Overdiagnosis and overtreatment of breast cancer: Overdiagnosis in randomised controlled trials of breast cancer screening

Data from randomised controlled trials of mammographic screening can be used to determine the extent of any overdiagnosis, as soon as either a time equivalent to the lead-time has elapsed after the final screen, or the control arm has been offered screening. This paper reviews those randomised trials for which breast cancer incidence data are available. In recent trials in which the control group has not been offered screening, an excess incidence of breast cancer remains after many years of follow-up. In those trials in which the control arm has been offered screening, although there is a possible shift from invasive to in situ disease, there is no evidence of overdiagnosis as a result of incident screens

Evidence of space–time clustering of childhood acute lymphoblastic leukaemia in Sweden

We have examined 645 recorded cases of childhood acute lymphatic leukaemia (ALL) in Sweden during 1973–89 to identify space–time clustering by using the close-pair method of Knox. The records included date of birth and of diagnosis as well as addresses at birth and at diagnosis. There was a significant excess of case pairs close in date of birth and place of birth in the 5- to 15-year age group. © 1999 Cancer Research Campaig

Interpreting Posterior Relative Risk Estimates in Disease-Mapping Studies

There is currently much interest in conducting spatial analyses of health outcomes at the small-area scale. This requires sophisticated statistical techniques, usually involving Bayesian models, to smooth the underlying risk estimates because the data are typically sparse. However, questions have been raised about the performance of these models for recovering the “true” risk surface, about the influence of the prior structure specified, and about the amount of smoothing of the risks that is actually performed. We describe a comprehensive simulation study designed to address these questions. Our results show that Bayesian disease-mapping models are essentially conservative, with high specificity even in situations with very sparse data but low sensitivity if the raised-risk areas have only a moderate (< 2-fold) excess or are not based on substantial expected counts (> 50 per area). Semiparametric spatial mixture models typically produce less smoothing than their conditional autoregressive counterpart when there is sufficient information in the data (moderate-size expected count and/or high true excess risk). Sensitivity may be improved by exploiting the whole posterior distribution to try to detect true raised-risk areas rather than just reporting and mapping the mean posterior relative risk. For the widely used conditional autoregressive model, we show that a decision rule based on computing the probability that the relative risk is above 1 with a cutoff between 70 and 80% gives a specific rule with reasonable sensitivity for a range of scenarios having moderate expected counts (~ 20) and excess risks (~1.5- to 2-fold). Larger (3-fold) excess risks are detected almost certainly using this rule, even when based on small expected counts, although the mean of the posterior distribution is typically smoothed to about half the true value

Residential mobility and risk of childhood acute lymphoblastic leukaemia: an ecological study

We conducted an ecological analysis of childhood acute lymphoblastic leukaemia-incidence data from children ⩽5 years old during 1992–1998 from the Surveillance, Epidemiology, and End Results Program in 200 counties and Hawaii. The response variable was the count of cases in each county race–sex stratum, examined in relation to data from the United States Census and the United States Department of Agriculture. The final models for both sexes included race, proportion moved during 1985–1990, and proportion of households with income ⩾$5000 as potential predictors. Incidence was lower among black boys (rate ratio (RR)=0.5) and black girls (RR=0.4) than among other children of the same sex; no other significant racial differences were detected. Incidence was elevated among males (but not females) residing in counties where ⩾50$5000 (RR=1.5). These sex differences in risk factors were unexpected

Planes para incrementar facturación de la empresa Best Technology en 30%, de 185k a 234k para el año 2024

