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1.
Nat Commun ; 15(1): 3899, 2024 May 09.
Article in English | MEDLINE | ID: mdl-38724548

ABSTRACT

The epitranscriptome embodies many new and largely unexplored functions of RNA. A significant roadblock hindering progress in epitranscriptomics is the identification of more than one modification in individual transcript molecules. We address this with CHEUI (CH3 (methylation) Estimation Using Ionic current). CHEUI predicts N6-methyladenosine (m6A) and 5-methylcytosine (m5C) in individual molecules from the same sample, the stoichiometry at transcript reference sites, and differential methylation between any two conditions. CHEUI processes observed and expected nanopore direct RNA sequencing signals to achieve high single-molecule, transcript-site, and stoichiometry accuracies in multiple tests using synthetic RNA standards and cell line data. CHEUI's capability to identify two modification types in the same sample reveals a co-occurrence of m6A and m5C in individual mRNAs in cell line and tissue transcriptomes. CHEUI provides new avenues to discover and study the function of the epitranscriptome.


Subject(s)
5-Methylcytosine , Adenosine , Sequence Analysis, RNA , Transcriptome , Adenosine/analogs & derivatives , Adenosine/metabolism , 5-Methylcytosine/metabolism , 5-Methylcytosine/analogs & derivatives , Humans , Methylation , Sequence Analysis, RNA/methods , RNA Processing, Post-Transcriptional , RNA, Messenger/metabolism , RNA, Messenger/genetics , RNA/metabolism , RNA/genetics
2.
Regul Toxicol Pharmacol ; 138: 105337, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36649819

ABSTRACT

An expert panel was assembled to evaluate reproductive toxicology study data and their application to health risk assessment to provide input on the data quality, interpretation, and application of data from three multi-generation reproductive toxicity studies of N-methylpyrrolidone (NMP). Panelists were engaged using a double-blinded, modified Delphi format that consisted of three rounds. Key studies were scored using the U.S. Environmental Protection Agency's (EPA) questions and general considerations to guide the evaluation of experimental animal studies for systematic review. The primary conclusions of the panel are that one of the studies (Exxon, 1991) is not a high-quality study due to several design flaws that includes: (1) exceedance of the maximum tolerable dose in the high dose group; (2) failure to adjust feed concentrations of NMP during the lactation period, resulting in NMP doses that were 2- to 3-fold higher than nominal levels; and/or (3) underlying reproductive performance problems in the strain of rats used. For these reasons, the panel recommended that this study should not be considered for quantitative risk assessment of NMP. Exclusion of this study, and its corresponding data for male fertility and female fecundity, from the quantitative risk assessment results in a change in the identification of the most sensitive endpoint. Instead, changes in rat fetal/pup body weight, an endpoint previously selected by EPA, was identified as an appropriate basis for human health risk assessment based on a consideration of the best available science and weight of scientific evidence supported by the NMP toxicity database.


Subject(s)
Pyrrolidinones , Reproduction , Humans , Rats , Male , Animals , Female , Pyrrolidinones/toxicity , Fetal Weight , Risk Assessment
3.
Syst Rev ; 11(1): 113, 2022 06 03.
Article in English | MEDLINE | ID: mdl-35659294

ABSTRACT

Rigorous evidence is vital in all disciplines to ensure efficient, appropriate, and fit-for-purpose decision-making with minimised risk of unintended harm. To date, however, disciplines have been slow to share evidence synthesis frameworks, best practices, and tools amongst one another. Recent progress in collaborative digital and programmatic frameworks, such as the free and Open Source software R, have significantly expanded the opportunities for development of free-to-use, incrementally improvable, community driven tools to support evidence synthesis (e.g. EviAtlas, robvis, PRISMA2020 flow diagrams and metadat). Despite this, evidence synthesis (and meta-analysis) practitioners and methodologists who make use of R remain relatively disconnected from one another. Here, we report on a new virtual conference for evidence synthesis and meta-analysis in the R programming environment (ESMARConf) that aims to connect these communities. By designing an entirely free and online conference from scratch, we have been able to focus efforts on maximising accessibility and equity-making these core missions for our new community of practice. As a community of practice, ESMARConf builds on the success and groundwork of the broader R community and systematic review coordinating bodies (e.g. Cochrane), but fills an important niche. ESMARConf aims to maximise accessibility and equity of participants across regions, contexts, and social backgrounds, forging a level playing field in a digital, connected, and online future of evidence synthesis. We believe that everyone should have the same access to participation and involvement, and we believe ESMARConf provides a vital opportunity to push for equitability across disciplines, regions, and personal situations.


