Colorectal Cancer Screening After Sequential Outreach Components in a Demographically Diverse Cohort.

Organized screening outreach can reduce differences in colorectal cancer (CRC) incidence and mortality between demographic subgroups. Outcomes associated with additional outreach, beyond universal outreach, are not well known. To compare CRC screening completion by race and ethnicity, age, and sex after universal automated outreach and additional personalized outreach. This observational cohort study included screening-eligible individuals aged 50 to 75 years assessed during 2019 in a community-based organized CRC screening program within the Kaiser Permanente Northern California (KPNC) integrated health care delivery setting. For KPNC members who are not up to date with screening by colonoscopy, each year the program first uses automated outreach (mailed prescreening notification postcards and fecal immunochemical test [FIT] kits, automated telephone calls, and postcard reminders), followed by personalized components for nonresponders (telephone calls, electronic messaging, and screening offers during office visits). Data analyses were performed between November 2021 and February 2023 and completed on February 5, 2023. Completed CRC screening via colonoscopy, sigmoidoscopy, or FIT. The primary outcome was the proportion of participants completing an FIT or colonoscopy after each component of the screening process. Differences across subgroups were assessed using the χ2 test. This study included 1 046 745 KPNC members. Their mean (SD) age was 61.1 (6.9) years, and more than half (53.2%) were women. A total of 0.4% of members were American Indian or Alaska Native, 18.5% were Asian, 7.2% were Black, 16.2% were Hispanic, 0.8% were Native Hawaiian or Other Pacific Islander, and 56.5% were White. Automated outreach significantly increased screening participation by 31.1%, 38.1%, 29.5%, 31.9%, 31.8%, and 34.5% among these groups, respectively; follow-up personalized outreach further significantly increased participation by absolute additional increases of 12.5%, 12.4%, 13.3%, 14.4%, 14.7%, and 11.2%, respectively (all differences P < .05 compared with White members). Overall screening coverage at the end of the yearly program differed significantly among members who were American Indian or Alaska Native (74.1%), Asian (83.5%), Black (77.7%), Hispanic (76.4%), or Native Hawaiian or Other Pacific Islander (74.4%) compared with White members (82.2%) (all differences P < .05 compared with White members). Screening completion was similar by sex; older members were substantially more likely to be up to date with CRC screening both before and at the end of the screening process. In this cohort study of a CRC screening program, sequential automated and personalized strategies each contributed to substantial increases in screening completion in all demographic groups. These findings suggest that such programs may potentially reduce differences in CRC screening completion across demographic groups

Program Components and Results From an Organized Colorectal Cancer Screening Program Using Annual Fecal Immunochemical Testing.

Programmatic colorectal cancer (CRC) screening increases uptake, but the design and resources utilized for such models are not well known. We characterized program components and participation at each step in a large program that used mailed fecal immunochemical testing (FIT) with opportunistic colonoscopy. Mixed-methods with site visits and retrospective cohort analysis of 51-75-year-old adults during 2017 in the Kaiser Permanente Northern California integrated health system. Among 1,023,415 screening-eligible individuals, 405,963 (40%) were up to date with screening at baseline, and 507,401 of the 617,452 not up-to-date were mailed a FIT kit. Of the entire cohort (n = 1,023,415), 206,481 (20%) completed FIT within 28 days of mailing, another 61,644 (6%) after a robocall at week 4, and 40,438 others (4%) after a mailed reminder letter at week 6. There were over 800,000 medical record screening alerts generated and about 295,000 FIT kits distributed during patient office visits. About 100,000 FIT kits were ordered during direct-to-patient calls by medical assistants and 111,377 people (11%) completed FIT outside of the automated outreach period. Another 13,560 (1.3%) completed a colonoscopy, sigmoidoscopy, or fecal occult blood test unrelated to FIT. Cumulatively, 839,463 (82%) of those eligible were up to date with screening at the end of the year and 12,091 of 14,450 patients (83.7%) with positive FIT had diagnostic colonoscopy. The >82% screening participation achieved in this program resulted from a combination of prior endoscopy (40%), large initial response to mailed FIT kits (20%), followed by smaller responses to automated reminders (10%) and personal contact (12%)

