324 research outputs found
Deceptive measures of progress in the NHS long-term plan for cancer: case-based vs. population-based measures
The NHS Long Term Plan for cancer aims to increase early-stage diagnoses from 50% to 75% and to have 55,000 more people each year survive their cancer for at least 5 years following diagnosis. The targets measures are flawed and could be met without improving outcomes that really matter to patients. The proportion of early-stage diagnoses could increase, while the number of patients presenting at a late-stage remains the same. More patients could survive their cancer for longer, but lead time and overdiagnosis bias make it impossible to know whether anyone had their life prolonged. The target measures should switch from biased case-based measures to unbiased population-based measures that reflect the key objectives in cancer care: reducing late-stage incidence and mortality
E-government adoption: A cultural comparison
This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ Springer Science + Business Media, LLC 2008.E-government diffusion is an international phenomenon. This study compares e-government adoption in the U.K. to adoption in the U.S. In particular, this study seeks to determine if the same factors are salient in both countries. Several studies have explored citizen acceptance of e-government services in the U.S. However, few studies have explored this phenomenon in the U.K. To identify the similarities and differences between the U.K. and the U.S. a survey is conducted in the U.K. and the findings are compared to the literature that investigates diffusion in the U.S. This study proposes a model of e-government adoption in the U.K. based on salient factors in the U.S. A survey is administered to 260 citizens in London to assess the importance of relative advantage, trust and the digital divide on intention to use e-government. The results of binary logistic regression indicate that there are cultural differences in e-government adoption in the U.K. and the U.S. The results indicate that of the prevailing adoption constructs, relative advantage and trust are pertinent in both the U.S. and the U.K., while ICT adoption barriers such as access and skill may vary by culture. Implications for research and practice are discussed
Coupling models of cattle and farms with models of badgers for predicting the dynamics of bovine tuberculosis (TB)
Bovine TB is a major problem for the agricultural industry in several
countries. TB can be contracted and spread by species other than cattle and
this can cause a problem for disease control. In the UK and Ireland, badgers
are a recognised reservoir of infection and there has been substantial
discussion about potential control strategies. We present a coupling of
individual based models of bovine TB in badgers and cattle, which aims to
capture the key details of the natural history of the disease and of both
species at approximately county scale. The model is spatially explicit it
follows a very large number of cattle and badgers on a different grid size for
each species and includes also winter housing. We show that the model can
replicate the reported dynamics of both cattle and badger populations as well
as the increasing prevalence of the disease in cattle. Parameter space used as
input in simulations was swept out using Latin hypercube sampling and
sensitivity analysis to model outputs was conducted using mixed effect models.
By exploring a large and computationally intensive parameter space we show that
of the available control strategies it is the frequency of TB testing and
whether or not winter housing is practised that have the most significant
effects on the number of infected cattle, with the effect of winter housing
becoming stronger as farm size increases. Whether badgers were culled or not
explained about 5%, while the accuracy of the test employed to detect infected
cattle explained less than 3% of the variance in the number of infected cattle
Voluntary motor drive: possible reduction in Tourette syndrome
Electrophysiologically, Tourette syndrome (TS) is characterized by shortened cortical silent period (CSP), reflecting decreased motor inhibition. However, voluntary versus involuntary aspects of inhibitory functions in TS are not well understood. Hence, investigating voluntary motor drive (VMD) could help to elucidate this issue. A group of 14 healthy adolescents was compared with subjects of same age suffering from TS with (NÂ =Â 6) and without (NÂ =Â 6) presence of distal tics. Basic resting and active motor thresholds (RMT and AMT, respectively) as well as suprathreshold transcranial magnetic stimulation-conditioned RMT and AMT were determined during the CSP. The difference between AMT and RMT was considered as VMD quantum. No group-differences were found in RMT or AMT. Subjects with distal tics showed reduced VMD compared to healthy controls while patients without distal tics did not differ from controls. In the second half of CSP, patients with distal tics showed also diminished VMD compared to tic-patients without distal tics. The findings support the notion, that TS shows possible reduction of VMD and is associated with central motor threshold alterations confined to the very motor networks related to the tics observed
COBRA framework to evaluate e-government services: A citizen-centric perspective
E-government services involve many stakeholders who have different objectives that can have an impact on success. Among these stakeholders, citizens are the primary stakeholders of government activities. Accordingly, their satisfaction plays an important role in e-government success. Although several models have been proposed to assess the success of e-government services through measuring users' satisfaction levels, they fail to provide a comprehensive evaluation model. This study provides an insight and critical analysis of the extant literature to identify the most critical factors and their manifested variables for user satisfaction in the provision of e-government services. The various manifested variables are then grouped into a new quantitative analysis framework consisting of four main constructs: cost; benefit; risk and opportunity (COBRA) by analogy to the well-known SWOT qualitative analysis framework. The COBRA measurement scale is developed, tested, refined and validated on a sample group of e-government service users in Turkey. A structured equation model is used to establish relationships among the identified constructs, associated variables and users' satisfaction. The results confirm that COBRA framework is a useful approach for evaluating the success of e-government services from citizens' perspective and it can be generalised to other perspectives and measurement contexts. Crown Copyright © 2014.PIAP-GA-2008-230658) from the European Union Framework Program and another grant (NPRP 09-1023-5-158) from the Qatar National Research Fund (amember of Qatar Foundation
