Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics.</p> <p>Methods</p> <p>We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use.</p> <p>Results</p> <p>Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively).</p> <p>Conclusions</p> <p>Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.</p

Using smart pumps to help deliver universal access to safe and affordable drinking water

It is estimated that broken water pumps impact 62 million people in sub-Saharan Africa. Over the last 20 years, broken handpumps have represented US$1·2–1·5 billion of lost investment in this region, with 30–40% of rural water systems failing prematurely. While the contributory factors are complex and multi-faceted, the authors consider that improved post-construction monitoring strategies for remote water projects, which rely on smart pumps to monitor operational performance in place of physical site visits, may address some of these problems and help reduce the heavy time and resource demands on stakeholders associated with traditional monitoring strategies. As such, smart pumps could play a significant role in improving project monitoring and might subsequently help deliver universal access to safe and affordable drinking water by 2030, which constitutes one of the key targets of United Nations sustainable development goal 6 and is embedded in some national constitutions

Electronic wavefunctions probed by all-optical attosecond interferometry

International audienc