Under utilisation of the 2-week wait initiative for lung cancer by primary care and its effect on the urgent referral pathway

The ‘2-week wait' scheme for referral of patients with cancer to secondary care coincided with the introduction of Department of Health (DoH) Guidelines on referral of patients with suspected lung cancer. The aim of this study was to examine the impact of this process on the urgent referral pathway for lung cancer. Medical records of all patients referred with suspected lung cancer were reviewed for the year prior to introduction of the 2-week wait and DoH guidelines and for the subsequent 24 months. A total of 1044 patients were referred, of which 650 (62%) were found to have malignancy. In the first and second years of the 2-week wait scheme, only 57 and 58% were referred via the scheme. Department of Health guidelines were followed in all but a small number. Median wait time increased from 7 to 9 days. The proportion of all urgent referrals seen within 2 weeks fell from 84 to 71%. The proportion of non-2-week wait urgent referrals being seen within 2 weeks was only 75.5% in the first year of the scheme and fell further to 60.9% in the second year. The absolute number of referrals rose and the proportion having cancer fell from 78% before the scheme to 46% in the second year. During this time, there was no change in stage at presentation. Symptoms were not helpful in discriminating benign from malignant disease and haemoptysis was actually more common in the benign group. However, over 50% of patients in the benign group were appropriate to be seen in secondary care. The 2-week wait scheme has so far failed to reduced waiting times for lung cancer. The findings of this study suggest that this is partly due to continued usage of urgent referral routes outside the 2-week wait scheme and secondly due to a large increase in referrals, probably generated by the introduction of the DoH guidelines. Some adjustment to the guidelines may be appropriate to reflect more emphasis on the early performance of a chest X-ray and the use of direct access to other imaging modalities such as CT. Patients referred outside the 2-week wait are disadvantaged and thus practitioners would be wise to refer all their patients through the 2-week wait system

A Comparison of Algorithms for the Construction of SZ Cluster Catalogues

We evaluate the construction methodology of an all-sky catalogue of galaxy clusters detected through the Sunyaev-Zel'dovich (SZ) effect. We perform an extensive comparison of twelve algorithms applied to the same detailed simulations of the millimeter and submillimeter sky based on a Planck-like case. We present the results of this "SZ Challenge" in terms of catalogue completeness, purity, astrometric and photometric reconstruction. Our results provide a comparison of a representative sample of SZ detection algorithms and highlight important issues in their application. In our study case, we show that the exact expected number of clusters remains uncertain (about a thousand cluster candidates at |b|> 20 deg with 90% purity) and that it depends on the SZ model and on the detailed sky simulations, and on algorithmic implementation of the detection methods. We also estimate the astrometric precision of the cluster candidates which is found of the order of ~2 arcmins on average, and the photometric uncertainty of order ~30%, depending on flux.Comment: Accepted for publication in A&A: 14 pages, 7 figures. Detailed figures added in Appendi

Ultra High Energy Cosmology with POLARBEAR

Observations of the temperature anisotropy of the Cosmic Microwave Background (CMB) lend support to an inflationary origin of the universe, yet no direct evidence verifying inflation exists. Many current experiments are focussing on the CMB's polarization anisotropy, specifically its curl component (called "B-mode" polarization), which remains undetected. The inflationary paradigm predicts the existence of a primordial gravitational wave background that imprints a unique B-mode signature on the CMB's polarization at large angular scales. The CMB B-mode signal also encodes gravitational lensing information at smaller angular scales, bearing the imprint of cosmological large scale structures (LSS) which in turn may elucidate the properties of cosmological neutrinos. The quest for detection of these signals; each of which is orders of magnitude smaller than the CMB temperature anisotropy signal, has motivated the development of background-limited detectors with precise control of systematic effects. The POLARBEAR experiment is designed to perform a deep search for the signature of gravitational waves from inflation and to characterize lensing of the CMB by LSS. POLARBEAR is a 3.5 meter ground-based telescope with 3.8 arcminute angular resolution at 150 GHz. At the heart of the POLARBEAR receiver is an array featuring 1274 antenna-coupled superconducting transition edge sensor (TES) bolometers cooled to 0.25 Kelvin. POLARBEAR is designed to reach a tensor-to-scalar ratio of 0.025 after two years of observation -- more than an order of magnitude improvement over the current best results, which would test physics at energies near the GUT scale. POLARBEAR had an engineering run in the Inyo Mountains of Eastern California in 2010 and will begin observations in the Atacama Desert in Chile in 2011.Comment: 8 pages, 6 figures, DPF 2011 conference proceeding