Estimating the Impact of Adding C-Reactive Protein as a Criterion for Lipid Lowering Treatment in the United States
BACKGROUND: There is growing interest in using C-reactive protein (CRP) levels to help select patients for lipid lowering therapyâalthough this practice is not yet supported by evidence of benefit in a randomized trial. OBJECTIVE: To estimate the number of Americans potentially affected if a CRP criteria were adopted as an additional indication for lipid lowering therapy. To provide context, we also determined how well current lipid lowering guidelines are being implemented. METHODS: We analyzed nationally representative data to determine how many Americans age 35 and older meet current National Cholesterol Education Program (NCEP) treatment criteria (a combination of risk factors and their Framingham risk score). We then determined how many of the remaining individuals would meet criteria for treatment using 2 different CRP-based strategies: (1) narrow: treat individuals at intermediate risk (i.e., 2 or more risk factors and an estimated 10â20% risk of coronary artery disease over the next 10Â years) with CRPâ>â3Â mg/L and (2) broad: treat all individuals with CRPâ>â3Â mg/L. DATA SOURCE: Analyses are based on the 2,778 individuals participating in the 1999â2002 National Health and Nutrition Examination Survey with complete data on cardiac risk factors, fasting lipid levels, CRP, and use of lipid lowering agents. MAIN MEASURES: The estimated number and proportion of American adults meeting NCEP criteria who take lipid-lowering drugs, and the additional number who would be eligible based on CRP testing. RESULTS: About 53 of the 153 million Americans aged 35 and older meet current NCEP criteria (that do not involve CRP) for lipid-lowering treatment. Sixty-five percent, however, are not currently being treated, even among those at highest risk (i.e., patients with established heart disease or its risk equivalent)â62% are untreated. Adopting the narrow and broad CRP strategies would make an additional 2.1 and 25.3 million Americans eligible for treatment, respectively. The latter strategy would make over half the adults age 35 and older eligible for lipid-lowering therapy, with most of the additionally eligible (57%) coming from the lowest NCEP heart risk category (i.e., 0â1 risk factors). CONCLUSION: There is substantial underuse of lipid lowering therapy for American adults at high risk for coronary disease. Rather than adopting CRP-based strategies, which would make millions more lower risk patients eligible for treatment (and for whom treatment benefit has not yet been demonstrated in a randomized trial), we should ensure the treatment of currently defined high-risk patients for whom the benefit of therapy is established
Addressing overdiagnosis and overtreatment in cancer: a prescription for change
A vast range of disordersâfrom indolent to fast-growing lesionsâare labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated. Furthermore, precursors of cancer or high-risk disorders should not have the term cancer in them. The rationale for this change in approach is that indolent lesions with low malignant potential are common, and screening brings indolent lesions and their precursors to clinical attention, which leads to overdiagnosis and, if unrecognised, possible overtreatment. To minimise that potential, new strategies should be adopted to better define and manage IDLEs. Screening guidelines should be revised to lower the chance of detection of minimal-risk IDLEs and inconsequential cancers with the same energy traditionally used to increase the sensitivity of screening tests. Changing the terminology for some of the lesions currently referred to as cancer will allow physicians to shift medicolegal notions and perceived risk to reflect the evolving understanding of biology, be more judicious about when a biopsy should be done, and organise studies and registries that offer observation or less invasive approaches for indolent disease. Emphasis on avoidance of harm while assuring benefit will improve screening and treatment of patients and will be equally effective in the prevention of death from cancer
The emerging structure of the Extended Evolutionary Synthesis: where does Evo-Devo fit in?
The Extended Evolutionary Synthesis (EES) debate is gaining ground in contemporary evolutionary biology. In parallel, a number of philosophical standpoints have emerged in an attempt to clarify what exactly is represented by the EES. For Massimo Pigliucci, we are in the wake of the newest instantiation of a persisting Kuhnian paradigm; in contrast, Telmo Pievani has contended that the transition to an EES could be best represented as a progressive reformation of a prior Lakatosian scientific research program, with the extension of its Neo-Darwinian core and the addition of a brand-new protective belt of assumptions and auxiliary hypotheses. Here, we argue that those philosophical vantage points are not the only ways to interpret what current proposals to âextendâ the Modern Synthesis-derived âstandard evolutionary theoryâ (SET) entail in terms of theoretical change in evolutionary biology. We specifically propose the image of the emergent EES as a vast network of models and interweaved representations that, instantiated in diverse practices, are connected and related in multiple ways. Under that assumption, the EES could be articulated around a paraconsistent network of evolutionary theories (including some elements of the SET), as well as models, practices and representation systems of contemporary evolutionary biology, with edges and nodes that change their position and centrality as a consequence of the co-construction and stabilization of facts and historical discussions revolving around the epistemic goals of this area of the life sciences. We then critically examine the purported structure of the EESâpublished by Laland and collaborators in 2015âin light of our own network-based proposal. Finally, we consider which epistemic units of Evo-Devo are present or still missing from the EES, in preparation for further analyses of the topic of explanatory integration in this conceptual framework
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