Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research

Purpose: To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. Methods: Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. Results: Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. Conclusion: This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development

Application of remote sensing to state and regional problems

There are no author-identified significant results in this report

High-intensity, unilateral resistance training of a non-paretic muscle group increases active range of motion in a severely paretic upper extremity muscle group after stroke

Limited rehabilitation strategies are available for movement restoration when paresis is too severe following stroke. Previous research has shown that high-intensity resistance training of one muscle group enhances strength of the homologous, contralateral muscle group in neurologically-intact adults. How this cross education phenomenon might be exploited to moderate severe weakness in an upper extremity muscle group after stroke is not well understood. The primary aim of this study was to examine adaptations in force-generating capacity of severely paretic wrist extensors resulting from high-intensity, dynamic contractions of the non-paretic wrist extensors. A secondary, exploratory aim was to probe neural adaptations in a subset of participants from each sample using a single-pulse, transcranial magnetic stimulation protocol. Separate samples of neurologically-intact controls (n=7) and individuals > 4 months post stroke (n=6) underwent 16 sessions of training. Following training, one-repetition maximum of the untrained wrist extensors in the control group and active range of motion of the untrained, paretic wrist extensors in the stroke group were significantly increased. No changes in corticospinal excitability, intracortical inhibition or interhemispheric inhibition were observed in control participants. Both stroke participants who underwent TMS testing, however, exhibited increased voluntary muscle activation following the intervention. In addition, motor-evoked potentials that were unobtainable prior to the intervention were readily elicited afterwards in a stroke participant. Results of this study demonstrate that high-intensity resistance training of a non-paretic upper extremity muscle group can enhance voluntary muscle activation and force-generating capacity of a severely paretic muscle group after stroke. There is also preliminary evidence that corticospinal adaptations may accompany these gains

Patient-Provider Discussions about Lung Cancer Screening Pre- and Post-Guidelines: Health Information National Trends Survey (HINTS)

Objective In 2013, the USPSTF issued a Grade B recommendation that long-term current and former smokers receive lung cancer screening. Shared decision-making is important for individuals considering screening, and patient-provider discussions an essential component of the process. We examined prevalence and predictors of lung cancer screening discussions pre- and post-USPSTF guidelines. Methods Data were obtained from two cycles of the Health Information National Trends Survey (2012; 2014). The analyzed sample comprised screening-eligible current and former smokers with no personal history of lung cancer (n = 746 in 2012; n = 795 in 2014). Descriptive and multiple logistic regression analyses were conducted; patient-reported discussion about lung cancer screening with provider was the outcome of interest. Results Contrary to expectations, patient-provider discussions about lung cancer screening were more prevalent pre-guideline, but overall patient-provider discussions were low in both years (17% in 2012; 10% in 2014). Current smokers were more likely to have had a discussion than former smokers. Significant predictors of patient-provider discussions included family history of cancer and having healthcare coverage. Conclusions The prevalence of patient-provider discussions about lung cancer screening is suboptimal. Practice implications There is a critical need for patient and provider education about shared decision-making and its importance in cancer screening decisions

Noah's ark conservation will not preserve threatened ecological communities under climate change

Background: Effective conservation of threatened ecological communities requires knowledge of where climatically suitable habitat is likely to persist into the future. We use the critically endangered Lowland Grassland community of Tasmania, Australia a

Deep ROSAT-HRI observations of the NGC 1399/NGC 1404 region: morphology and structure of the X-ray halo

We present the analysis of a deep (167 ks) ROSAT HRI observation of the cD galaxy NGC 1399 in the Fornax cluster. Using both HRI and, at larger radii, archival PSPC data, we find that the radial behavior of the X-ray surface brightness profile is not consistent with a simple Beta model and suggests instead three distinct components. We use a multi-component bidimensional model to study in detail these three components that we identify respectively with the cooling flow region, the galactic and the cluster halo. From these data we derive a binding mass distribution in agreement with that suggested by optical dynamical indicators, with an inner core dominated by luminous matter and an extended dark halo differently distributed on galactic and cluster scales. The HRI data and a preliminary analysis of Chandra public data, allow us to detect significant density fluctuations in the halo. We discuss possible non-equilibrium scenarios to explain the hot halo structure, including tidal interactions with neighboring galaxies, ram stripping from the intra-cluster medium and merging events. In the innermost region of NGC 1399, the comparison between the X-ray and radio emission suggests that the radio emitting plasma is displacing and producing shocks in the hot X-ray emitting gas. We found that the NGC 1404 halo is well represented by a single symmetric Beta model and follows the stellar light profile within the inner 8 kpc. The mass distribution is similar to the `central' component of the NGC 1399 halo. At larger radii ram pressure stripping from the intra-cluster medium produces strong asymmetries in the gas distribution. Finally we discuss the properties of the point source population finding evidence of correlation between the source excess and NGC 1399.Comment: 34 pages in aastex5.0 format, including 28 B&W and 4 color figures. Uses LaTex packages: subfigure, lscape and psfig. Accepted for publication in ApJ. High resolution version can be found at: http://www.na.astro.it/~paolillo/publications.htm