Hawking Spectrum and High Frequency Dispersion

We study the spectrum of created particles in two-dimensional black hole geometries for a linear, hermitian scalar field satisfying a Lorentz non-invariant field equation with higher spatial derivative terms that are suppressed by powers of a fundamental momentum scale $k_0$. The preferred frame is the ``free-fall frame" of the black hole. This model is a variation of Unruh's sonic black hole analogy. We find that there are two qualitatively different types of particle production in this model: a thermal Hawking flux generated by ``mode conversion" at the black hole horizon, and a non-thermal spectrum generated via scattering off the background into negative free-fall frequency modes. This second process has nothing to do with black holes and does not occur for the ordinary wave equation because such modes do not propagate outside the horizon with positive Killing frequency. The horizon component of the radiation is astonishingly close to a perfect thermal spectrum: for the smoothest metric studied, with Hawking temperature $T_H\simeq0.0008k_0$, agreement is of order $(T_H/k_0)^3$ at frequency $\omega=T_H$, and agreement to order $T_H/k_0$ persists out to $\omega/T_H\simeq 45$ where the thermal number flux is $O(10^{-20}$). The flux from scattering dominates at large $\omega$ and becomes many orders of magnitude larger than the horizon component for metrics with a ``kink", i.e. a region of high curvature localized on a static worldline outside the horizon. This non-thermal flux amounts to roughly 10\% of the total luminosity for the kinkier metrics considered. The flux exhibits oscillations as a function of frequency which can be explained by interference between the various contributions to the flux.Comment: 32 pages, plain latex, 16 figures included using psfi

Looking Beyond Inflationary Cosmology

In spite of the phenomenological successes of the inflationary universe scenario, the current realizations of inflation making use of scalar fields lead to serious conceptual problems which are reviewed in this lecture. String theory may provide an avenue towards addressing these problems. One particular approach to combining string theory and cosmology is String Gas Cosmology. The basic principles of this approach are summarized.Comment: invited talk at "Theory Canada 1" (Univ. of British Columbia, Vancouver, Canada, June 2 - 4, 2005) (references updated

Influence of Varying Quantitative Fecal Immunochemical Test Positivity Thresholds on Colorectal Cancer Detection: A Community-Based Cohort Study.

The fecal immunochemical test (FIT) is commonly used for colorectal cancer (CRC) screening. Despite demographic variations in stool hemoglobin concentrations, few data exist regarding optimal positivity thresholds by age and sex. To identify programmatic (multitest) FIT performance characteristics and optimal FIT quantitative hemoglobin positivity thresholds in a large, population-based, screening program. Retrospective cohort study. Kaiser Permanente Northern and Southern California. Adults aged 50 to 75 years who were eligible for screening and had baseline quantitative FIT results (2013 to 2014) and 2 years of follow-up. Nearly two thirds (411 241) had FIT screening in the previous 2 years. FIT programmatic sensitivity for CRC and number of positive test results per cancer case detected, overall and by age and sex. Of 640 859 persons who completed a baseline FIT and were followed for 2 years, 481 817 (75%) had at least 1 additional FIT and 1245 (0.19%) received a CRC diagnosis. Cancer detection (programmatic sensitivity) increased at lower positivity thresholds, from 822 in 1245 (66.0%) at 30 µg/g to 925 (74.3%) at 20 µg/g and 987 (79.3%) at 10 µg/g; the number of positive test results per cancer case detected increased from 43 at 30 µg/g to 52 at 20 µg/g and 85 at 10 µg/g. Reducing the positivity threshold from 20 to 15 µg/g would detect 3% more cancer cases and require 23% more colonoscopies. At the conventional FIT threshold of 20 µg/g, programmatic sensitivity decreased with increasing age (79.0%, 73.4%, and 68.9% for ages 50 to 59, 60 to 69, and 70 to 75 years, respectively; P = 0.009) and was higher in men than women (77.0% vs. 70.6%; P = 0.011). Information on advanced adenoma was lacking. Increased cancer detection at lower positivity thresholds is counterbalanced by substantial increases in positive tests. Tailored thresholds may provide screening benefits that are more equal among different demographic groups, depending on local resources. National Cancer Institute