Subject(s)
Software , Humans
4.
Br J Cancer ; 124(9): 1540-1542, 2021 04.
Article in English | MEDLINE | ID: mdl-33558706

ABSTRACT

BACKGROUND: Combinations of inflammatory markers are used as prognostic scores in cancer patients with cachexia. We investigated whether they could also be used to prioritise patients attending primary care with unexpected weight loss for cancer investigation. METHODS: We used English primary care electronic health records data linked to cancer registry data from 12,024 patients with coded unexpected weight loss. For each individual inflammatory marker and score we estimated the sensitivity, specificity, likelihood ratios, positive predictive value (PPV) and the area under the curve along with 95% confidence intervals for a cancer diagnosis within six months. RESULTS: The risk of cancer associated with two abnormal inflammatory markers combined in a score was higher than the risk associated with individual inflammatory marker abnormalities. However, the risk of cancer in weight loss associated with individual abnormalities, notably a raised C-reactive protein, was sufficient to trigger further investigation for cancer under current NICE guidelines. CONCLUSIONS: If scores including pairs of inflammatory marker abnormalities were to be used, in preference to individual abnormalities, fewer people would be investigated to diagnose one cancer with fewer false positives, but fewer people with cancer would be diagnosed overall.


Subject(s)
Biomarkers/metabolism , Inflammation Mediators/metabolism , Inflammation/complications , Neoplasms/diagnosis , Primary Health Care/statistics & numerical data , Registries/statistics & numerical data , Weight Loss , Adolescent , Adult , Aged , Aged, 80 and over , Electronic Health Records , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms/epidemiology , Neoplasms/etiology , Prognosis , United Kingdom/epidemiology , Young Adult
5.
Ann Behav Med ; 55(4): 298-307, 2021 04 07.
Article in English | MEDLINE | ID: mdl-32914832

ABSTRACT

BACKGROUND: In August 2019, the U.S. Food and Drug Administration proposed a set of 13 new graphic warnings for cigarette packaging and advertisements. PURPOSE: We evaluated these warnings relative to text-only equivalents for their ability to educate the public regarding harms of smoking and influence outcomes associated with quitting. METHODS: In an experimental within-subjects design, U.S. adult nonsmokers, smokers, and dual smoker/electronic cigarette (e-cigarette) users (N = 412) recruited from an online internet platform evaluated the newly proposed graphic warnings and corresponding text-only warnings on understandability, perceived new knowledge, worry elicited about the content of the warning, discouragement from smoking, and encouragement to use e-cigarettes. RESULTS: Graphic warnings were generally rated as providing better understanding, more new knowledge, eliciting more worry about harms of smoking, and providing more discouragement from smoking relative to text-only warnings. CONCLUSIONS: The newly proposed graphic warnings could influence important responses to warnings associated with motivation to reduce smoking.


