Risk and the importance of absent symptoms in constructions of the ‘cancer candidate’

Cancer is a disease that is imbued with notions of risk, with individuals expected to avoid ‘risky’ behaviours and act swiftly when symptoms indicating a risk of cancer emerge. Cancer symptoms, however, are often ambiguous and indicative of a number of other conditions, making it difficult for people to assess when symptoms may, or may not, be the result of cancer. Here, we discuss interview data from a study examining the symptom appraisal and help-seeking experiences of patients referred for assessment of symptoms suspicious of a lung or colorectal cancer in the North-East of England. We explore how individuals draw upon ideas about cancer risks to assess whether cancer may be a possible explanation for their symptoms and to inform their decisions about help-seeking. In our analysis, we applied the concept of candidacy to the data, to highlight how lay epidemiology shapes people’s perceptions of cancer risk, and their subsequent responses to it. We found that participants appraised their symptoms, and the likelihood that they may have cancer, in light of relevant information on risk. These sources of information related to lifestyle factors, family history of cancer, environmental factors, and importantly, the symptomatic experience itself, including the absence of symptoms that participants associated with cancer. The importance of experienced, and absent, symptoms was a core element of participants’ everyday constructions of the ‘cancer candidate’, which informed symptom appraisal and subsequent help-seeking decision-making

Reconceptualising Rural Cancer Inequalities : Time for a New Research Agenda

Peer reviewedPublisher PD

The Effects of Beetroot Juice on VO2max and Blood Pressure during Submaximal Exercise

International Journal of Exercise Science 12(2): 332-342, 2019. Beetroot juice (BR) has been shown to reduce blood pressure (BP) at rest and improve several performance parameters during exercise. However, the effect of BR on BP during submaximal exercise has not been investigated and its effects on VO2max are inconclusive. The purpose of this study was to investigate the effects of BR on VO2max and BP during submaximal exercise. 20 healthy, recreationally trained volunteers (age 21.8±2.35 years, weight 75.10±10.62 kg, height 177.4±6.39 cm) participated in this study, which had a double-blind placebo controlled randomized crossover design. Participants supplemented with either 237 ml servings of placebo or 70 ml BR servings (nitrate concentration of 6.4 mmol/day) for 7 days. Participants completed a ramp treadmill protocol to determine VO2max. BP was taken at 70% max heart rate calculated using the Karvonen method. There was no significant change in VO2max after BR supplementation (51.07±6.12 ml/kg/min) versus placebo (50.46±6.06 ml/kg/min), t(19)=1.41, p=0.17. There was no significant change in either systolic BP after BR supplementation (180.65±23.37 mm Hg) versus placebo (177.65±22.07 mm Hg), t(19)=0.49, p=0.63, or in diastolic BP after BR (92.90±18.89 mm Hg) versus placebo (90.75±17.73 mm Hg), t(19)=0.51, p=0.62. BR did not affect VO2max, nor did it affect BP during submaximal exercise

The Influence of a Slow-Breathing Protocol on Heart Rate and Blood Pressure from Exercise in Moderately Trained Females

International Journal of Exercise Science 12(2): 714-725, 2019. Heart rate recovery (HRR) and blood pressure recovery (BPR) from exercise are both important indicators of health and fitness and are strongly associated with cardiovascular disease. The purpose of this study was to compare the effects of a slow-breathing technique, upright passive recovery (PASS), and active recovery (ACT) on HRR and BPR from exercise. Nine moderately trained, college-aged (20.22 ± 0.97 yrs) female participants cycled three times on an ergometer for 15 mins at 70% of their heart rate maximum (HRmax), each of which was followed by one of three 5 min recovery interventions with heart rate (HR) and blood pressure (BP) objectively measured. Each participant completed all three recovery protocols. One recovery protocol consisted of breathing at a rate of 6 breaths per minute (BRE), another involved PASS and the third was ACT at 60 RPM and 25 W. A repeated measures ANOVA revealed there was a significant effect of protocol (p= 0.00, hp2= 0.67) with HRR. BRE resulted in the fastest HRR of 69 ± 9.31 bpm (40.12%) at the end of the 5 min recovery compared to 63 ± 10.60 bpm (36.57%) and 47 ± 12.54 bpm (27.34%) for PASS and ACT, respectively. A second repeated measures ANOVA indicated there was no effect of protocol (P = 0.43), nor was there a significant interaction with time (p= 0.68), for BPR. The results indicated that BRE increased HRR after exercise more rapidly than PASS or ACT with no influence on BPR. These findings lead to future research needed to explore different breathing protocols following exercise in at-risk populations, such as individuals with cardiovascular disease

Simulation and Measurement of High-Beta Plasma in a Magnetic Nozzle

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76273/1/AIAA-2007-5259-239.pd

Barriers to Early Presentation amongst Rural Residents Experiencing Symptoms of Colorectal Cancer : A Qualitative Interview Study

Peer reviewedPublisher PD

Regional Climate Trends and Scenarios for the U.S. National Climate Assessment Part 4. Climate of the U.S. Great Plains

This document is one of series of regional climate descriptions designed to provide input that can be used in the development of the National Climate Assessment (NCA). As part of a sustained assessment approach, it is intended that these documents will be updated as new and well-vetted model results are available and as new climate scenario needs become clear. It is also hoped that these documents (and associated data and resources) are of direct benefit to decision makers and communities seeking to use this information in developing adaptation plans. There are nine reports in this series, one each for eight regions defined by the NCA, and one for the contiguous U.S. The eight NCA regions are the Northeast, Southeast, Midwest, Great Plains, Northwest, Southwest, Alaska, and Hawai‘i/Pacific Islands. These documents include a description of the observed historical climate conditions for each region and a set of climate scenarios as plausible futures – these components are described in more detail below. While the datasets and simulations in these regional climate documents are not, by themselves, new, (they have been previously published in various sources), these documents represent a more complete and targeted synthesis of historical and plausible future climate conditions around the specific regions of the NCA. There are two components of these descriptions. One component is a description of the historical climate conditions in the region. The other component is a description of the climate conditions associated with two future pathways of greenhouse gas emissions

Phocine distemper Virus: Current knowledge and future directions

Phocine distemper virus (PDV) was first recognized in 1988 following a massive epidemic in harbor and grey seals in north-western Europe. Since then, the epidemiology of infection in North Atlantic and Arctic pinnipeds has been investigated. In the western North Atlantic endemic infection in harp and grey seals predates the European epidemic, with relatively small, localized mortality events occurring primarily in harbor seals. By contrast, PDV seems not to have become established in European harbor seals following the 1988 epidemic and a second event of similar magnitude and extent occurred in 2002. PDV is a distinct species within the Morbillivirus genus with minor sequence variation between outbreaks over time. There is now mounting evidence of PDV-like viruses in the North Pacific/Western Arctic with serological and molecular evidence of infection in pinnipeds and sea otters. However, despite the absence of associated mortality in the region, there is concern that the virus may infect the large Pacific harbor seal and northern elephant seal populations or the endangered Hawaiian monk seals. Here, we review the current state of knowledge on PDV with particular focus on developments in diagnostics, pathogenesis, immune response, vaccine development, phylogenetics and modeling over the past 20 years

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

BACKGROUND: To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS: In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. FINDINGS: Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0·685 (95% CI 0·629-0·741) to 0·833 (0·783-0·882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. INTERPRETATION: We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. FUNDING: World Health Organization, British Heart Foundation (BHF), BHF Cambridge Centre for Research Excellence, UK Medical Research Council, and National Institute for Health Research