On Slow Light as a Black Hole Analogue

Although slow light (electromagnetically induced transparency) would seem an ideal medium in which to institute a ``dumb hole'' (black hole analog), it suffers from a number of problems. We show that the high phase velocity in the slow light regime ensures that the system cannot be used as an analog displaying Hawking radiation. Even though an appropriately designed slow-light set-up may simulate classical features of black holes -- such as horizon, mode mixing, Bogoliubov coefficients, etc. -- it does not reproduce the related quantum effects. PACS: 04.70.Dy, 04.80.-y, 42.50.Gy, 04.60.-m.Comment: 14 pages RevTeX, 5 figure

Linking the trans-Planckian and the information loss problems in black hole physics

The trans-Planckian and information loss problems are usually discussed in the literature as separate issues concerning the nature of Hawking radiation. Here we instead argue that they are intimately linked, and can be understood as "two sides of the same coin" once it is accepted that general relativity is an effective field theory.Comment: 10 pages, 2 figures. Replaced with the version to be published in General Relativity and Gravitatio

Dietary sugar/starches intake and Barrett’s esophagus: a pooled analysis

Barrett’s esophagus (BE) is the key precursor lesion of esophageal adenocarcinoma, a lethal cancer that has increased rapidly in westernized countries over the past four decades. Dietary sugar intake has also been increasing over time, and may be associated with these tumors by promoting hyperinsulinemia. The study goal was to examine multiple measures of sugar/starches intake in association with BE. This pooled analysis included 472 BE cases and 492 controls from two similarly conducted case–control studies in the United States. Dietary intake data, collected by study-specific food frequency questionnaires, were harmonized across studies by linking with the University of Minnesota Nutrient Database, and pooled based on study-specific quartiles. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for age, sex, race, total energy intake, study indicator, body mass index, frequency of gastro-esophageal reflux, and fruit/vegetable intake. In both studies, intake of sucrose (cases vs. controls, g/day: 36.07 vs. 33.51; 36.80 vs. 35.06, respectively) and added sugar (46.15 vs. 41.01; 44.18 vs. 40.68, respectively) were higher in cases than controls. BE risk was increased 79% and 71%, respectively, for associations comparing the fourth to the first quartile of intake of sucrose (ORQ4vs.Q1 = 1.79, 95% CI = 1.07–3.02, Ptrend = 0.01) and added sugar (ORQ4vs.Q1 = 1.71, 95% CI = 1.05–2.80, Ptrend = 0.15). Intake of sweetened desserts/beverages was associated with 71% increase in BE risk (ORQ4vs.Q1 = 1.71, 95% CI = 1.07–2.73, Ptrend = 0.04). Limiting dietary intake of foods and beverages that are high in added sugar, especially refined table sugar, may reduce the risk of developing BE

Non-minimally Coupled Tachyonic Inflation in Warped String Background

We show that the non-minimal coupling of tachyon field to the scalar curvature, as proposed by Piao et al, with the chosen coupling parameter does not produce the effective potential where the tachyon field can roll down from T=0 to large $T$ along the slope of the potential. We find a correct choice of the parameters which ensures this requirement and support slow-roll inflation. However, we find that the cosmological parameter found from the analysis of the theory are not in the range obtained from observations. We then invoke warped compactification and varying dilaton field over the compact manifold, as proposed by Raeymaekers, to show that in such a setup the observed parameter space can be ensured.Comment: minor typos corrected and references adde