The role of primary oral healthcare clinicians in the detection and diagnosis of oral and oropharyngeal cancer in New Zealand

Background Oral and oropharyngeal cancer (commonly referred to collectively as oral cancer, or OC) is the sixth most common cancer. Cancer Registry records show that the incidence of OC in New Zealand (NZ) has increased over the last 50 years, and distinct incidence patterns persist by gender, age, ethnicity and anatomical site. Despite advances in treatment, a poor prognosis persists for those diagnosed. Improving survival rates will need better rates of early diagnosis. Little is known about the factors leading to delays in OC diagnosis in NZ or whether clinicians’ deficiencies in knowledge contribute to delays in diagnosis. International studies have observed regular dental care to be associated with an earlier stage of OC diagnosis, but whether this holds in NZ is not known. This study explored factors which may contribute to the stage of diagnosis of OC in NZ. It had two main aims: to assess the OC knowledge, beliefs and practices of NZ dentists and clinical dental technicians (CDTs); and to determine whether regular dental care affects the stage of OC diagnosis in the Canterbury region. Methods A self-administered questionnaire was developed and sent to all general dentists and CDTs registered with the Dental Council of NZ. The questionnaire data were compared with those from the NZ Cancer Registry (cases diagnosed with OC from 1 January 2012 until 31 December 2013), to determine whether clinicians have adequate knowledge to enable early detection of suspicious oral lesions. Data from the OC cases from the Canterbury District Health Board (CDHB) were analysed for associations of tumour extent by regular dental attendance. Results Dental clinicians were found to be knowledgeable about many aspects of OC, but differences in knowledge exist among clinicians, suggesting that some are more able to detect early OCs than others. Time from graduation, the type of clinician and the graduation country may influence some beliefs and practices about OC, thereby affecting clinicians’ ability to detect malignant lesions. Most clinicians reported providing OC screening (OCS) examinations for all patients, but one-third identified barriers to doing so. Consequently, it is likely that a proportion of dentists and CDTs do not provide routine OCS examinations. Non-smokers and those of higher socio-economic status were more likely than others to be routine users of dental care. However, there was a lack of data on the dental history of cases, and so, whether differential access to dental care impacts on stage of diagnosis of OC could not be explored in this study. It was noteworthy that general medical practitioners (GMPs) continue to detect most of the OC in NZ, but their knowledge, beliefs and practices in respect of OC have yet to be explored. Conclusion Missed opportunities for early diagnosis of OC may result from identified deficiencies in dental clinicians’ knowledge of OC, their failure to provide an OCS examination for all patients, and high-risk patients not seeking regular dental care. A better understanding of these is required to increase rates for early diagnosis of OC and ultimately improve patient outcomes

A respiratory syncytial virus vaccine based on the small hydrophobic protein ectodomain presented with a novel lipid-based formulation is highly immunogenic and safe in adults : a first-in-humans study

Background: Respiratory syncytial virus infection can cause lower respiratory tract infection in older adults comparable to influenza, but no vaccines are available. Methods: This was a randomized, observer-blinded, first-in-humans study of a novel synthetic RSV antigen based on the ectodomain of the small hydrophobic glycoprotein (SHe) of RSV subgroup A, formulated with either the lipid and oil-based vaccine platform DepoVax (DPX-RSV[A]) or alum (RSV[A]-Alum), in healthy, 50-64-year-old individuals. Two dose levels (10 or 25 mu g) of SHe with each formulation were compared to placebo. A booster dose was administered on day 56. Results: There was no indication that the vaccine was unsafe. Mild pain, drowsiness, and muscles aches were the most common solicited adverse events (AEs), and the frequencies of the AEs did not increase after dose 2. Robust anti-SHe-specific immune responses were demonstrated in the DPX-RSV(A) 10-mu g and 25-mu g groups (geometric mean titer, approximately 10-fold and 100-fold greater than that of placebo at days 56 and 236, respectively), and responses were sustained in the DPX-RSV(A) 25-mu g group at day 421. Responses to the RSV(A)-Alum vaccines were very low. Conclusions: A novel antigen from the SH protein of RSV, formulated in a lipid and oil-based vaccine platform, was highly immunogenic, with sustained antigen-specific antibody responses, and had an acceptable safety profile

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

The role of primary oral healthcare clinicians in the detection and diagnosis of oral and oropharyngeal cancer in New Zealand

