A PROGRAM EVALUATION OF A COLON CANCER SCREENING PROGRAM USING AT-HOME FECAL IMMUNOCHEMICAL TESTS WITH CERTIFIED PATIENT NAVIGATORS

Colorectal cancer is the second leading cause of cancer-related death in this country, but 33% of these deaths could be prevented by screening. While colonoscopy is an effective screening tool, it is expensive, invasive, and prone to encounter considerable patient resistance. An alternative is to first screen those at-risk using at-home fecal immunochemical test (FIT) kits. This study determined factors associated with the return of these kits distributed by Kentucky CancerLink, a non-profit organization, and its affiliates to participants in a colon cancer prevention program. Objectives: To identify factors associated with: completing a FIT kit, completing the kit with minimal prompting, a positive FIT kit result, and a positive colonoscopy result. To evaluate a colon cancer screening program for internal and Commission on Cancer (CoC) implementation goals: ship kits promptly; notify patients and their physician, if requested, of FIT results promptly; follow-up on positive FIT results; encourage a high percentage of patients with a positive FIT to complete physician recommended follow-up; and evaluate effectiveness of follow-up contact policy. Design: Descriptive Setting: Non-profit organization in central Kentucky Participants: The study analyzed data collected on 436 FIT kit participants, and 17 direct to colonoscopy participants, during the period January 1 through October 30, 2016. Participants were eligible if over 45 and African American or over 50 for all other races or family history of early-onset colon cancer or precancerous condition, Kentucky resident, and no history of colonoscopy in the past 5 years. Outcome measures: FIT kit return, return of the FIT kit with 0-2 follow-up calls, FIT kit result, colonoscopy result, percentage of FIT kits shipped to participants in 0-2 business days, percentage of patients notified of FIT results in 0-2 business days, percentage of physicians notified in 0-2 business days, percentage of patients with positive FIT followed, percentage of patients with positive FIT who completed follow-up, number of calls and last attempt letters. Results: Participants over 60 years of age had higher return rates than those under 60. Participants recruited via advertising, physician referrals, or health fairs had better return rates than participants recruited via church, work, or cold calls. Men were more likely than women to promptly return their kits. Caucasian: non- Hispanics were more likely to have a positive FIT result than African American or Hispanic & Other ethnicities. Participants referred by physician cold call list or advertising were more likely to have a positive FIT than those recruited via physician referrals, health fairs, church, or work. Participants directly referred to colonoscopy were more likely to have a positive finding on colonoscopy than those who had a positive FIT kit. The program met its goals statistically of shipping kits promptly and following up on positive FIT results. A policy of 3 follow-up calls and a last attempt letter was successful in encouraging the majority of participants to complete their kits. Conclusions: While this study involved a relatively small sample size and cannot be generalized to a larger population, the value of evaluating a screening program, learning which methods of recruitment bear more fruit than others, and using that information can be generalized to other organizations, no matter the size of the program. Patient navigators encouraged 73.62% of participants to complete their FIT kits through the use of follow-up calls and last attempt letters. Adults at greater risk of colon cancer responded well to the program. Adults over 60 were more likely to complete their kit. Men were more likely to complete their kit with minimal prompting. Patients who were screened directly to colonoscopy were more likely to have positive colonoscopy result. The program met its internal and CoC guidelines. These findings inform public health officials on how to allocate resources to maximize return of FIT kits in a colon cancer prevention program. Future programs would do well to recognize that participants themselves were still the rate limiting step, so patient navigators should put the kits in the hands of at risk people, and remind them

Ethical Brand Perception Formation When Information Is Inconsistent -an Impression Formation Perspective

This research builds on the recently emerging literature on consumer perceived ethicality (CPE) and experimentally explores how consumers form moral impressions of brands when confronted with inconsistent information. Findings suggest that impression formation processes differ depending on whether consumers are explicitly requested to evaluate brand ethics or not. This work is copyrighted by The Association for Consumer Research. For permission to copy or use this work in whole or in part, please contact the Copyright Clearance Center at http://www.copyright.com/. 319 Advances in Consumer Research Volume 43, ©2015 Ethical Brand Perception Formation when Information is InconsistentAn Impression Formation Perspective Katja H. Brunk, European University Viadrina, Frankfurt (Oder), Germany Cara DeBoer, ESMT European School of Management and Technology, Berlin, Germany ABSTRACT This research builds on the recently emerging literature on consumer perceived ethicality (CPE) and experimentally explores how consumers form moral impressions of brands when confronted with inconsistent information. Findings suggest that impression formation processes differ depending on whether consumers are explicitly requested to evaluate brand ethics or not

The Long Shadow of Senescence: Age Impacts Survival and Territory Defense in Loons

Senescence, increased mortality that occurs among animals of advanced age, impacts behavior and ecology in many avian species. We investigated actuarial, reproductive, and behavioral senescence using capture, marking, and resighting data from a 26-year study of common loons (Gavia immer). Territorial residents of both sexes exhibited high annual survival (0.94) until their mid 20s, at which point survival fell to 0.76 and 0.77 in males and females, respectively. Sexual symmetry in actuarial senescence is somewhat surprising in this species, because males make a substantially greater investment in territory defense and chick-rearing and because males engage in lethal contests for territory ownership. Survival of displaced breeders (0.80) was lower than that of territorial residents in both young and old individuals. Old males and females also experienced slightly higher annual probability of eviction (0.16 for males; 0.17 for females) than prime-aged breeders (0.13 for both sexes), indicating senescence in territory defense. Prime-aged males reclaimed territories at a high rate (0.49), in contrast to females of the same age (0.33). However, old males resettled with success (0.35) similar to old females (0.31), suggesting that males decline in competitive ability as they age. Nonetheless males, but not females, showed an apparent increase in breeding success over the entire lifetime, a possible indication that very old males make a terminal investment in reproductive output at the cost of survival