Subject(s)
Health Communication/methods , Product Labeling/methods , Smoking/psychology , Tobacco Products/adverse effects , Adult , Aged , Female , Humans , Male , Middle Aged , Smoking Prevention/methods , United States , United States Food and Drug Administration
7.
Br J Cancer ; 123(5): 722-729, 2020 09.
Article in English | MEDLINE | ID: mdl-32624574

ABSTRACT

BACKGROUND: Patients with non-specific symptoms often experience longer times to diagnosis and poorer clinical outcomes than those with site-specific symptoms. This paper reports initial results from five multidisciplinary diagnostic centre (MDC) projects in England, piloting rapid referral for patients with non-specific symptoms. METHODS: The evaluation covered MDC activity from 1st December 2016 to 31st July 2018, with projects using a common dataset. Logistical regression analyses were conducted, with a diagnosis of any cancer as the dependent variable. Exploratory analysis was conducted on presenting symptoms and diagnoses of cancer, and on comparisons within these groupings. RESULTS: In total, 2961 patients were referred into the MDCs and 241 cancers were diagnosed. The pathway detected cancers across a broad range of tumour sites, including several rare and less common cancers. An association between patient age and cancer was identified (p < 0.001). GP 'clinical suspicion' was identified as a strong predictor of cancer (p = 0.006), with a reduced association with cancer observed in patients with higher numbers of GP consultation before referral (p = 0.008). CONCLUSIONS: The MDC model diagnoses cancer in patients with non-specific symptoms, with a conversion rate of 8%, demonstrating the diagnostic potential of a non-site-specific symptomatic referral pathway.


Subject(s)
Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Early Detection of Cancer/methods , Female , Humans , Interdisciplinary Communication , Male , Middle Aged , Patient Care Team , Referral and Consultation
8.
BMC Med ; 17(1): 222, 2019 11 29.
Article in English | MEDLINE | ID: mdl-31783757

ABSTRACT

BACKGROUND: Excess weight and unexpected weight loss are associated with multiple disease states and increased morbidity and mortality, but weight measurement is not routine in many primary care settings. The aim of this study was to characterise who has had their weight recorded in UK primary care, how frequently, by whom and in relation to which clinical events, symptoms and diagnoses. METHODS: A longitudinal analysis of UK primary care electronic health records (EHR) data from 2000 to 2017. Descriptive statistics were used to summarise weight recording in terms of patient sociodemographic characteristics, health professional encounters, clinical events, symptoms and diagnoses. Negative binomial regression was used to model the likelihood of having a weight record each year, and Cox regression to the likelihood of repeated weight recording. RESULTS: A total of 14,049,871 weight records were identified in the EHR of 4,918,746 patients during the study period, representing 26,998,591 person-years of observation. Around a third of patients had a weight record each year. Forty-nine percent of weight records were repeated within a year with an average time to a repeat weight record of 1.92 years. Weight records were most often taken by nursing staff (38-42%) and GPs (37-39%) as part of a routine clinical care, such as chronic disease reviews (16%), medication reviews (6-8%) and health checks (6-7%), or were associated with consultations for contraception (5-8%), respiratory disease (5%) and obesity (1%). Patient characteristics independently associated with an increased likelihood of weight recording were as follows: female sex, younger and older adults, non-drinkers, ex-smokers, low or high BMI, being more deprived, diagnosed with a greater number of comorbidities and consulting more frequently. The effect of policy-level incentives to record weight did not appear to be sustained after they were removed. CONCLUSION: Weight recording is not a routine activity in UK primary care. It is recorded for around a third of patients each year and is repeated on average every 2 years for these patients. It is more common in females with higher BMI and in those with comorbidity. Incentive payments and their removal appear to be associated with increases and decreases in weight recording.


Subject(s)
Body-Weight Trajectory , Electronic Health Records/statistics & numerical data , Adult , Comorbidity , Female , History, 21st Century , Humans , Longitudinal Studies , Male , Primary Health Care/statistics & numerical data , United Kingdom
9.
BMC Fam Pract ; 20(1): 118, 2019 08 20.
Article in English | MEDLINE | ID: mdl-31431191

