Effect of time to diagnostic testing for breast, cervical, and colorectal cancer screening abnormalities on screening efficacy: A modeling study

Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices. Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to follow-up for breast, cervical, and colorectal cancers was increased. Estimates were based on four independently developed microsimulation models that each simulated the life course of adults eligible for breast (women ages 50–74 years), cervical (women ages 21–65 years), or colorectal (adults ages 50–75 years) cancer screening. We assumed screening based on biennial mammography for breast cancer, triennial Papanicolaou testing for cervical cancer, and annual fecal immunochemical testing for colorectal cancer. For each cancer type, we simulated diagnostic testing immediately and at 3, 6, and 12 months after an abnormal screening exam. Results: We found declines in screening benefit with longer times to diagnostic testing, particularly for breast cancer screening. Compared to immediate diagnostic testing, testing at 3 months resulted in reduced screening benefit, with fewer undiscounted life years gained per 1,000 screened (breast: 17.3%, cervical: 0.8%, colorectal: 2.0% and 2.7%, from two colorectal cancer models), fewer cancers prevented (cervical: 1.4% fewer, colorectal: 0.5% and 1.7% fewer, respectively), and, for breast and colorectal cancer, a less favorable stage distribution. Conclusions: Longer times to diagnostic testing after an abnormal screening test can decrease screening effectiveness, but the impact varies substantially by cancer type. Impact: Understanding the impact of time to diagnostic testing on screening effectiveness can help inform quality improvement efforts. Cancer Epidemiol Biomarkers Prev; 27(2); 158–64. 2017 AACR

Outcome and medical management in dogs with lower motor neuron disease undergoing mechanical ventilation: 14 cases (2003-2009)

Objective To describe the application of intermittent positive pressure ventilation (IIPV) in dogs with lower motor neuron disease (LMND). Design Multi‐institutional, retrospective study (2003–2009). Setting Intensive care units at multiple university teaching hospitals. Animals Fourteen dogs with LMND that underwent IIPV. Interventions None. Measurements and Main Results The ventilatory logs of 4 teaching hospitals were searched for dogs undergoing IIPV in association with a diagnosis of acute LMND. The medical records were evaluated for signalment, specific LMND, ventilatory management and duration, complications associated with ventilation, duration of hospitalization, and outcome. Descriptive statistics were used as indicated. Fifteen records were evaluated, 1 dog was excluded since it experienced cardiopulmonary arrest (CPA) before commencement of IIPV. The median age was 7.0 years (range 10 mo to 12 y). There were 5 Labrador retrievers, 4 mixed breeds, and 5 other breeds were each represented once. Five dogs were diagnosed with myasthenia gravis, 4 dogs with polyradiculoneuritis, and 5 dogs had an undetermined LMND. Clinical signs of weakness before ventilation were present for a median of 36 hours (range 6 h to 14 d). Dogs were ventilated for a median of 109 hours (range 5–261 h). Nine dogs had temporary tracheostomies performed, and 8 dogs received nutritional support. Five dogs developed ventilator associated pneumonia. Six dogs were successfully weaned from the ventilator with a median ventilatory time of 49 hours (range 25–192 h). Three dogs survived to discharge. No single LMND was associated with a better outcome. Conclusions High euthanasia rates and iatrogenic complications limit the ability to accurately prognosticate for affected dogs in this retrospective study, but in dogs with LMND that is severe enough to require IIPV, support may be required days to weeks

Genetically encoded FRET sensors to monitor intracellular Zn2+ homeostasis

We developed genetically encoded fluorescence resonance energy transfer (FRET)-based sensors that display a large ratiometric change upon Zn2+ binding, have affinities that span the pico- to nanomolar range and can readily be targeted to subcellular organelles. Using this sensor toolbox we found that cytosolic Zn2+ was buffered at 0.4 nM in pancreatic ß cells, and we found substantially higher Zn2+ concentrations in insulin-containing secretory vesicles

The integration of GPS, vegetation mapping and GIS in ecological and behavioural studies

Global Positioning System (GPS) satellite navigation receivers are increasingly being used in ecological and behavioural studies to track the movements of animals in relation to the environments in which they live and forage. Concurrent recording of the animal's foraging behaviour (e.g. from jaw movement recording) allows foraging locations to be determined. By combining the animal GPS movement and foraging data with habitat and vegetation maps using a Geographical Information System (GIS) it is possible to relate animal movement and foraging location to landscape and habitat features and vegetation types. This powerful approach is opening up new opportunities to study the spatial aspects of animal behaviour, especially foraging behaviour, with far greater precision and objectivity than before. Advances in GPS technology now mean that sub-metre precision systems can be used to track animals, extending the range of application of this technology from landscape and habitat scale to paddock and patch scale studies. As well as allowing ecological hypotheses to be empirically tested at the patch scale, the improvements in precision are also leading to the approach being increasing extended from large scale ecological studies to smaller (paddock) scale agricultural studies. The use of sub-metre systems brings both new scientific opportunities and new technological challenges. For example, fitting all of the animals in a group with sub-metre precision GPS receivers allows their relative inter-individual distances to be precisely calculated, and their relative orientations can be derived from data from a digital compass fitted to each receiver. These data, analyzed using GIS, could give new insights into the social behaviour of animals. However, the improvements in precision with which the animals are being tracked also needs equivalent improvements in the precision with which habitat and vegetation are mapped. This needs some degree of automation, as vegetation mapping at a fine spatial scale using the traditional manual approach is far too time consuming. This paper explores these issues, discussing new applications as well as approaches to overcoming some of the associated problems