Serum and blood based biomarkers for lung cancer screening : a systematic review

Background Lung cancer is the second most common cancer and the leading cause of cancer death for both men and women. Although low-dose CT (LDCT) is recommended for lung cancer screening in high-risk populations and may decrease lung cancer mortality, there is a need to improve the accuracy of lung cancer screening to decrease over-diagnosis and morbidity. Blood and serum-based biomarkers, including EarlyCDT-lung and microRNA based biomarkers, are promising adjuncts to LDCT in lung cancer screening. We evaluated the diagnostic performance of EarlyCDT-lung, micro-RNA signature classifier (MSC), and miR-test, and their impact on lung cancer-related mortality and all-cause mortality. Methods References were identified using searches of PubMed, EMBASE, and Ovid Medline® from January 2000 to November 2015. Phase three or greater studies in the English language evaluating the diagnostic performance of EarlyCDT-lung, MSC, and miR-test were selected for inclusion. Results Three phase 3 studies were identified, one evaluating EarlyCDT-lung, one evaluating miR-Test, and one evaluating MSC respectively. No phase 4 or 5 studies were identified. All three biomarker assays show promise for the detection of lung cancer. MSC shows promise when used in conjunction with LDCT for lung cancer detection, achieving a positive likelihood ratio of 18.6 if both LDCT and MSC are positive, and a negative likelihood ratio of 0.03 if both LDCT and MSC are negative. However, there is a paucity of high-quality studies that can guide clinical implementation. Conclusion There is currently no high quality evidence to support or guide the implementation of these biomarkers in clinical practice. Reports of further research at stages four and five for these, and other promising methods, is required.Publisher PDFPeer reviewe

Identifying top 10 primary care research priorities from international stakeholders using a modified Delphi method

This project received funding from the North York General Hospital Foundation (to BO) and was supported by the Besrour Centre, a hub of collaboration to advance global family medicine affiliated with the College of Family Physicians of Canada.Background: High quality primary care is fundamental to achieving health for all. Research priority setting is a key facilitator of improving how research activity responds to concrete needs. There has never before been an attempt to identify international primary care research priorities, in order to guide resource allocation and to enhance global primary care. This study aimed to identify a list of top 10 primary care research priorities, as identified by members of the public, health professionals working in primary care, researchers, and policymakers. Methods: We adapted the James Lind Alliance Priority Setting Partnership process, to conduct multiple rounds of stakeholder recruitment and prioritization. The study included an online survey conducted in three languages, followed by an in-person priority setting exercise involving primary care stakeholders from 13 countries. Findings: Participants identified a list of top 10 international primary care research priorities. These were focused on diverse topics such as enhancing use of information and communication technology, and improving integration of indigenous communities’ knowledge in the design of primary care services. The main limitations of the study related to challenges in engaging an adequate diversity and number of appropriate stakeholders, particularly members of the public, in aggregating the diverse set of responses into coherent categories representative of the participants’ perspectives and in adequately representing the diversity of submitted responses while ensuring research priorities on the final list are sufficiently actionable to guide resource allocation. Conclusions: The top 10 identified research priorities have the potential to guide research resource allocation, supporting funding agencies and initiatives to promote global primary care research and practice.Publisher PDFPeer reviewe

An instrumental perspective on apologizing in bargaining: the importance of forgiveness to apologize

Although very little research in bargaining has addressed how perpetrators should deal with the aftermath of unfair allocations, it has been proposed that an apology may help the reconciliation process. Prior research, however, only focused on whether apologies can reveal positive effects on the reconciliation process but did not focus yet on whether perpetrators are actually willing to apologize. In this paper we investigate perpetrator’s willingness to apologize for a trust violation in a bargaining setting. We hypothesized that perpetrators willingness to apologize would be a function of the extent to which the victim of the trust violation is willing to forgive. This effect, however, was expected to emerge only among those perpetrators who are low in dispositional trust. The results from a laboratory study with actual transgressions and actual apologetic behavior supported our predictions and thus emphasize an instrumental view on apologizing in bargaining situations

The apology mismatch: asymmetries between victim's need for apologies and perpetrator's willingness to apologize

Although previous research on apologies has shown that apologies can have many beneficial effects on victims’ responses, the dyadic nature of the apology process has largely been ignored. As a consequence, very little is known about the congruence between perpetrators’ willingness to apologize and victims’ willingness to receive an apology. In three experimental studies we showed that victims mainly want to receive an apology after an intentional transgression, whereas perpetrators want to offer an apology particularly after an unintentional transgression. As expected, these divergent apologetic needs among victims and perpetrators were mediated by unique emotions: guilt among perpetrators and anger among victims. These results suggest that an apology serves very different goals among victims and perpetrators, thus pointing at an apology mismatch

An exploration of the implementation of open disclosure of adverse events in the UK : a scoping review and qualitative exploration

Background: In 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice. Aim: The aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS. Methods: This work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders' views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure. Results: A total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance. Conclusions: There are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events

Underwater excimer laser ablation of polymers

In this paper, we study the photoablation kinetic of poly (ethylene terephthalate) (PET), polycarbonate (PC), polyimide (PI) and polystyrene (PS) in both air and water. Compared to the results obtained in air, we highlight the decrease of the ablation threshold (AT) of polyesters in contact with water as a function of polymer chemical structure. In order to check the expected hydrolytic reaction of polyesters near the ablation threshold, the chemical modification of the polymer surfaces, as well the composition of the ablation products, were investigated after irradiation near the fluence of ablation threshold in air (air-F t ) by X-ray photoelectron spectroscopy (XPS) and confocal Raman microspectroscopy. The morphology of polymers obtained by underwater irradiation and near the air-F t was also examined using scanning electron microscopy (SEM). To understand the process and its dynamics in contact with water, we consider the model of temperature at the polymer-water interface based on the semi-analytical solution of the transit heat-diffusion equation