Screening for colorectal cancer: possible improvements by risk assessment evaluation?

Emerging results indicate that screening improves survival of patients with colorectal cancer. Therefore, screening programs are already implemented or are being considered for implementation in Asia, Europe and North America. At present, a great variety of screening methods are available including colono- and sigmoidoscopy, CT- and MR-colonography, capsule endoscopy, DNA and occult blood in feces, and so on. The pros and cons of the various tests, including economic issues, are debated. Although a plethora of evaluated and validated tests even with high specificities and reasonable sensitivities are available, an international consensus on screening procedures is still not established. The rather limited compliance in present screening procedures is a significant drawback. Furthermore, some of the procedures are costly and, therefore, selection methods for these procedures are needed. Current research into improvements of screening for colorectal cancer includes blood-based biological markers, such as proteins, DNA and RNA in combination with various demographically and clinically parameters into a “risk assessment evaluation” (RAE) test. It is assumed that such a test may lead to higher acceptance among the screening populations, and thereby improve the compliances. Furthermore, the involvement of the media, including social media, may add even more individuals to the screening programs. Implementation of validated RAE and progressively improved screening methods may reform the cost/benefit of screening procedures for colorectal cancer. Therefore, results of present research, validating RAE tests, are awaited with interest

Significant benefits of AIP testing and clinical screening in familial isolated and young-onset pituitary tumors

Context Germline mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are responsible for a subset of familial isolated pituitary adenoma (FIPA) cases and sporadic pituitary neuroendocrine tumors (PitNETs). Objective To compare prospectively diagnosed AIP mutation-positive (AIPmut) PitNET patients with clinically presenting patients and to compare the clinical characteristics of AIPmut and AIPneg PitNET patients. Design 12-year prospective, observational study. Participants & Setting We studied probands and family members of FIPA kindreds and sporadic patients with disease onset ≤18 years or macroadenomas with onset ≤30 years (n = 1477). This was a collaborative study conducted at referral centers for pituitary diseases. Interventions & Outcome AIP testing and clinical screening for pituitary disease. Comparison of characteristics of prospectively diagnosed (n = 22) vs clinically presenting AIPmut PitNET patients (n = 145), and AIPmut (n = 167) vs AIPneg PitNET patients (n = 1310). Results Prospectively diagnosed AIPmut PitNET patients had smaller lesions with less suprasellar extension or cavernous sinus invasion and required fewer treatments with fewer operations and no radiotherapy compared with clinically presenting cases; there were fewer cases with active disease and hypopituitarism at last follow-up. When comparing AIPmut and AIPneg cases, AIPmut patients were more often males, younger, more often had GH excess, pituitary apoplexy, suprasellar extension, and more patients required multimodal therapy, including radiotherapy. AIPmut patients (n = 136) with GH excess were taller than AIPneg counterparts (n = 650). Conclusions Prospectively diagnosed AIPmut patients show better outcomes than clinically presenting cases, demonstrating the benefits of genetic and clinical screening. AIP-related pituitary disease has a wide spectrum ranging from aggressively growing lesions to stable or indolent disease course

Opera, theatre, and audience in antebellum New York. (Volumes I and II).

Post-War of 1812 New York City was hardly prime territory for a musically elaborate, European theatrical genre such as Italian opera. Indeed, the earliest opera houses in the city were disdained by a Jacksonian democracy sensitive to aristocratic excess, while even opera's source, the theatre, was condemned as immoral. Yet by the Civil War, the disparaged aristocratic genre had been accepted as democratic, respectable, and appealing. New York's theatre audiences had long enjoyed English opera, in which music had ornamented the spoken drama. Thus in 1825-6, writers responding to the first Italian performances faulted them for their musical power. Meanwhile, attempts to create an elegant social setting for opera were criticized as pandering to aristocratic fashion. Opera's success, then, depended on New Yorkers accepting music as its source of meaning, and its social ambiance and economic basis as consistent with American values. Hybrid Englished opera facilitated the process. In the 1830s and 40s, New York's commercial theatres presented unobjectionable stories in English translation with Italian music. Works such as Bellini's La Sonnambula linked music's aesthetic quality with moral value and attracted a polite, sexually mixed, non-elite audience. However, in showing New Yorkers how music could create its own emotional world, they also fostered the acceptance of later Italian works whose stories flouted Victorian moral scruples, thus paving the way for the success of the opera house. By the 1850s, entrepreneurs supplemented the theatre's commercial financing with mass marketing techniques, winning public support for opera in a setting still seen as elegant but no longer aristocratic. This study draws on theatre and opera house documents, playbills, promptbooks, correspondence, scrapbooks, diaries, financial records, scores, librettos, scripts, sheet music, newspapers, magazines, books, pamphlets, articles, and dissertations. It explores the gray area between high and popular culture, chronicling the shift from a socially based distinction between elite and popular genres to an aesthetic one between art and entertainment. In so doing, it incorporates individual operas into a socio-historical argument and addresses the role of reception and social factors in defining musical genres.Ph.D.American historyCommunication and the ArtsMusicSocial SciencesTheaterUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128674/2/9123967.pd