Background Oral and oropharyngeal cancer (commonly referred to collectively as oral cancer, or OC) is the sixth most common cancer. Cancer Registry records show that the incidence of OC in New Zealand (NZ) has increased over the last 50 years, and distinct incidence patterns persist by gender, age, ethnicity and anatomical site. Despite advances in treatment, a poor prognosis persists for those diagnosed. Improving survival rates will need better rates of early diagnosis. Little is known about the factors leading to delays in OC diagnosis in NZ or whether clinicians’ deficiencies in knowledge contribute to delays in diagnosis. International studies have observed regular dental care to be associated with an earlier stage of OC diagnosis, but whether this holds in NZ is not known. This study explored factors which may contribute to the stage of diagnosis of OC in NZ. It had two main aims: to assess the OC knowledge, beliefs and practices of NZ dentists and clinical dental technicians (CDTs); and to determine whether regular dental care affects the stage of OC diagnosis in the Canterbury region. Methods A self-administered questionnaire was developed and sent to all general dentists and CDTs registered with the Dental Council of NZ. The questionnaire data were compared with those from the NZ Cancer Registry (cases diagnosed with OC from 1 January 2012 until 31 December 2013), to determine whether clinicians have adequate knowledge to enable early detection of suspicious oral lesions. Data from the OC cases from the Canterbury District Health Board (CDHB) were analysed for associations of tumour extent by regular dental attendance. Results Dental clinicians were found to be knowledgeable about many aspects of OC, but differences in knowledge exist among clinicians, suggesting that some are more able to detect early OCs than others. Time from graduation, the type of clinician and the graduation country may influence some beliefs and practices about OC, thereby affecting clinicians’ ability to detect malignant lesions. Most clinicians reported providing OC screening (OCS) examinations for all patients, but one-third identified barriers to doing so. Consequently, it is likely that a proportion of dentists and CDTs do not provide routine OCS examinations. Non-smokers and those of higher socio-economic status were more likely than others to be routine users of dental care. However, there was a lack of data on the dental history of cases, and so, whether differential access to dental care impacts on stage of diagnosis of OC could not be explored in this study. It was noteworthy that general medical practitioners (GMPs) continue to detect most of the OC in NZ, but their knowledge, beliefs and practices in respect of OC have yet to be explored. Conclusion Missed opportunities for early diagnosis of OC may result from identified deficiencies in dental clinicians’ knowledge of OC, their failure to provide an OCS examination for all patients, and high-risk patients not seeking regular dental care. A better understanding of these is required to increase rates for early diagnosis of OC and ultimately improve patient outcomes

Spoken Language Parsing Using Phrase-Level Grammars and Trainable Classifiers

In this paper, we describe a novel approach to spoken language analysis for translation, which uses a combination of grammar-based phrase-level parsing and automatic classification. The job of the analyzer is to produce a shallow semantic interlingua representation for spoken task-oriented utterances. The goal of our hybrid approach is to provide accurate real-time analyses while improving robustness and portability to new domains and languages

FLO and Friends: City Jam Melbourne, Australia

FLO (Female Laptop Orchestra) is an all-female, internet based, networked, music ensemble exploring online global, multi-location music performance. This output comprises a 6 minute live tele-improvised performance took place at the Testing Grounds, Melbourne on June 1, 2019. The performance featured 4 musicians, including 2 live performers at Testing Grounds, 1 performer in Sydney and 1 performer in Italy. The performers were also joined by a digital drawing artist in Melbourne. The performance was an improvised response to video streamed performance of 2 Japanese based dancers in woodlands in Tokyo, Japan. The performance explored a number of emergent technologies including Live Shout and Soundjack and comprised an eclectic mix of sound sources, including pre-recorded samples and field recordings and live processed vocals. The project investigates the integration of a number of emerging technologies and compositional approaches to live performance with inherent latency brought about by the technologies in use. The performance was supported by a competitive artist residency at Macgeorge House along with Melbourne University, Testing Grounds, Rode Microphones and Audio Technica technology company

Domain Specific Speech Acts for Spoken Language Translation

We describe a coding scheme for machine translation of spoken taskoriented dialogue. The coding scheme covers two levels of speaker intention - domain independent speech acts and domain dependent domain actions. Our database contains over 14,000 tagged sentences in English, Italian, and German. We argu

Domain portability in speech-to-speech translation

Speech-to-speech translation has made significant advances over the past decade, with several high-visibility projects (C-STAR, Verbmobil, the Spoken Language Translator, and others) significantly advancing the state-of-the-art. While speech recognition can currentl