Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors

Background Ethnic disparities in cancer survival have been documented in many populations and cancer types. The causes of these inequalities are not well understood but may include disease and patient characteristics, treatment differences and health service factors. Survival was compared in a cohort of Maori ( Indigenous) and non-Maori New Zealanders with colon cancer, and the contribution of demographics, disease characteristics, patient comorbidity, treatment and healthcare factors to survival disparities was assessed. Methods Maori patients diagnosed as having colon cancer between 1996 and 2003 were identified from the New Zealand Cancer Registry and compared with a randomly selected sample of non-Maori patients. Clinical and outcome data were obtained from medical records, pathology reports and the national mortality database. Cancer-specific survival was examined using Kaplane-Meier survival curves and Cox hazards modelling with multivariable adjustment. Results 301 Maori and 328 non-Maori patients with colon cancer were compared. Maori had a significantly poorer cancer survival than non-Maori ( hazard ratio (HR) 1.33, 95% CI 1.03 to 1.71) that was not explained by demographic or disease characteristics. The most important factors contributing to poorer survival in Maori were patient comorbidity and markers of healthcare access, each of which accounted for around a third of the survival disparity. The final model accounted for almost all the survival disparity between Maori and non-Maori patients ( HR 1.07, 95% CI 0.77 to 1.47). Conclusion Higher patient comorbidity and poorer access and quality of cancer care are both important explanations for worse survival in Maori compared with non-Maori New Zealanders with colon cancer

Atypicalities in Perceptual Adaptation in Autism Do Not Extend to Perceptual Causality

A recent study showed that adaptation to causal events (collisions) in adults caused subsequent events to be less likely perceived as causal. In this study, we examined if a similar negative adaptation effect for perceptual causality occurs in children, both typically developing and with autism. Previous studies have reported diminished adaptation for face identity, facial configuration and gaze direction in children with autism. To test whether diminished adaptive coding extends beyond high-level social stimuli (such as faces) and could be a general property of autistic perception, we developed a child-friendly paradigm for adaptation of perceptual causality. We compared the performance of 22 children with autism with 22 typically developing children, individually matched on age and ability (IQ scores). We found significant and equally robust adaptation aftereffects for perceptual causality in both groups. There were also no differences between the two groups in their attention, as revealed by reaction times and accuracy in a change-detection task. These findings suggest that adaptation to perceptual causality in autism is largely similar to typical development and, further, that diminished adaptive coding might not be a general characteristic of autism at low levels of the perceptual hierarchy, constraining existing theories of adaptation in autism.16 page(s

Gender Monstrosity

Deadgirl (2008) is based around a group of male teens discovering and claiming ownership of a bound female zombie, using her as a sex slave. This narrative premise raises numerous tensions that are particularly amplified by using a zombie as the film’s central victim. The Deadgirl is sexually passive yet monstrous, reifying the horrors associated with the female body in patriarchal discourses. She is objectified on the basis of her gender, and this has led many reviewers to dismiss the film as misogynistic Torture Porn. However, the conditions under which masculinity is formed here – where adolescent males become "men" by enacting sexual violence – are as problematic as the specter of the female zombie. Deadgirl is clearly horrific and provocative: in this article I seek to probe implications arising from the film’s gender conflicts

Free will, punishment and criminal responsibility

Retributive attitudes are deeply held and widespread in the general population and most legal systems incorporate retributive elements. It is probably also the dominant theory of punishment among contemporary philosophers of criminal justice. However, retributivism relies on conceptions of free will and responsibility that have, for millennia, fundamentally divided those who have thought seriously about the subject. Our legal system upholds the principle that the responsibility of the offender has to be proven beyond reasonable doubt, before the accused can be punished. In view of the intractable doubts surrounding the soundness of retributivism’s very conception of responsibility, my thesis argues that it is ethically dubious to punish individuals for solely retributive reasons. Instead, my thesis proposes that a person should only be punished if the main theories of punishment agree that punishing that person is appropriate – I call this ‘the convergence requirement’. This approach, I argue, is in accordance with the considerations underlying the beyond reasonable doubt standard. In addition to considering the question of ‘whom to punish’ my thesis considers what methods of responding to criminal behaviour are acceptable. In particular, it attempts to explain, without appealing to the contested notions of free will or retributive desert, what is problematic about ‘manipulative’ methods of dealing with criminal offenders (focussing in particular on the possibility of modifying their behaviour through neurological interventions). The final part of this thesis also gives an overview of some of the practical implications for Scots criminal law of taking doubts about free will and retributivism seriously. Given the severe treatment that offenders undergo within the Scottish penal system (e.g. deprivation of liberty, stigma) and the high rate of recidivism, it is important to consider whether our current penal practices are justified, what alternatives are available and what goals and values should guide attempts at reforming the system