El presente caso de estudio tiene como objetivo poder brindar a la empresa Best Technology SAC una solución al problema actual que es la cantidad limitada de clientes que tienen actualmente, para que puedan incrementar su facturación y seguir creciendo sosteniblemente. Best Technology SAC es una empresa B2B que ofrece productos y servicios tecnológicos adaptándose a cualquier rubro de pequeñas, medianas y algunas grandes empresas. La metodología empleada es el estudio de caso intrínseco y empleamos como principal autor a Sampieri y Mendoza. Para el presente estudio de caso se emplearon fuentes primarias por parte del gerente general donde se realizó un análisis tanto interno como externo de la empresa Best Technology SAC y fuentes secundarias de múltiples estudios relacionados al tema a tratar. El motivo de este estudio es poder tomar en cuenta la creación de un perfil guía, para generar un área comercial donde se pueda tener un contacto directo con las empresas prospectos y clientes actuales, con el fin de incrementar la facturación anual y generar un mayor ticket promedio, fidelizar y mejorar el servicio para los clientes actuales. Finalmente se entregará el presente caso a manera de informe para la empresa, así como el plan de generación del área comercial y el presupuesto en soles que esta implementación traerá para lograr el objetivo principal que es un incremento del 30% de facturación anual. Adicionalmente esta propuesta, así como los objetivos tanto del área como del estudio podrán ir variando y ajustándose en el proceso de implementación y funcionamiento.This case study aims to provide the company Best Technology SAC with a solution to the current problem, which is the limited number of customers they currently have, so that they can increase their turnover and continue to grow sustainably. Best Technology SAC is a B2B company that offers technological products and services adapted to any type of small, medium and some large companies. The methodology used is the intrinsic case study and we use Sampieri and Mendoza as the main author. For this case study, primary sources were used by the general manager where an internal and external analysis of the company Best Technology SAC and secondary sources of multiple studies related to the subject were made. The reason for this study is to take into account the creation of a profile guide, to generate a commercial area where you can have direct contact with prospective companies and current customers, in order to increase annual turnover and generate a higher average ticket, loyalty and improve service for existing customers. Finally, this case will be delivered as a report for the company as well as the generation plan of the commercial area and the budget in soles that this implementation will bring to achieve the main objective, which is a 30% increase in annual turnover. Additionally, this proposal as well as the objectives of both the area and the study may vary and be adjusted in the process of implementation and operation.Trabajo de Suficiencia Profesiona

Unraveling the Light-Activated Reaction Mechanism in a Catalytically Competent Key Intermediate of a Multifunctional Molecular Catalyst for Artificial Photosynthesis

Understanding photodriven multielectron reaction pathways requires the identification and spectroscopic characterization of intermediates and their excited-state dynamics, which is very challenging due to their short lifetimes. To the best of our knowledge, this manuscript reports for the first time on in situ spectroelectrochemistry as an alternative approach to study the excited-state properties of reactive intermediates of photocatalytic cycles. UV/Vis, resonance-Raman, and transient-absorption spectroscopy have been employed to characterize the catalytically competent intermediate [(tbbpy)2RuII(tpphz)RhICp*] of [(tbbpy)2Ru(tpphz)Rh(Cp*)Cl]Cl(PF6)2 (Ru(tpphz)RhCp*), a photocatalyst for the hydrogenation of nicotinamide (NAD-analogue) and proton reduction, generated by electrochemical and chemical reduction. Electronic transitions shifting electron density from the activated catalytic center to the bridging tpphz ligand significantly reduce the catalytic activity upon visible-light irradiation. © 2019 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA

Urbanisation and incidence of acute lymphocytic leukaemia among United States children aged 0–4

Acute lymphocytic leukaemia (ALL) incidence among children under 5 years of age was examined, utilising data from 24 United States cancer registries. County-based incidence rates among white children were compared across four levels of urbanisation: large and small metropolitan counties, and adjacent and nonadjacent rural counties. In metropolitan areas, the incidence of ALL was lower among blacks (rate ratio (RR)=0.38, confidence interval (CI)=0.33–0.44) and among Asians/Pacific Islanders (RR=0.78, CI=0.63–0.97) than among whites. Among white children, the incidence of ALL decreased across the four strata of urbanisation, from 67 to 62 to 65 to 54 cases per million person-years at-risk (two-sided trend P=0.009), such that rates were significantly lower in the most remote rural counties than in the most populous metropolitan counties (RR=0.80, 95% CI=0.70–0.91)

Higher risk for acute childhood lymphoblastic leukaemia in Swedish population centres 1973-94

A population-based sample of acute childhood leukaemia cases in Sweden 1973–94 was analysed by a geographical information system (GIS) for spatial leukaemia distribution in relation to population density. The annual incidence rate for acute lymphoblastic leukaemia (ALL) was 3.6, and for acute non-lymphoblastic leukaemia (ANLL) 0.7, cases per 100 000 children. Incidence rates in population centres, constituting 1.3% of Sweden's land area and approximately 80% of the population, compared with the rest of Sweden showed a statistically significant excess of ALL [odds ratio (OR) 1.68; 95% confidence interval (CI) 1.44–1.95], but not ANLL (OR 1.13; 95% CI 0.98–1.32). An increasing trend, however not statistically significant, was found for ALL incidence with both increasing population density in parishes and increasing degree of urbanity in municipalities. These findings support the theories that some environmental factors associated with high population density, such as infectious agents, may be of aetiological importance for childhood acute lymphoblastic leukaemia. © 1999 Cancer Research Campaig