A telephone survey of cancer awareness among frontline staff: informing training needs

Background: Studies have shown limited awareness about cancer risk factors among hospital-based staff. Less is known about general cancer awareness among community frontline National Health Service and social care staff. Methods: A cross-sectional computer-assisted telephone survey of 4664 frontline community-based health and social care staff in North West England. Results: A total of 671 out of 4664 (14.4%) potentially eligible subjects agreed to take part. Over 92% of staff recognised most warning signs, except an unexplained pain (88.8%, n=596), cough or hoarseness (86.9%, n=583) and a sore that does not heal (77.3%, n=519). The bowel cancer-screening programme was recognised by 61.8% (n=415) of staff. Most staff agreed that smoking and passive smoking ‘increased the chance of getting cancer.’ Fewer agreed about getting sunburnt more than once as a child (78.0%, n=523), being overweight (73.5%, n=493), drinking more than one unit of alcohol per day (50.2%, n=337) or doing less than 30 min of moderate physical exercise five times a week (41.1%, n=276). Conclusion: Cancer awareness is generally good among frontline staff, but important gaps exist, which might be improved by targeted education and training and through developing clearer messages about cancer risk factors

Development of a measurement tool to assess public awareness of cancer

<p>Objective: We aimed to develop and validate a measurement tool to assess cancer awareness in the general population: the cancer awareness measure (CAM).</p> <p>Methods: Items assessing awareness of cancer warning signs, risk factors, incidence, screening programmes and attitudes towards help seeking were extracted from the literature or generated by expert groups. To determine reliability, the CAM was administered to a university participant panel (n=148), with a sub-sample (n=94) completing it again 2 weeks later. To establish construct validity, CAM scores of cancer experts (n=12) were compared with those of non-medical academics (n=21). Finally, university students (n=49) were randomly assigned to read either a cancer information leaflet or a leaflet with control information before completing the measure, to ensure the CAM was sensitive to change.</p> <p>Results: Cognitive interviewing indicated that the CAM was being interpreted as intended. Internal reliability (Cronbach's α=0.77) and test–retest reliability (r=0.81) were high. Scores for cancer experts were significantly higher than those for non-medical academics (t(31)=6.8, P<0.001). CAM scores were higher among students who received an intervention leaflet than the control leaflet (t(47)=4.8, P<0.001).</p> <p>Conclusions: These studies show the psychometric properties of the CAM and support its validity as a measure of cancer awareness in the general population.</p&gt

What parathyroid hormone levels should we aim for in children with stage 5 chronic kidney disease; what is the evidence?

The bone disease that occurs as a result of chronic kidney disease (CKD) is not only debilitating but also linked to poor growth and cardiovascular disease. It is suspected that abnormal bone turnover is the main culprit for these poor outcomes. Plasma parathyroid hormone (PTH) levels are used as a surrogate marker of bone turnover, and there is a small number of studies in children that have attempted to identify the range of PTH levels that correlates with normal bone histology. It is clear that high PTH levels are associated with high bone turnover, although the range is wide. However, the ability of PTH levels to distinguish between low and normal bone turnover is less clear. This is an important issue, because current guidelines for calcium and phosphate management are based upon there being an “optimum” range for PTH. This editorial takes a critical look at the evidence upon which these recommendations are based

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals

Paleophysical Oceanography with an Emphasis on Transport Rates

Paleophysical oceanography is the study of the behavior of the fluid ocean of the past, with a specific emphasis on its climate implications, leading to a focus on the general circulation. Even if the circulation is not of primary concern, heavy reliance on deep-sea cores for past climate information means that knowledge of the oceanic state when the sediments were laid down is a necessity. Like the modern problem, paleoceanography depends heavily on observations, and central difficulties lie with the very limited data types and coverage that are, and perhaps ever will be, available. An approximate separation can be made into static descriptors of the circulation (e.g., its water-mass properties and volumes) and the more difficult problem of determining transport rates of mass and other properties. Determination of the circulation of the Last Glacial Maximum is used to outline some of the main challenges to progress. Apart from sampling issues, major difficulties lie with physical interpretation of the proxies, transferring core depths to an accurate timescale (the “age-model problem”), and understanding the accuracy of time-stepping oceanic or coupled-climate models when run unconstrained by observations. Despite the existence of many plausible explanatory scenarios, few features of the paleocirculation in any period are yet known with certainty.National Science Foundation (U.S.) (grant OCE-0645936

Transfer of immunoglobulins through the mammary endothelium and epithelium and in the local lymph node of cows during the initial response after intramammary challenge with E. coli endotoxin

