Rates of inclusion of teenagers and young adults in England into National Cancer Research Network clinical trials: Report from the National Cancer Research Institute (NCRI) Teenage and Young Adult Clinical Studies Development Group

Poor inclusion rates into clinical trials for teenagers and young adults (TYA; aged 13–24 years) have been assumed but not systematically investigated in England. We analysed accrual rates (AR) from 1 April 2005 up to 31 March 2007 to National Cancer Research Network (NCRN) Phase III trials for the commonest tumour types occurring in TYA and children: leukaemia, lymphoma, brain and central nervous system, bone sarcomas and male germ cell tumours. AR for 2005–2007 were 43.2% for patients aged 10–14 years, 25.2% for patients aged 15–19 years, and 13.1% for patients aged 20–24 years in the tumour types analysed. Compared with accrual from 1 April 2005 to 31 March 2006, AR between 1 April 2006 and 31 March 2007 increased for those aged 10–14 and 15–19 years, but fell for those aged 20–24 years. AR varied considerably among cancer types. Despite four trials being available, patients over 16 years with central nervous system tumours were not recruited. Rates of participation in clinical trials in England from 2005 to 2007 were much lower for TYA older than 15 years compared with children and younger teenagers. The variations in open trials, trial age eligibility criteria and extent of trial activation in treatment centres in part explain this observation. Other possible influences, such as difficulties associated with the consent of TYA require further evaluation. Closer dialogue between those involved in planning and running trials for children and for adults is necessary to improve trial availability and recruitment. Further research is required to identify trends in trial availability and accrual for those tumours constituting the remaining 26% of TYA cancers

Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol)

<p>Abstract</p> <p>Background</p> <p>A common and potentially life-threatening complication of the treatment of childhood cancer is infection, which frequently presents as fever with neutropenia. The standard management of such episodes is the extensive use of intravenous antibiotics, and though it produces excellent survival rates of over 95%, it greatly inconveniences the three-fourths of patients who do not require such aggressive treatment. There have been a number of studies which have aimed to develop risk prediction models to stratify treatment. Individual participant data (IPD) meta-analysis in therapeutic studies has been developed to improve the precision and reliability of answers to questions of treatment effect and recently have been suggested to be used to answer questions regarding prognosis and diagnosis to gain greater power from the frequently small individual studies.</p> <p>Design</p> <p>In the IPD protocol, we will collect and synthesise IPD from multiple studies and examine the outcomes of episodes of febrile neutropenia as a consequence of their treatment for malignant disease. We will develop and evaluate a risk stratification model using hierarchical regression models to stratify patients by their risk of experiencing adverse outcomes during an episode. We will also explore specific practical and methodological issues regarding adaptation of established techniques of IPD meta-analysis of interventions for use in synthesising evidence derived from IPD from multiple studies for use in predictive modelling contexts.</p> <p>Discussion</p> <p>Our aim in using this model is to define a group of individuals at low risk for febrile neutropenia who might be treated with reduced intensity or duration of antibiotic therapy and so reduce the inconvenience and cost of these episodes, as well as to define a group of patients at very high risk of complications who could be subject to more intensive therapies. The project will also help develop methods of IPD predictive modelling for use in future studies of risk prediction.</p

Shortened Telomere Length Is Associated with Increased Risk of Cancer: A Meta-Analysis

BACKGROUND: Telomeres play a key role in the maintenance of chromosome integrity and stability, and telomere shortening is involved in initiation and progression of malignancies. A series of epidemiological studies have examined the association between shortened telomeres and risk of cancers, but the findings remain conflicting. METHODS: A dataset composed of 11,255 cases and 13,101 controls from 21 publications was included in a meta-analysis to evaluate the association between overall cancer risk or cancer-specific risk and the relative telomere length. Heterogeneity among studies and their publication bias were further assessed by the χ(2)-based Q statistic test and Egger's test, respectively. RESULTS: The results showed that shorter telomeres were significantly associated with cancer risk (OR = 1.35, 95% CI = 1.14-1.60), compared with longer telomeres. In the stratified analysis by tumor type, the association remained significant in subgroups of bladder cancer (OR = 1.84, 95% CI = 1.38-2.44), lung cancer (OR = 2.39, 95% CI = 1.18-4.88), smoking-related cancers (OR = 2.25, 95% CI = 1.83-2.78), cancers in the digestive system (OR = 1.69, 95% CI = 1.53-1.87) and the urogenital system (OR = 1.73, 95% CI = 1.12-2.67). Furthermore, the results also indicated that the association between the relative telomere length and overall cancer risk was statistically significant in studies of Caucasian subjects, Asian subjects, retrospective designs, hospital-based controls and smaller sample sizes. Funnel plot and Egger's test suggested that there was no publication bias in the current meta-analysis (P = 0.532). CONCLUSIONS: The results of this meta-analysis suggest that the presence of shortened telomeres may be a marker for susceptibility to human cancer, but single larger, well-design prospective studies are warranted to confirm these findings

