Quality of life in the five years after intensive care : a cohort study

Peer reviewedPublisher PD

Eltrombopag for the treatment of chronic idiopathic (immune) thrombocytopenic purpura : A Single Technology Appraisal

Evidence Review Group (ERG) final report for the National Institute for Health and Clinical ExcellencePublisher PD

Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse

The original publication is available at www.springerlink.comPeer reviewedPostprin

Choice architecture modifies fruit and vegetable purchasing in a university campus grocery store : time series modelling of a natural experiment

Background In developed countries, adolescent and young adult diets have been found to be nutritionally poor. The aim of this study was to examine whether a choice architecture intervention, re-arrangement of produce within a grocery store to increase the accessibility of fruit and vegetables, affected purchasing behaviour on a university campus. Methods A database of daily sales data from January 2012 to July 2017 was obtained from a campus grocery store. Two changes to the layout were made during this time period. In January 2015, fruit and vegetables were moved from the back of the store, furthest from the entrance, to the aisle closest to the entrance and an entrance-facing display increasing their accessibility. In April 2016, the entrance-facing display of fruit and vegetables was replaced with a chiller cabinet so that fruit and vegetables remained more accessible than during the baseline period, but less accessible than in the period immediately previously. A retrospective interrupted time series analysis using dynamic regression was used to model the data and to examine the effect of the store re-arrangements on purchasing. All analyses were carried out both for sales-by-quantity and for sales-by-money. Results The first shop re-arrangement which made fruit and vegetables more prominent, increased the percentage of total sales that were fruit and vegetables, when analysed by either items purchased or money spent. The second rearrangement also had a positive effect on the percentage of total sales that were fruit and vegetables compared to baseline, however this was not significant at the 5% level. Over the five year period, the percentage of sales that were fruit and vegetables declined both in terms of items purchased, and money spent. Conclusions Increasing accessibility of fruit and vegetables in a grocery store is a feasible way to improve the diet of students in tertiary education. There is evidence of declining fruit and vegetable consumption among the studied population, which should be further investigated

Double reading in breast cancer screening : cohort evaluation in the CO-OPS trial

Purpose: To investigate the effect of double readings by a second radiologist on recall rates, cancer detection and characteristics of cancers detected in the National Health Service Breast Screening Program in England. Materials and Methods: In this retrospective analysis we evaluated 805,206 women through screening and diagnostic test results by extracting one year of routine data from 33 English breast screening centers. Centers used double reading of digital mammograms, with arbitration if there were discrepant reads. Information on reader decisions, with results of follow-up tests, were used to explore the effect of the second reader. The statistical tests used were the test for equality of proportions, the χ2 test for independence and the t-test. Results: The first reader recalled 4·76%, (38295/805206, 95% CI 4·71%-4·80%) of women. Two readers recalled 6·19% in total, (49857/805206, 95% CI 6·14%- 6·24%), but arbitration of discordant reads reduced recall rate to 4·08%, (32863/805206, 95% CI 4·04%-4·12%, p<0.001). 7055 cancers were detected of which 627 (8·89%, 95% CI 8·22%-9·55%, p<0.001) were detected by the second reader only. These additional cancers were more likely to be ductal carcinoma in situ, (30·5% (183/600) vs 22.0% (1344/6114), p<0.001); and additional invasive cancers were smaller (mean 14·2mm vs 16·7mm, p<0.001), had fewer involved nodes, and were likely to be lower grade. Conclusion: Double reading with arbitration reduces recall and increases cancer detection compared to single reading. Cancers detected only by the second reader were smaller, lower grade, and had less nodal involvement

The use of the SF-36 questionnaire in adult survivors of childhood cancer: evaluation of data quality, score reliability, and scaling assumptions

BACKGROUND: The SF-36 has been used in a number of previous studies that have investigated the health status of childhood cancer survivors, but it never has been evaluated regarding data quality, scaling assumptions, and reliability in this population. As health status among childhood cancer survivors is being increasingly investigated, it is important that the measurement instruments are reliable, validated and appropriate for use in this population. The aim of this paper was to determine whether the SF-36 questionnaire is a valid and reliable instrument in assessing self-perceived health status of adult survivors of childhood cancer. METHODS: We examined the SF-36 to see how it performed with respect to (1) data completeness, (2) distribution of the scale scores, (3) item-internal consistency, (4) item-discriminant validity, (5) internal consistency, and (6) scaling assumptions. For this investigation we used SF-36 data from a population-based study of 10,189 adult survivors of childhood cancer. RESULTS: Overall, missing values ranged per item from 0.5 to 2.9 percent. Ceiling effects were found to be highest in the role limitation-physical (76.7%) and role limitation-emotional (76.5%) scales. All correlations between items and their hypothesised scales exceeded the suggested standard of 0.40 for satisfactory item-consistency. Across all scales, the Cronbach's alpha coefficient of reliability was found to be higher than the suggested value of 0.70. Consistent across all cancer groups, the physical health related scale scores correlated strongly with the Physical Component Summary (PCS) scale scores and weakly with the Mental Component Summary (MCS) scale scores. Also, the mental health and role limitation-emotional scales correlated strongly with the MCS scale score and weakly with the PCS scale score. Moderate to strong correlations with both summary scores were found for the general health perception, energy/vitality, and social functioning scales. CONCLUSION: The findings presented in this paper provide support for the validity and reliability of the SF-36 when used in long-term survivors of childhood cancer. These findings should encourage other researchers and health care practitioners to use the SF-36 when assessing health status in this population, although it should be recognised that ceiling effects can occur