<p>Abstract</p> <p>Background</p> <p>The first hours after antigen stimulation, interactions occur influencing the outcome of the immunological reaction. Immunoglobulins originate in blood and/or are locally synthesized. The transfer of Ig isotypes (Igs) in the udder has been studied previously but without the possibility to distinguish between the endothelium and the epithelium. The purpose of this study was to map the Ig transfer through each barrier, separately, and Ig transfer in the local lymph nodes of the bovine udder during the initial innate immune response.</p> <p>Methods</p> <p>The content of IgG1, IgG2, IgM, IgA and albumin (BSA) was examined in peripheral/afferent mammary lymph and lymph leaving the supramammary lymph nodes, and in blood and milk before (0 h) and during 4 hours after intramammary challenge with <it>Esherichia coli </it>endotoxin in 5 cows.</p> <p>Results</p> <p>Igs increased most rapidly in afferent lymph resulting in higher concentrations than in efferent lymph at postinfusion hour (PIH) 2, contrary to before challenge. Ig concentrations in milk were lower than in lymph; except for IgA at 0 h; and they increased more slowly. <it>Afferent lymph:serum </it>and <it>efferent lymph:serum </it>concentration ratios (CR) of Igs were similar to those of BSA but slightly lower. <it>Milk:afferent lymph </it>(M:A) CRs of each Ig, except for IgG2, showed strikingly different pattern than those of BSA. The M:A CR of IgG1, IgM and IgA were higher than that of BSA before challenge and the CR of IgA and IgG1 remained higher also thereafter. At PIH 2 there was a drop in Ig CRs, except for IgG2, in contrast to the BSA CR which gradually increased. The M:A CR of IgM and Ig A <it>decreased </it>from 0 h to PIH 4, in spite of increasing permeability.</p> <p>Conclusion</p> <p>The transfer of Igs through the <it>endothelium </it>appeared to be merely a result of diffusion although their large molecular size may hamper the diffusion. The transfer through the <it>epithelium </it>and the Ig concentrations in milk seemed more influenced by selective mechanisms and local sources, respectively. Our observations indicate a selective mechanism in the transfer of IgG1 through the epithelium also in lactating glands, not previously shown; a local synthesis of IgA and possibly of IgM, released primarily into milk, not into tissue fluid; that IgG2 transfer through both barriers is a result of passive diffusion only and that the content of efferent lymph is strongly influenced by IgG1, IgM and IgA in the mammary tissue, brought to the lymph node by afferent lymph.</p

No advantage for remembering horizontal over vertical spatial locations learned from a single viewpoint

Previous behavioral and neurophysiological research has shown better memory for horizontal than for vertical locations. In these studies, participants navigated toward these locations. In the present study we investigated whether the orientation of the spatial plane per se was responsible for this difference. We thus had participants learn locations visually from a single perspective and retrieve them from multiple viewpoints. In three experiments, participants studied colored tags on a horizontally or vertically oriented board within a virtual room and recalled these locations with different layout orientations (Exp. 1) or from different room-based perspectives (Exps. 2 and 3). All experiments revealed evidence for equal recall performance in horizontal and vertical memory. In addition, the patterns for recall from different test orientations were rather similar. Consequently, our results suggest that memory is qualitatively similar for both vertical and horizontal two-dimensional locations, given that these locations are learned from a single viewpoint. Thus, prior differences in spatial memory may have originated from the structure of the space or the fact that participants navigated through it. Additionally, the strong performance advantages for perspective shifts (Exps. 2 and 3) relative to layout rotations (Exp. 1) suggest that configurational judgments are not only based on memory of the relations between target objects, but also encompass the relations between target objects and the surrounding room—for example, in the form of a memorized view

Local Spatial and Temporal Processes of Influenza in Pennsylvania, USA: 2003–2009

Background: Influenza is a contagious respiratory disease responsible for annual seasonal epidemics in temperate climates. An understanding of how influenza spreads geographically and temporally within regions could result in improved public health prevention programs. The purpose of this study was to summarize the spatial and temporal spread of influenza using data obtained from the Pennsylvania Department of Health's influenza surveillance system. Methodology and Findings: We evaluated the spatial and temporal patterns of laboratory-confirmed influenza cases in Pennsylvania, United States from six influenza seasons (2003-2009). Using a test of spatial autocorrelation, local clusters of elevated risk were identified in the South Central region of the state. Multivariable logistic regression indicated that lower monthly precipitation levels during the influenza season (OR = 0.52, 95% CI: 0.28, 0.94), fewer residents over age 64 (OR = 0.27, 95% CI: 0.10, 0.73) and fewer residents with more than a high school education (OR = 0.76, 95% CI: 0.61, 0.95) were significantly associated with membership in this cluster. In addition, time series analysis revealed a temporal lag in the peak timing of the influenza B epidemic compared to the influenza A epidemic. Conclusions: These findings illustrate a distinct spatial cluster of cases in the South Central region of Pennsylvania. Further examination of the regional transmission dynamics within these clusters may be useful in planning public health influenza prevention programs. © 2012 Stark et al