The Experiment Station

14 pgExperiments started - Experiment in cattle feeding - Analyses of fertilizers and ores - Horticultural Department - Meteorological Departmen

A Path Algorithm for Constrained Estimation

Many least squares problems involve affine equality and inequality constraints. Although there are variety of methods for solving such problems, most statisticians find constrained estimation challenging. The current paper proposes a new path following algorithm for quadratic programming based on exact penalization. Similar penalties arise in $l_1$ regularization in model selection. Classical penalty methods solve a sequence of unconstrained problems that put greater and greater stress on meeting the constraints. In the limit as the penalty constant tends to $\infty$, one recovers the constrained solution. In the exact penalty method, squared penalties are replaced by absolute value penalties, and the solution is recovered for a finite value of the penalty constant. The exact path following method starts at the unconstrained solution and follows the solution path as the penalty constant increases. In the process, the solution path hits, slides along, and exits from the various constraints. Path following in lasso penalized regression, in contrast, starts with a large value of the penalty constant and works its way downward. In both settings, inspection of the entire solution path is revealing. Just as with the lasso and generalized lasso, it is possible to plot the effective degrees of freedom along the solution path. For a strictly convex quadratic program, the exact penalty algorithm can be framed entirely in terms of the sweep operator of regression analysis. A few well chosen examples illustrate the mechanics and potential of path following.Comment: 26 pages, 5 figure

Universal features of correlated bursty behaviour

Inhomogeneous temporal processes, like those appearing in human communications, neuron spike trains, and seismic signals, consist of high-activity bursty intervals alternating with long low-activity periods. In recent studies such bursty behavior has been characterized by a fat-tailed inter-event time distribution, while temporal correlations were measured by the autocorrelation function. However, these characteristic functions are not capable to fully characterize temporally correlated heterogenous behavior. Here we show that the distribution of the number of events in a bursty period serves as a good indicator of the dependencies, leading to the universal observation of power-law distribution in a broad class of phenomena. We find that the correlations in these quite different systems can be commonly interpreted by memory effects and described by a simple phenomenological model, which displays temporal behavior qualitatively similar to that in real systems

Role of P-selectin in platelet sequestration in pulmonary capillaries during endotoxemia

Background: There is growing evidence that platelets accumulate in the lung and contribute to the pathogenesis of acute lung injury during endotoxemia. The aims of the present study were to localize platelet sequestration in the pulmonary microcirculation and to investigate the role of P-selectin as a molecular mechanism of platelet endothelial cell interaction. Methods: We used in vivo fluorescence microscopy to quantify the kinetics of fluorescently labeled erythrocytes and platelets in alveolar capillary networks in rabbit lungs. Results: Six hours after onset of endotoxin infusion we observed a massive rolling along and firm adherence of platelets to lung capillary endothelial cells whereas under control conditions no platelet sequestration was detected. P-selectin was expressed on the surface of separated platelets which were incubated with endotoxin and in lung tissue. Pretreatment of platelets with fucoidin, a P-selectin antagonist, significantly attenuated the endotoxin-induced platelet rolling and adherence. In contrast, intravenous infusion of fucoidin in endotoxin-treated rabbits did not inhibit platelet sequestration in pulmonary capillaries. Conclusion: We conclude that platelets accumulate in alveolar capillaries following endotoxemia. P-selectin expressed on the surface of platelets seems to play an important role in mediating this platelet-endothelial cell interaction. Copyright (c) 2006 S. Karger AG, Basel

Lysosomes in iron metabolism, ageing and apoptosis

The lysosomal compartment is essential for a variety of cellular functions, including the normal turnover of most long-lived proteins and all organelles. The compartment consists of numerous acidic vesicles (pH ∼4 to 5) that constantly fuse and divide. It receives a large number of hydrolases (∼50) from the trans-Golgi network, and substrates from both the cells’ outside (heterophagy) and inside (autophagy). Many macromolecules contain iron that gives rise to an iron-rich environment in lysosomes that recently have degraded such macromolecules. Iron-rich lysosomes are sensitive to oxidative stress, while ‘resting’ lysosomes, which have not recently participated in autophagic events, are not. The magnitude of oxidative stress determines the degree of lysosomal destabilization and, consequently, whether arrested growth, reparative autophagy, apoptosis, or necrosis will follow. Heterophagy is the first step in the process by which immunocompetent cells modify antigens and produce antibodies, while exocytosis of lysosomal enzymes may promote tumor invasion, angiogenesis, and metastasis. Apart from being an essential turnover process, autophagy is also a mechanism by which cells will be able to sustain temporary starvation and rid themselves of intracellular organisms that have invaded, although some pathogens have evolved mechanisms to prevent their destruction. Mutated lysosomal enzymes are the underlying cause of a number of lysosomal storage diseases involving the accumulation of materials that would be the substrate for the corresponding hydrolases, were they not defective. The normal, low-level diffusion of hydrogen peroxide into iron-rich lysosomes causes the slow formation of lipofuscin in long-lived postmitotic cells, where it occupies a substantial part of the lysosomal compartment at the end of the life span. This seems to result in the diversion of newly produced lysosomal enzymes away from autophagosomes, leading to the accumulation of malfunctioning mitochondria and proteins with consequent cellular dysfunction. If autophagy were a perfect turnover process, postmitotic ageing and several age-related neurodegenerative diseases would, perhaps, not take place