Informatics and data mining tools and strategies for the Human Connectome Project

The Human Connectome Project (HCP) is a major endeavor that will acquire and analyze connectivity data plus other neuroimaging, behavioral, and genetic data from 1,200 healthy adults. It will serve as a key resource for the neuroscience research community, enabling discoveries of how the brain is wired and how it functions in different individuals. To fulfill its potential, the HCP consortium is developing an informatics platform that will handle: 1) storage of primary and processed data, 2) systematic processing and analysis of the data, 3) open access data sharing, and 4) mining and exploration of the data. This informatics platform will include two primary components. ConnectomeDB will provide database services for storing and distributing the data, as well as data analysis pipelines. Connectome Workbench will provide visualization and exploration capabilities. The platform will be based on standard data formats and provide an open set of application programming interfaces (APIs) that will facilitate broad utilization of the data and integration of HCP services into a variety of external applications. Primary and processed data generated by the HCP will be openly shared with the scientific community, and the informatics platform will be available under an open source license. This paper describes the HCP informatics platform as currently envisioned and places it into the context of the overall HCP vision and agenda

Combining random forest and 2D correlation analysis to identify serum spectral signatures for neuro-oncology

Fourier transform infrared (FTIR) spectroscopy has long been established as an analytical tech- nique for the measurement of vibrational modes of molecular systems. More recently, FTIR has been used for the analysis of biofluids with the aim of becoming a tool to aid diagnosis. For the clinician, this represents a convenient, fast, non-subjective option for the study of biofluids and the diagnosis of disease states. The patient also benefits from this method, as the procedure for the collection of serum is much less invasive and stressful than traditional biopsy. This is especially true of patients in whom brain cancer is suspected. A brain biopsy carries a degree of morbidity and mortality and on occasion may even be inconclusive. We therefore present a method for the diagnosis of brain cancer from serum samples using FTIR and machine learning techniques. The scope of the study involved 433 patients from whom were collected 9 spectra each in the range 600-4000 cm−1. To begin development of the novel method, various pre-processing steps were investigated and ranked in terms of final accuracy of the diagnosis. Random Forest machine learning was utilised as a classifier to separate patients into cancer or non-cancer categories based upon the intensities of wavenumbers present in their spectra. Generalised 2D correlational analysis was then employed to further augment the machine learning, and also to establish spec- tral features important for the distinction between cancer and non-cancer serum samples. Using these methods, sensitivities of up to 92.8% and specificities of up to 91.5% were possible. Fur- thermore, ratiometrics were also investigated in order to establish any correlations present in the dataset. We show a rapid, computationally light, accurate, statistically robust methodology for the identification of spectral features present in differing disease states. With current advances in IR technology, such as the development of rapid discrete frequency collection, this approach is import to allow future clinical translation and enables IR to achieve its potential

Regulation and Banking after the Crisis

The Central Bank of Ireland and SUERF organised a joint conference in Dublin on 20th September, 2010 on the general theme of Regulation and Banking after the Crisis. In the best traditions of SUERF, the programme included papers and presentations from the three main constituencies of SUERF: Central Banks (including notably the Governor of the Central Bank of Ireland), academics, and financial practitioners. As always, the papers illuminated some of the different perspectives of the three constituencies. We are grateful to the many distinguished contributors who were prepared to make powerful contributions to the conference

Design, Synthesis, and Evaluation of Tetrasubstituted Pyridines as Potent 5-HT2C Receptor Agonists.

A series of pyrido[3,4-d]azepines that are potent and selective 5-HT2C receptor agonists is disclosed. Compound 7 (PF-04781340) is identified as a suitable lead owing to good 5-HT2C potency, selectivity over 5-HT2B agonism, and in vitro ADME properties commensurate with an orally available and CNS penetrant profile. The synthesis of a novel bicyclic tetrasubstituted pyridine core template is outlined, including rationale to account for the unexpected formation of aminopyridine 13 resulting from an ammonia cascade cyclization.We would like to thank the EPSRC (SVL, grant nº EP/K0099494/1 and nº EP/K039520/1) for financial support.This is the accepted manuscript. The final version is available from ACS at http://pubs.acs.org/doi/abs/10.1021/ml500507v