ABSTRACT

BACKGROUND: Brain tumour patients see their primary care doctor on average three or more times before diagnosis, so there may be an opportunity to identify 'at risk' patients earlier. Suspecting a brain tumour diagnosis is difficult because brain tumour-related symptoms are typically non-specific. METHODS: We explored the predictive value of referral guidelines (Kernick and NICE 2005) for brain imaging where a tumour is suspected, in a population-based patient group referred for direct access CT of the head. A consensus panel reviewed whether non-tumour findings were clinically important or whether further investigation was necessary. RESULTS: Over a 5-year period, 3257 head scans were performed; 318 scans were excluded according to pre-specified criteria. 53 patients (1.8%) were reported to have intracranial tumours, of which 42 were significant (diagnostic yield of 1.43%). There were no false negative CT scans for tumour. With symptom-based referral guidelines primary care doctors can identify patients with a 3% positive predictive value (PPV). 559 patients had non-tumour findings, 31% of which were deemed clinically significant. In 34% of these 559 patients, referral for further imaging and/or specialist assessment from primary care was still thought warranted. CONCLUSION: Existing referral guidelines are insufficient to stratify patients adequately based on their symptoms, according to the likelihood that a tumour will be found on brain imaging. Identification of non-tumour findings may be significant for patients and earlier specialist input into interpretation of these images may be beneficial. Improving guidelines to better identify patients at risk of a brain tumour should be a priority, to improve speed of diagnosis, and reduce unnecessary imaging and costs. Future guidelines may incorporate groups of symptoms, clinical signs and tests to improve the predictive value.


Subject(s)
Brain Neoplasms/diagnostic imaging , Neuroimaging , Referral and Consultation , Tomography, X-Ray Computed , Adolescent , Adult , Aged , Aged, 80 and over , Brain Neoplasms/diagnosis , Female , Humans , Male , Middle Aged , Referral and Consultation/organization & administration , Referral and Consultation/standards , Young Adult
10.
Rev. peru. biol. (Impr.) ; 26(3)ago. 2019.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1508852

ABSTRACT

Durante el período 2000 - 2016, se llevaron a cabo 15 inventarios biológicos en áreas remotas en el pie de monte andino y el llano amazónico del Perú. En estos inventarios, 27 botánicos colectaron un total de 9397 especímenes de plantas vasculares fértiles. Hasta finales del 2017, más de la mitad de estos especímenes se han identificado a nivel de especie, de los cuales 64 especies y 2 géneros (Dicorynia y Monopteryx) representan nuevos registros para la flora del Perú. Si esta tasa de novedades se mantiene, el número de registros nuevos en el material de los inventarios podría aumentar, lo cual nos indica que aún queda mucho por descubrir en la flora andino-amazónica del Perú.


Between 2000 and 2016 we carried out 15 rapid biological inventories in remote areas of the Andean foothills and Amazon basin in Peru. During these inventories, 27 botanists collected 9397 fertile vascular plant specimens. By the end of 2017, more than half of these specimens had been identified to species. Of the 2303 species identified to date, 64 species and 2 genera (Dicorynia and Monopteryx) are new records for the flora of Peru. If this rate of discovery proves typical, the number of new records for Peru in the rapid inventory material could increase, which indicates that there is still much to discover in the Peruvian flora.

