off value (scenario 2). We estimated program outcomes in the two scenarios by evaluating the numbers of cancers and adenomas missed or not diagnosed in due time (delayed). Results: The current FIT cut-off (20-mg hemoglobin/g feces) led to 6606 colonoscopies per 100,000 people invited annually. Without modifying this FIT cut-off value (scenario 1), when the number of colonoscopies available was reduced by 10-30%, a high non-negligible number of CRCs and adenomas (low, intermediate, and high risk) were undetected. As shown in the Table 1, when the FIT cut-off value was increased to where the colonoscopy demand matched the colonoscopy availability (scenario 2), the number of missed lesions was remarkably reduced. Moreover, the unmodified FIT scenario outcomes were improved by prioritizing the selection process based on sex (prioritized call criterion), rather than randomly reducing the number invited (random call criterion). Conclusion: Assuming a mismatch between the availability and demand for annual colonoscopies, increasing the FIT cut-off point was more effective than randomly reducing the number of people invited. Using specific risk factors (sex and age, for example) to prioritize access to colonoscopies should be also considered.

Money for female entrepreneurs does not grow on trees: start-ups’ financing implications in times of COVID-19

Purpose: The purpose of this paper is to understand women’s approaches to acquiring financial and other resources is essential for closing the entrepreneurship gender gap. In nearly 40% of economies, women’s early-stage entrepreneurial activity is half or less than half of that of men’s. Design/methodology/approach: Even when there is extensive literature on female entrepreneurs, the authors review the findings through a Coronavirus Disease 2019 (COVID-1)9 crisis lens, trying to find new perspectives and solutions. With the approach of a systematic review of 4,520 publications on financing topics related to female entrepreneurs, various sources of financing available to female entrepreneurs are considered: bootstrapping, banks, business angels, venture capital and crowdfunding. Findings: Identifying potential gender bias both on the supply and the demand side of financing, this research highlights new directions in encouraging female entrepreneurship and gives guidelines to public organisations on how to foster advanced forms of financing for female entrepreneurs in COVID-19 times. Social implications: The COVID-19 pandemic has posed an unprecedented challenge for economies and companies. Female entrepreneurs are the ones who have been hit harder, as they overcome pre-existing barriers, such as lack of access to finance, lack of networks and mentors and gendered priorities, among others. Without ensuring gender policies to counter these incremental negative effects, the authors face the risk of widening the gender gap. Originality/value: Regarding previous systematic reviews of literature, this paper focusses on a specific challenge, how women entrepreneurs finance their activity, with a double vision: supply and demand of money. © 2020, Emerald Publishing Limited.