A systematic review of the organizational, environmental, professional and child and family factors influencing the timing of admission to hospital for children with serious infectious illness

Abstract Background Infection, particularly in the first 5 years of life, is a major cause of childhood deaths globally, many deaths from infections such as pneumonia and meningococcal disease are avoidable, if treated in time. Some factors that contribute to morbidity and mortality can be modified. These include organisational and environmental factors as well as those related to the child, family or professional. Objective Examine what organizational and environmental factors and individual child, family and professional factors affect timing of admission to hospital for children with a serious infectious illness. Design Systematic review. Data sources Key search terms were identified and used to search CINAHL Plus, Medline, ASSIA, Web of Science, The Cochrane Library, Joanna Briggs Institute Database of Systematic Review. Study appraisal methods Primary research (e.g. quantitative, qualitative and mixed methods studies) and literature reviews (e.g., systematic, scoping and narrative) were included if participants included or were restricted to children under 5 years of age with serious infectious illnesses, included parents and/or first contact health care professionals in primary care, urgent and emergency care and where the research had been conducted in OECD high income countries. The Mixed Methods Appraisal Tool was used to review the methodological quality of the studies. Main findings Thirty-six papers were selected for full text review; 12 studies fitted the inclusion criteria. Factors influencing the timing of admission to hospital included the variability in children’s illness trajectories and pathways to hospital, parental recognition of symptoms and clinicians non-recognition of illness severity, parental help-seeking behaviour and clinician responses, access to services, use and non-use of ‘gut feeling’ by clinicians, and sub-optimal management within primary, secondary and tertiary services. Conclusions The pathways taken by children with a serious infectious illness to hospital are complex and influenced by a variety of potentially modifiable individual, organisational, environmental and contextual factors. Supportive, accessible, respectful services that provide continuity, clear communication, advice and safety-netting are important as is improved training for clinicians and a mandate to attend to ‘gut feeling’. Implications Relatively simple interventions such as improved communication have the potential to improve the quality of care and reduce morbidity and mortality in children with a serious infectious illness

Quantifying and monitoring overdiagnosis in cancer screening: a systematic review of methods

Objective To determine the optimal method for quantifying and monitoring overdiagnosis in cancer screening over time.Design Systematic review of primary research studies of any design that quantified overdiagnosis from screening for nine types of cancer. We used explicit criteria to critically appraise individual studies and assess strength of the body of evidence for each study design (double blinded review), and assessed the potential for each study design to accurately quantify and monitor overdiagnosis over time.Data sources PubMed and Embase up to 28 February 2014; hand searching of systematic reviews.Eligibility criteria for selecting studies English language studies of any design that quantified overdiagnosis for any of nine common cancers (prostate, breast, lung, colorectal, melanoma, bladder, renal, thyroid, and uterine); excluded case series, case reports, and reviews that only reported results of other studies.Results 52 studies met the inclusion criteria. We grouped studies into four methodological categories: (1) follow-up of a well designed randomized controlled trial (n=3), which has low risk of bias but may not be generalizable and is not suitable for monitoring; (2) pathological or imaging studies (n=8), drawing conclusions about overdiagnosis by examining biological characteristics of cancers, a simple design limited by the uncertain assumption that the measured characteristics are highly correlated with disease progression; (3) modeling studies (n=21), which can be done in a shorter time frame but require complex mathematical equations simulating the natural course of screen detected cancer, the fundamental unknown question; and (4) ecological and cohort studies (n=20), which are suitable for monitoring over time but are limited by a lack of agreed standards, by variable data quality, by inadequate follow-up time, and by the potential for population level confounders. Some ecological and cohort studies, however, have addressed these potential weaknesses in reasonable ways.Conclusions Well conducted ecological and cohort studies in multiple settings are the most appropriate approach for quantifying and monitoring overdiagnosis in cancer screening programs. To support this work, we need internationally agreed standards for ecological and cohort studies and a multinational team of unbiased researchers to perform ongoing analysis

Brane Decay of a (4+n)-Dimensional Rotating Black Hole. II: spin-1 particles

The present works complements and expands a previous one, focused on the emission of scalar fields by a (4+n)-dimensional rotating black hole on the brane, by studying the emission of gauge fields on the brane from a similar black hole. A comprehensive analysis of the particle, energy and angular momentum emission rates is undertaken, for arbitrary angular momentum of the black hole and dimensionality of spacetime. Our analysis reveals the existence of a number of distinct features associated with the emission of spin-1 fields from a rotating black hole on the brane, such as the behaviour and magnitude of the different emission rates, the angular distribution of particles and energy, the relative enhancement compared to the scalar fields, and the magnitude of the superradiance effect. Apart from their theoretical interest, these features can comprise clear signatures of the emission of Hawking radiation from a brane-world black hole during its spin-down phase upon successful detection of this effect during an experiment.Comment: 35 pages, 19 figures, Latex fil