11.
Rapid Commun Mass Spectrom ; 33(15): 1258-1266, 2019 Aug 15.
Article in English | MEDLINE | ID: mdl-30993809

ABSTRACT

RATIONALE: The use of multi-isotopic analysis (δ15 N, δ13 C and δ34 S values) of archaeological bone collagen to assist in the interpretation of diet, movement and mobility of prehistoric populations is gradually increasing, yet many researchers have traditionally avoided investigating sulphur due to its very low concentrations (<0.3%) in mammalian collagen. For this reason, and as a consequence of analytical detection limits, sulphur is usually measured separately from carbon and nitrogen, which leads to longer analytical times and higher costs. METHODS: A Thermo Scientific™ EA IsoLink™ isotope ratio mass spectrometry (IRMS) system, with the ability to rapidly heat a gas chromatography (GC) column and concentrate the sample gas online without cryo-trapping, was used at the Radiocarbon Laboratory at the Scottish Universities Environmental Research Centre (SUERC). Optimisation of the GC temperature and carrier gas flow rate in the elemental analyser resulted in improved signal-to-noise (S/N) ratio and sensitivity for SO2 . This allowed for routine sequential N2 , CO2 and SO2 measurements on small samples of bone collagen. RESULTS: Improvements in sample gas transfer to the mass spectrometer allows for sequential δ15 N, δ13 C and δ34 S values to be measured in 1-1.5 mg samples of bone collagen. Moreover, the sensitivity and S/N ratio of the sample gas, especially SO2 , is improved, resulting in precisions of ±0.15‰ for δ15 N values, ±0.1‰ for δ13 C values and ±0.3‰ for δ34 S values. Previous instrumentation allowed for the analysis of ~30 unknown samples before undertaking maintenance; however, ~150 unknown samples can now be measured, meaning a 5-fold increase in sample throughput. CONCLUSIONS: The ability to sequentially measure δ15 N, δ13 C and δ34 S values rapidly in archaeological bone collagen is an attractive option to researchers who want to build larger, more succinct datasets for their sites of interest, at a much-reduced analytical cost and without destroying larger quantities of archaeological material.


Subject(s)
Archaeology/methods , Bone and Bones/chemistry , Carbon Isotopes/analysis , Collagen/analysis , Gas Chromatography-Mass Spectrometry/methods , Nitrogen Isotopes/analysis , Sulfur Isotopes/analysis , Animals , Scotland , Universities
12.
Soc Cogn ; 37(3): 314-340, 2019 Jun.
Article in English | MEDLINE | ID: mdl-33828353

ABSTRACT

Widespread messages use metaphoric language and imagery to prompt recipients to interpret health-related concepts in terms of dissimilar, familiar concepts (e.g., "fight the war on cancer"). When do these messages work? According to Conceptual Metaphor Theory, thinking metaphorically involves looking past concepts' superficial differences to identify their similarities at a structural level. Thus, we hypothesized that when people's general construal mindset is oriented to focus on information's abstract meaning, not its concrete details, they would process a metaphor's target health concept in ways that correspond to the dissimilar concept. Accordingly, after priming an abstract, but not concrete, construal mindset: framing sun exposure as enemy confrontation (vs. literally) increased cancer risk perceptions and sun-safe intentions (Study 1; N=186); and framing smoking cessation as an arduous journey (vs. literally) increased appreciation of quitting difficulties and interest in cessation tools (Study 2; N=244). We discuss practical and theoretical implications for improving health communication.

13.
Child Abuse Negl ; 79: 423-433, 2018 05.
Article in English | MEDLINE | ID: mdl-29544158

ABSTRACT

This phase II trial evaluated psychosocial and health outcomes of an intervention designed to improve emotion regulation skills in adults suffering from Adverse Childhood Experiences (ACEs). The study utilized a pretest-posttest design in which 92 adults enrolled in the community-based program completed pretest measures, attended either a faith-based or secular version of the 12-week ACE Overcomers program, and then completed posttest measures. The theory-guided program involved group sessions providing education and skills training to improve emotion regulation, self-awareness, resilience, and social functioning. Pretest and posttest surveys included measures of emotional regulation (suppression, rumination, cognitive reappraisal, and mindfulness), resilience (ego resilience and general self-efficacy), emotional experiences (perceived stress, moods, and depressive symptoms), quality of life (the SF-36 domains), and physical symptoms and illness (symptom load and sick days). Analyses revealed significant improvements from pretest to posttest in all facets of emotion regulation (p < .01), psychological resilience (p < .001), mental well-being (p < .001) and physical symptoms and illness (p < .001), and in specific facets of quality of life (p < .001). The faith-based and secular versions of the program yielded comparable improvements in well-being. Improvements were comparable for older versus younger participants, except that younger participants reported greater improvements in perceived stress (p < .05). These preliminary findings support the application of an emotion regulation perspective to interventions for adults with high ACEs. The study, with its single-group design, represents a promising step in the translational research pathway and provides support for further studies utilizing comparison groups.