Oppilaitten eettinen toimijuus videotutkimuksessa

The rapid development of various recording technologies in recent years has created appealing opportunities for researchers to document and study science, technology, engineering, and mathematics (STEM) learning in ways which previously were either impossible, high-priced, or impractical. The potential access that low-cost and ever-smaller recorders provide us has been wisely tempered with cautions that researchers critically reflect on whether the benefits of the research outweigh the invasion of participants’ privacy, especially in research with children. These cautions rightfully place the burden of ethical deliberation on the researcher. However, by so doing they also direct attention away from the ethical work done by study participants and overshadow their agency in relation to the research. In effect, the cautions join and reinforce dominant narratives of participant, especially children’s, vulnerability in research and the researcher as the main ethical actor during the research process. This study seeks to balance such narratives by drawing attention to how children demonstrate their awareness of the audience of nearby recorders to each other and, through such actions, also create spaces for private, out-of-view interaction they do not wish to be recorded. With demonstrative vignettes from a yearlong ethnographic study of children’s learning in an alternative STEM learning infrastructure, the study argues that such moments highlight children’s ethical agency in research.The rapid development of various recording technologies in recent years has created appealing opportunities for researchers to document and study science, technology, engineering, and mathematics (STEM) learning in ways which previously were either impossible, high-priced, or impractical. The potential access that low-cost and ever-smaller recorders provide us has been wisely tempered with cautions that researchers critically reflect on whether the benefits of the research outweigh the invasion of participants’ privacy, especially in research with children. These cautions rightfully place the burden of ethical deliberation on the researcher. However, by so doing they also direct attention away from the ethical work done by study participants and overshadow their agency in relation to the research. In effect, the cautions join and reinforce dominant narratives of participants’, especially children’s, vulnerability in research and the researcher as the main ethical actor during the research process. This study seeks to balance such narratives by drawing attention to how children demonstrate their awareness of the audience of nearby recorders to each other and, through such actions, also create spaces for private, out-of-view interaction they do not wish to be recorded. With demonstrative vignettes from a yearlong ethnographic study of children’s learning in an alternative STEM learning infrastructure, the study argues that such moments highlight children’s ethical agency in research.Peer reviewe

A study of empyema thoracis and role of intrapleural streptokinase in its management

BACKGROUND: Clinical spectrum, microbiology and outcome of empyema thoracis are changing. Intrapleural instillation of fibrinolytic agents is being increasingly used for management of empyema thoracis. The present study was carried out to describe the clinical profile and outcome of patients with empyema thoracis including those with chronic empyema and to study the efficacy and safety of intrapleural streptokinase in its management. METHODS: Clinical profile, etiological agents, hospital course and outcome of 31 patients (mean age 40 ± 16 years, M: F 25: 6) with empyema thoracis treated from 1998 to 2003 was analyzed. All patients were diagnosed on the basis of aspiration of frank pus from pleural cavity. Clinical profile, response to therapy and outcome were compared between the patients who received intrapleural streptokinase (n = 12) and those who did not (n = 19). RESULTS: Etiology was tubercular in 42% of the patients (n = 13) whereas the rest were bacterial. Amongst the patients in which organisms could be isolated (n = 13, 42%) Staphylococcus aureus was the commonest (n = 5). Intrapleural streptokinase was instilled in 12 patients. This procedure resulted in increase of drainage of pleural fluid in all patients. Mean daily pleural fluid drainage after streptokinase instillation was significantly higher for patients who received intrapleural streptokinase than those who did not (213 ml vs 57 ml, p = 0.006). Only one patient who was instilled streptokinase eventually required decortication, which had to be done in five patients (16.1%). Mean hospital stay was 30.2 ± 17.6 days whereas two patients died. CONCLUSIONS: Tubercular empyema is common in Indian patients. Intrapleural streptokinase appears to be a useful strategy to preserve lung function and reduce need for surgery in patients with late stage of empyema thoracis