Nonlinear Dynamics in Distributed Systems

We build on a previous statistical model for distributed systems and formulate it in a way that the deterministic and stochastic processes within the system are clearly separable. We show how internal fluctuations can be analysed in a systematic way using Van Kanpen's expansion method for Markov processes. We present some results for both stationary and time-dependent states. Our approach allows the effect of fluctuations to be explored, particularly in finite systems where such processes assume increasing importance.Comment: Two parts: 8 pages LaTeX file and 5 (uuencoded) figures in Postscript forma

Multi-Label Classifier Chains for Bird Sound

Bird sound data collected with unattended microphones for automatic surveys, or mobile devices for citizen science, typically contain multiple simultaneously vocalizing birds of different species. However, few works have considered the multi-label structure in birdsong. We propose to use an ensemble of classifier chains combined with a histogram-of-segments representation for multi-label classification of birdsong. The proposed method is compared with binary relevance and three multi-instance multi-label learning (MIML) algorithms from prior work (which focus more on structure in the sound, and less on structure in the label sets). Experiments are conducted on two real-world birdsong datasets, and show that the proposed method usually outperforms binary relevance (using the same features and base-classifier), and is better in some cases and worse in others compared to the MIML algorithms.Comment: 6 pages, 1 figure, submission to ICML 2013 workshop on bioacoustics. Note: this is a minor revision- the blind submission format has been replaced with one that shows author names, and a few corrections have been mad

Importance and Limits of the Cost-Benefit Analysis for GMOs Regulation

New technologies and innovations suspected to affect environment or public health need to be regulated. Scientific risk assessment is considered as a key element for the regulation. Its role is reinforced when the regulation has the potential of constraining the international trade. The Sanitary and Phytosanitary Agreement of the WTO dealing with this kind of issues gives primacy to scientific risk assessment. Interesting situations arise with small risks that is to say situations where the probability of damage is tiny and/or expected damages are very small. If risk assessment is the only scientific element considered, the mere presence of risk – even small - should give reason for regulation. Does it rationalize the public decision for all that? If the social benefits associated with the blocked activity are consequent accepting the risk could be worthwhile. Recent works from the economic literature have shown that in order to get a good ‘risk governance’ cost-benefit analysis should be considered together with risk assessment (Bureau et al. 1998, Turvey and Mojduszka 2005). The aim of cost-benefit analysis is indeed to help public decision making. It consists in a set of methods that enables to evaluate the relevance of a regulation, comparing it with other possible options (from other types of regulation to the absence of any regulation). For that purpose cost-benefit analysis aims at estimating a monetary valuation, on the one hand, for environmental (or public health) degradation and, on the other hand, for the expected benefits implied by environmental conservation and technologies’ development.Agribusiness, Agricultural and Food Policy, Farm Management, Food Consumption/Nutrition/Food Safety, Industrial Organization,

Developing interactive multimedia learning materials for chemistry pre-lab training

This article is a progress update on a project investigating the impact of embedding interactive pre-lab materials into the preparation resources for 2nd year undergraduate students in an organic chemistry practical module. Materials were developed as part of a collaborative innovation grant that embedded students as collaborators in the development process. Resulting activities included a mixture of multimedia and active learning exercises, including animations, quizzes, videos, interactive simulations and 3D and 360-degree tours. Prototype evaluation results were used to refine the final version prior to release. A full evaluation is being carried out, and final results will be reported in a future article