Subject(s)
Adverse Childhood Experiences , Depression/therapy , Emotions , Psychotherapy/methods , Stress, Psychological/therapy , Adult , Child , Depression/psychology , Female , Humans , Male , Mental Health , Quality of Life , Resilience, Psychological , Surveys and Questionnaires
14.
Diagn Progn Res ; 2: 1, 2018.
Article in English | MEDLINE | ID: mdl-31093551

ABSTRACT

BACKGROUND: Unexpected weight loss is a symptom of serious disease in primary care, for example between 1 in 200 and 1 in 30 patients with unexpected weight loss go on to develop cancer. However, it remains unclear how and when general practitioners (GPs) should investigate unexpected weight loss. Without clarification, GPs may wait too long before referring (choosing to watch and wait and potentially missing a diagnosis) or not long enough (overburdening hospital services and exposing patients to the risks of investigation). The overall aim of this study is to provide the evidence necessary to allow GPs to more effectively manage patients with unexpected weight loss. METHODS: A retrospective cohort analysis of UK Clinical Practice Research Datalink (CPRD) data to: (1) describe how often in UK primary care the symptom of reported weight loss is coded, when weight is measured, and how GPs respond to a patient attending with unexpected weight loss; (2) identify the predictive value of recorded weight loss for cancer and serious disease in primary care, using cumulative incidence plots to compare outcomes between subgroups and Cox regression to explore and adjust for covariates. Preliminary work in CPRD estimates that weight loss as a symptom is recorded for approximately 148,000 eligible patients > 18 years and is distributed evenly across decades of age, providing adequate statistical power and precision in relation to cancer overall and common cancers individually. Further stratification by cancer stage will be attempted but may not be possible as not all practices within CPRD are eligible for cancer registry linkage, and staging information is often incomplete. The feasibility of using multiple imputation to address missing covariate values will be explored. DISCUSSION: This will be the largest reported retrospective cohort of primary care patients with weight measurements and unexpected weight loss codes used to understand the association between weight measurement, unexpected weight loss, and serious disease including cancer. Our findings will directly inform international guidelines for the management of unexpected weight loss in primary care populations.

15.
Br J Cancer ; 118(1): 24-31, 2018 01.
Article in English | MEDLINE | ID: mdl-29182609

ABSTRACT

BACKGROUND: In England, 'fast-track' (also known as 'two-week wait') general practitioner referrals for suspected cancer in symptomatic patients are used to shorten diagnostic intervals and are supported by clinical guidelines. However, the use of the fast-track pathway may vary for different patient groups. METHODS: We examined data from 669 220 patients with 35 cancers diagnosed in 2006-2010 following either fast-track or 'routine' primary-to-secondary care referrals using 'Routes to Diagnosis' data. We estimated the proportion of fast-track referrals by sociodemographic characteristic and cancer site and used logistic regression to estimate respective crude and adjusted odds ratios. We additionally explored whether sociodemographic associations varied by cancer. RESULTS: There were large variations in the odds of fast-track referral by cancer (P<0.001). Patients with testicular and breast cancer were most likely to have been diagnosed after a fast-track referral (adjusted odds ratios 2.73 and 2.35, respectively, using rectal cancer as reference); whereas patients with brain cancer and leukaemias least likely (adjusted odds ratios 0.05 and 0.09, respectively, for brain cancer and acute myeloid leukaemia). There were sex, age and deprivation differences in the odds of fast-track referral (P<0.013) that varied in their size and direction for patients with different cancers (P<0.001). For example, fast-track referrals were least likely in younger women with endometrial cancer and in older men with testicular cancer. CONCLUSIONS: Fast-track referrals are less likely for cancers characterised by nonspecific presenting symptoms and patients belonging to low cancer incidence demographic groups. Interventions beyond clinical guidelines for 'alarm' symptoms are needed to improve diagnostic timeliness.