Circulating Extracellular Vesicle MicroRNA as Diagnostic Biomarkers in Early Colorectal Cancer—A Review

Colorectal cancer (CRC) is one of the most common malignancies in the developed world, with global deaths expected to double in the next decade. Disease stage at diagnosis is the single greatest prognostic indicator for long-term survival. Unfortunately, early stage CRC is often asymptomatic and diagnosis frequently occurs at an advanced stage, where long-term survival can be as low as 14%. Circulating microRNAs encapsulated in extracellular vesicles (EVs) have recently come to prominence as novel diagnostic markers for cancer. EV-miRNAs are dysregulated in the circulation of CRC patients compared to healthy controls, and several specific miRNA candidates have been posited as diagnostic markers, including miR-21, miR-23a, miR-1246, and miR-92a. This review outlines the current landscape of EV-miRNAs as potential diagnostic markers for CRC, with a specific focus on those able to detect early stage disease

Identifying important comorbidity among cancer populations using administrative data: Prevalence and impact on survival

Aims: Our study sought to optimize the identification and investigate the impact of comorbidity in cancer patients using routinely collected hospitalization data. Methods: We undertook an iterative process of classification of important clinical conditio

Iron isotope geochemistry of biogenic magnetite-bearing sediments from the Bay of Vidy, Lake Geneva

Dissimilatory microbial iron oxide reduction (DIR) has been hypothesized to be an important respiratory pathway on early Earth, potentially generating significant quantities of Fe(II) that have been preserved in Proterozoic and Archean sedimentary rocks. In particular, DIR has been implicated in the formation of magnetite in Precambrian marine sediments. To date, however, only one modern sedimentary environment existswhere in situ magnetite formation has been linked to DIR: the Bay of Vidy in Lake Geneva, Switzerland. Previous work at this locality has characterized a magnetic susceptibility anomaly that reflects the presence of fine-grained magnetite produced via microbial reduction of amorphous Fe(III) oxides that enter the Bay of Vidy froma nearby sewage treatment plant. In this study, we report on the Fe isotope composition of aqueous and solid-phase Fe in the Bay of Vidy sediments. Extensive Fe(III) reduction has occurred, resulting in the conversion of nearly all reactive (non-silicate) Fe(III) to a variety of Fe(II)-bearing phases, with mixed Fe valence magnetite being a minor but easily detectable component (0.5–8wt.%). Very little Fe isotope variation was observed in any solid phase Fe components, including magnetite, although significant fractionation was observed between aqueous and solid-phase Fe(II). Because Fe mass-balance was dominated by the solid phase, little net change in δ56Fe values for Fe(II)-bearing components was produced despite clear evidence for DIR. This study provides a basis for interpreting instances in the rock recordwhere DIR was the driving force for Fe(II) production and magnetite formation, yet no significant deviations in δ56Fe valueswere preserved. A key implication of the results is that Fe isotope homogeneity is not sufficient to rule out a biological mechanismfor magnetite formation, and this should be taken into account when examining the Precambrian rock record

Cancer-specific administrative data-based comorbidity indices provided valid alternative to Charlson and National Cancer Institute Indices.

OBJECTIVE: We aimed to develop and validate administrative data-based comorbidity indices for a range of cancer types that included all relevant concomitant conditions. STUDY DESIGN AND SETTINGS: Patients diagnosed with colorectal, breast, gynecological, upper gastrointestinal, or urological cancers identified from the National Cancer Registry between July 1, 2006 and June 30, 2008 for the development cohort (n=14,096) and July 1, 2008 to December 31, 2009 for the validation cohort (n=11,014) were identified. A total of 50 conditions were identified using hospital discharge data before cancer diagnosis. Five site-specific indices and a combined site index were developed, with conditions weighted according to their log hazard ratios from age- and stage-adjusted Cox regression models with noncancer death as the outcome. We compared the performance of these indices (the C3 indices) with the Charlson and National Cancer Institute (NCI) comorbidity indices. RESULTS: The correlation between the Charlson and C3 index scores ranged between 0.61 and 0.78. The C3 index outperformed the Charlson and NCI indices for all sites combined, colorectal, and upper gastrointestinal cancer, performing similarly for urological, breast, and gynecological cancers. CONCLUSION: The C3 indices provide a valid alternative to measuring comorbidity in cancer populations, in some cases providing a modest improvement over other indices