Preliminary results of a feasibility study of the use of information technology for identification of suspected colorectal cancer in primary care: the CREDIBLE study

This is the final version of the article. Available from Cancer Research UK/Nature Publishing Group via the DOI in this record.BACKGROUND: We report the findings of a feasibility study using information technology to search electronic primary care records and to identify patients with possible colorectal cancer. METHODS: An algorithm to flag up patients meeting National Institute for Health and Care Excellence (NICE) urgent referral criteria for suspected colorectal cancer was developed and incorporated into clinical audit software. This periodically flagged up such patients aged 60 to 79 years. General practitioners (GPs) reviewed flagged-up patients and decided on further clinical management. We report the numbers of patients identified and the numbers that GPs judged to need further review, investigations or referral to secondary care and the final diagnoses. RESULTS: Between January 2012 and March 2014, 19,580 records of patients aged 60 to 79 years were searched in 20 UK general practices, flagging up 809 patients who met urgent referral criteria. The majority of the patients had microcytic anaemia (236 (29%)) or rectal bleeding (205 (25%)). A total of 274 (34%) patients needed further clinical review of their records; 199 (73%) of these were invited for GP consultation, and 116 attended, of whom 42 were referred to secondary care. Colon cancer was diagnosed in 10 out of 809 (1.2%) flagged-up patients and polyps in a further 28 out of 809 (3.5%). CONCLUSIONS: It is technically possible to identify patients with colorectal cancer by searching electronic patient records.We acknowledge the General Practitioners, practice nurses, practice managers and administrative staff who supported this study, our trial co-ordinator Marie Crook, Anthony Ingold who was one of our patient representatives and MSDi for their support in developing the software algorithm. We also acknowledge the support of the National Institute for Health Research Clinical Research Network. This study was funded by the National Awareness and Early Diagnosis Initiative (NAEDI). TM is partly funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for the West Midlands (CLAHRC-WM) programme

Cetaceans in the Mediterranean Sea. Encounter rate, dominant species, and diversity hotspots

We investigated the presence and diversity of cetaceans in the Mediterranean Sea, analysing the data collected by 32 different research units, over a period of 15 years (2004–2018), and shared on the common web-GIS platform named Intercet. We used the encounter rate, the species prevalence, and the Shannon diversity index as parameters for data analysis. The results show that cetacean diversity, in the context of the Mediterranean basin, is generally quite low when compared with the eastern Atlantic, as few species, namely the striped dolphin, the bottlenose dolphin, the fin whale, and the sperm whale, dominate over all the others. However, some areas, such as the Alboran Sea or the north-western Mediterranean Sea, which includes the Pelagos Sanctuary (the Specially Protected Area of Mediterranean Interest located in the northern portion of the western basin), show higher levels of diversity and should be considered hotspots to be preserved. Primary production and seabed profile seem to be the two main drivers influencing the presence and distribution of cetaceans, with the highest levels of diversity observed in areas characterized by high levels of primary production and high bathymetric variability and gradient. This collective work underlines the importance of data sharing to deepen our knowledge on marine fauna at the scale of the whole Mediterranean Sea and encourages greater efforts in the networking process, also to accomplish the requirements of the Marine Strategy Framework Directive, with particular reference to Descriptor 1: biological diversity is maintained

Non-targeted tourism affects the behavioural budgets of bottlenose dolphins Tursiops truncatus in the South Adriatic (Montenegro)

We investigated the short-term effects of non-targeted tourism on the behaviour of bottlenose dolphins Tursiops truncatus in the South Adriatic off the coast of Montenegro, by comparing dolphin group behaviour during impact (the presence of non-targeted tourism vessels) and control (absence of all marine vessels) scenarios. Tourism vessel and dolphin behavioural data were collected through systematic weekly land-based surveys. Using instantaneous focal ‘group’ scan sampling, the predominant behaviour of bottlenose dolphin groups was determined. To quantify the effect of vessel interactions on the behavioural budget of the dolphins, we followed a stepwise modelling approach. A first-order Markov chain was used to calculate the transition probabilities between behavioural states before a Monte Carlo simulation estimated the behavioural budgets of dolphins during impact and control situations. In the presence of non-targeted tourism, dolphins were found to be less likely to remain diving (during which dolphins were assumed to be feeding), whilst milling-socialising and surface feeding were completely absent from their behavioural repertoires. Nevertheless, the behavioural budgets demonstrated an increase in resting behaviour in the presence of non-targeted tourism vessels. No significant changes to travelling behaviour were observed. The decrease in foraging behaviour (both surface feeding and diving) could result in a reduction in energy intake for dolphins, which over time (assuming repeated disturbance) could negatively affect body condition, and ultimately survival and reproduction. Regulations on non-targeted tourism should therefore be considered to minimise potential long-term negative effects on dolphins within Montenegrin territorial water

Comparison of acoustic patterns recorded for the sperm whale (Physeter macrocephalus) in the Northern Ionian Sea (Central Mediterranean Sea) and in the North-western Levantine Sea (Eastern Mediterranean Sea)

Sperm whales Physeter macrocephalus show a steady population decline, yet despite their threatened status, there remains a dearth of knowledge in the Mediterranean Sea. The current study reports the preliminary results of sperm whales' acoustic patterns within the Gulf of Taranto and the Northwestern Levantine Sea. "Regular" clicks were recorded in both regions indicating the presence of foraging grounds. "Codas" were also present in the Northwestern Levantine. The presence of codas and social units emphasises the importance of the North-western Levantine as potential nursery grounds. Further, interclick intervals were slightly smaller for the Taranto Gulf while recordings from the North-western Levantine Sea showed similarities with the Mediterranean Sea. Lastly, sperm whales were larger in size in the Taranto Gulf compared to the Northwestern Levantine Sea. The current results depended on data collected on a single date, therefore further research must be implemented to understand the acoustic patterns of sperm whales