Subject(s)
Neoplasms/classification , Neoplasms/diagnosis , Referral and Consultation , Age Factors , Early Detection of Cancer , Evidence-Based Medicine , Female , Humans , Male , Odds Ratio , Regression Analysis , Sex Factors
16.
Br J Cancer ; 117(6): 888-897, 2017 Sep 05.
Article in English | MEDLINE | ID: mdl-28787432

ABSTRACT

BACKGROUND: The benefits from expedited diagnosis of symptomatic cancer are uncertain. We aimed to analyse the relationship between stage of colorectal cancer (CRC) and the primary and specialist care components of the diagnostic interval. METHODS: We identified seven independent data sets from population-based studies in Scotland, England, Canada, Denmark and Spain during 1997-2010 with a total of 11 720 newly diagnosed CRC patients, who had initially presented with symptoms to a primary care physician. Data were extracted from patient records, registries, audits and questionnaires, respectively. Data sets were required to hold information on dates in the diagnostic interval (defined as the time from the first presentation of symptoms in primary care until the date of diagnosis), symptoms at first presentation in primary care, route of referral, gender, age and histologically confirmed stage. We carried out reanalysis of all individual data sets and, using the same method, analysed a pooled individual patient data set. RESULTS: The association between intervals and stage was similar in the individual and combined data set. There was a statistically significant convex (∩-shaped) association between primary care interval and diagnosis of advanced (i.e., distant or regional) rather than localised CRC (P=0.004), with odds beginning to increase from the first day on and peaking at 90 days. For specialist care, we saw an opposite and statistically significant concave (∪-shaped) association, with a trough at 60 days, between the interval and diagnosis of advanced CRC (P<0.001). CONCLUSIONS: This study provides evidence that longer diagnostic intervals are associated with more advanced CRC. Furthermore, the study cannot define a specific 'safe' waiting time as the length of the primary care interval appears to have negative impact from day one.


Subject(s)
Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Delayed Diagnosis , Early Detection of Cancer , Primary Health Care , Adult , Aged , Aged, 80 and over , Canada , Cohort Studies , Datasets as Topic , Denmark , England , Female , Humans , Male , Middle Aged , Referral and Consultation , Scotland , Spain , Symptom Assessment , Time Factors
17.
Article in English | MEDLINE | ID: mdl-28474381

ABSTRACT

There are approximately 3,000 new UK diagnoses of cervical cancer annually, with many women presenting symptomatically. We aimed to identify and quantify features of cervical cancer in primary care in a case-control study in the UK. Putative features of cervical cancer were identified, and odd ratios and positive predictive values (PPVs) were calculated. About 1,006 women aged ≥40 years diagnosed with cervical cancer and 4,992 age-, sex- and practice-matched controls were selected from the Clinical Practice Research Datalink. Median age at diagnosis was 61 years (interquartile range 51-75). Seven symptoms and two abnormal investigations were associated with cervical cancer: post-menopausal bleeding, odds ratio 43 (95% confidence interval 25, 75); vaginal discharge or vaginitis 8.8 (5.2, 15), intermenstrual bleeding 4.7 (1.6, 14); haematuria 4.6 (2.1, 10); irregular menstruation 3.8 (1.6, 9.0); urinary tract infection 1.9 (1.3, 2.8); abdominal pain 1.8 (1.4, 2.5); high white cell count 5.1 (2.9, 8.8) and low haemoglobin 2.6 (1.8, 3.8): all p < .005. The PPV of cervical cancer in women aged ≥55 with post-menopausal bleeding was 4.6% (2.5, 8.3). Other than for post-menopausal bleeding no symptom is high risk. Some symptoms, particularly haematuria, may be helpful. The primary care clinician must consider the unlikely diagnosis when the likely diagnosis does not settle with treatment.


