Gastro-esophageal reflux disease symptoms and demographic factors as a pre-screening tool for Barrett's esophagus.

BACKGROUND: Barrett's esophagus (BE) occurs as consequence of reflux and is a risk factor for esophageal adenocarcinoma. The current "gold-standard" for diagnosing BE is endoscopy which remains prohibitively expensive and impractical as a population screening tool. We aimed to develop a pre-screening tool to aid decision making for diagnostic referrals. METHODOLOGY/PRINCIPAL FINDINGS: A prospective (training) cohort of 1603 patients attending for endoscopy was used for identification of risk factors to develop a risk prediction model. Factors associated with BE in the univariate analysis were selected to develop prediction models that were validated in an independent, external cohort of 477 non-BE patients referred for endoscopy with symptoms of reflux or dyspepsia. Two prediction models were developed separately for columnar lined epithelium (CLE) of any length and using a stricter definition of intestinal metaplasia (IM) with segments ≥ 2 cm with areas under the ROC curves (AUC) of 0.72 (95%CI: 0.67-0.77) and 0.81 (95%CI: 0.76-0.86), respectively. The two prediction models included demographics (age, sex), symptoms (heartburn, acid reflux, chest pain, abdominal pain) and medication for "stomach" symptoms. These two models were validated in the independent cohort with AUCs of 0.61 (95%CI: 0.54-0.68) and 0.64 (95%CI: 0.52-0.77) for CLE and IM ≥ 2 cm, respectively. CONCLUSIONS: We have identified and validated two prediction models for CLE and IM ≥ 2 cm. Both models have fair prediction accuracies and can select out around 20% of individuals unlikely to benefit from investigation for Barrett's esophagus. Such prediction models have the potential to generate useful cost-savings for BE screening among the symptomatic population

Depths and Thermal Habitat Used by Large versus Small Northern Pike in Three Minnesota Lakes

We monitored depths and temperatures used by large (>71‐cm) versus small Northern Pike Esox lucius in three north‐central Minnesota lakes with either acoustic telemetry or archival tags. Individual Northern Pike demonstrated flexibility in depths used within a season and between years. The fish had some tolerance for low levels of dissolved oxygen (<3 mg/L), but depth selection was generally constrained by low dissolved oxygen in summer and winter. The fish more fully exploited all available depths during winter and thermal turnover periods. During July and August, large Northern Pike tended to follow the thermocline into cooler water as upper water layers warmed. Selection ratios indicated that large Northern Pike preferred water temperatures of 16–21°C during August when temperatures up to 28°C were available. In two lakes providing dense overhead cover from water lilies in shallow water, small Northern Pike used warmer, shallower water compared with large fish during summer. In a third lake providing no such cover, small fish were more often in deeper, cooler water. For small Northern Pike, temperature seemed to be a secondary habitat consideration behind the presence of shallow vegetated cover. This study provided detailed temperature selection information that will be useful when considering temperature as an ecological resource for different sizes of Northern Pike.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141595/1/tafs1629.pd

Demographic characteristics according to endoscopic BE and pathological BE in the training cohort^*.

<p>^*Data shown are mean (SD) for continuous variables and number (percentage) for categorical variables</p>†<p>P for trend test.</p

ROC curve for a) endoscopically visible CLE of any length independent of histology (AUC: 0.61), b) segment containing IM≥2 cm (AUC: 0.64) in the external validation cohort (N = 477).

<p>ROCs curve were developed using the risk scores which are calculated by the weights of different predictors. The weights were developed based on the coefficients of predictors in the backward logistic regression model in the training cohort.</p

ROC curve for a) endoscopically visible CLE of any length independent of histology (AUC: 0.72), b) segment containing IM≥2 cm (AUC: 0.81) in the training cohort (N = 1603).

<p>ROCs curve were developed using the risk scores which are calculated using the weights of different predictors. The weights were developed based on the coefficients of predictors in the backward logistic regression model in the training cohort.</p

The coefficients, weights and odds ratios of selected predictors for BE.

<p>^*n/a: not applicable.</p

Summary of the predictors for BE in the external validation cohort^*.

<p>^*Data shown are mean (SD) for continuous variables and number (percentage) for categorical variables.</p

Learning and Change in 20th-Century British Economic Policy

Despite considerable interest in the means by which policy learning occurs, and in how it is that the framework of policy may be subject to radical change, the “black box” of economic policy making remains surprisingly murky. This article utilizes Peter Hall’s concept of “social learning” to develop a more sophisticated model of policy learning; one in which paradigm failure does not necessarily lead to wholesale paradigm replacement, and in which an administrative battle of ideas may be just as important a determinant of paradigm change as a political struggle. It then applies this model in a survey of U.K. economic policy making since the 1930s: examining the shift to “Keynesianism” during the 1930s and 1940s; the substantial revision of this framework in the 1960s; the collapse of the“Keynesian-plus” framework in the 1970s; and the major revisions to the new “neoliberal” policy framework in the 1980s and 1990s