Subject(s)
Uterine Cervical Neoplasms/epidemiology , Abdominal Pain/etiology , Adult , Age of Onset , Aged , Case-Control Studies , Diagnosis, Differential , Early Detection of Cancer , Electronic Health Records , England/epidemiology , Female , Hematuria/etiology , Hemoglobinopathies/etiology , Humans , Leukocyte Count , Menstruation Disturbances/etiology , Middle Aged , Risk Factors , Urinary Tract Infections/etiology , Uterine Cervical Neoplasms/complications , Uterine Cervical Neoplasms/diagnosis , Vaginal Diseases/etiology
18.
PLoS One ; 12(1): e0169670, 2017.
Article in English | MEDLINE | ID: mdl-28056071

ABSTRACT

In the California Current ecosystem, global climate change is predicted to trigger large-scale changes in ocean chemistry within this century. Ocean acidification-which occurs when increased levels of atmospheric CO2 dissolve into the ocean-is one of the biggest potential threats to marine life. In a coastal upwelling system, we compared the effects of chronic exposure to low pH (elevated pCO2) at four treatment levels (i.e., pCO2 = ambient [500], moderate [750], high [1900], and extreme [2800 µatm]) on behavior, physiology, and patterns of gene expression in white muscle tissue of juvenile rockfish (genus Sebastes), integrating responses from the transcriptome to the whole organism level. Experiments were conducted simultaneously on two closely related species that both inhabit kelp forests, yet differ in early life history traits, to compare high-CO2 tolerance among species. Our findings indicate that these congeners express different sensitivities to elevated CO2 levels. Copper rockfish (S. caurinus) exhibited changes in behavioral lateralization, reduced critical swimming speed, depressed aerobic scope, changes in metabolic enzyme activity, and increases in the expression of transcription factors and regulatory genes at high pCO2 exposure. Blue rockfish (S. mystinus), in contrast, showed no significant changes in behavior, swimming physiology, or aerobic capacity, but did exhibit significant changes in the expression of muscle structural genes as a function of pCO2, indicating acclimatization potential. The capacity of long-lived, late to mature, commercially important fish to acclimatize and adapt to changing ocean chemistry over the next 50-100 years is likely dependent on species-specific physiological tolerances.


Subject(s)
Carbon Dioxide/analysis , Genomics/methods , Perciformes/metabolism , Animals , Behavior, Animal , Carbon Dioxide/metabolism , Perciformes/physiology , Principal Component Analysis , Transcription Factors/metabolism
19.
Rev Sci Instrum ; 87(3): 033901, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27036785

ABSTRACT

We describe a simple, compact device for spherical neutron polarimetry measurements at small neutron scattering angles. The device consists of a sample chamber with very low (<0.01 G) magnetic field flanked by regions within which the neutron polarization can be manipulated in a controlled manner. This allows any selected initial and final polarization direction of the neutrons to be obtained. We have constructed a prototype device using high-T(c) superconducting films and mu-metal to isolate regions with different magnetic fields and tested device performance in transmission geometry. Finite-element methods were used to simulate the device's field profile and these have been verified by experiment using a small solenoid as a test sample. Measurements are reported using both monochromatic and polychromatic neutron sources. The results show that the device is capable of extracting sample information and distinguishing small angular variations of the sample magnetic field. As a more realistic test, we present results on the characterization of a 10 µm thick Permalloy film in zero magnetic field, as well as its response to an external magnetic field.

20.
Soft Matter ; 12(21): 4709-14, 2016 May 25.
Article in English | MEDLINE | ID: mdl-27021920

ABSTRACT

Stöber silica particles are used in a diverse range of applications. Despite their widespread industrial and scientific uses, information on the internal structure of the particles is non-trivial to obtain and is not often reported. In this work we have used spin-echo small angle neutron scattering (SESANS) in conjunction with ultra small angle X-ray scattering (USAXS) and pycnometry to study an aqueous dispersion of Stöber particles. Our results are in agreement with models which propose that Stöber particles have a porous core, with a significant fraction of the pores inaccessible to solvent. For samples prepared from the same master sample in a range of H2O : D2O ratio solutions we were able to model the SESANS results for the solution series assuming monodisperse, smooth surfaced spheres of radius 83 nm with an internal open pore volume fraction of 32% and a closed pore fraction of 10%. Our results are consistent with USAXS measurements. The protocol developed and discussed here shows that the SESANS technique is a powerful way to investigate particles much larger than those studied using conventional small angle scattering methods.

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