Exciton Spin Dynamics in Semiconductor Quantum Wells

In this paper we will review Exciton Spin Dynamics in Semiconductor Quantum Wells. The spin properties of excitons in nanostructures are determined by their fine structure. We will mainly focus in this review on GaAs and InGaAs quantum wells which are model systems.Comment: 55 pages, 27 figure

The pre-launch Planck Sky Model: a model of sky emission at submillimetre to centimetre wavelengths

We present the Planck Sky Model (PSM), a parametric model for the generation of all-sky, few arcminute resolution maps of sky emission at submillimetre to centimetre wavelengths, in both intensity and polarisation. Several options are implemented to model the cosmic microwave background, Galactic diffuse emission (synchrotron, free-free, thermal and spinning dust, CO lines), Galactic H-II regions, extragalactic radio sources, dusty galaxies, and thermal and kinetic Sunyaev-Zeldovich signals from clusters of galaxies. Each component is simulated by means of educated interpolations/extrapolations of data sets available at the time of the launch of the Planck mission, complemented by state-of-the-art models of the emission. Distinctive features of the simulations are: spatially varying spectral properties of synchrotron and dust; different spectral parameters for each point source; modeling of the clustering properties of extragalactic sources and of the power spectrum of fluctuations in the cosmic infrared background. The PSM enables the production of random realizations of the sky emission, constrained to match observational data within their uncertainties, and is implemented in a software package that is regularly updated with incoming information from observations. The model is expected to serve as a useful tool for optimizing planned microwave and sub-millimetre surveys and to test data processing and analysis pipelines. It is, in particular, used for the development and validation of data analysis pipelines within the planck collaboration. A version of the software that can be used for simulating the observations for a variety of experiments is made available on a dedicated website.Comment: 35 pages, 31 figure

The bolometric focal plane array of the Polarbear CMB experiment

The Polarbear Cosmic Microwave Background (CMB) polarization experiment is currently observing from the Atacama Desert in Northern Chile. It will characterize the expected B-mode polarization due to gravitational lensing of the CMB, and search for the possible B-mode signature of inflationary gravitational waves. Its 250 mK focal plane detector array consists of 1,274 polarization-sensitive antenna-coupled bolometers, each with an associated lithographed band-defining filter. Each detector's planar antenna structure is coupled to the telescope's optical system through a contacting dielectric lenslet, an architecture unique in current CMB experiments. We present the initial characterization of this focal plane

Development and characterization of the readout system for POLARBEAR-2

POLARBEAR-2 is a next-generation receiver for precision measurements of the polarization of the cosmic microwave background (Cosmic Microwave Background (CMB)). Scheduled to deploy in early 2015, it will observe alongside the existing POLARBEAR-1 receiver, on a new telescope in the Simons Array on Cerro Toco in the Atacama desert of Chile. For increased sensitivity, it will feature a larger area focal plane, with a total of 7,588 polarization sensitive antenna-coupled Transition Edge Sensor (TES) bolometers, with a design sensitivity of 4.1 uKrt(s). The focal plane will be cooled to 250 milliKelvin, and the bolometers will be read-out with 40x frequency domain multiplexing, with 36 optical bolometers on a single SQUID amplifier, along with 2 dark bolometers and 2 calibration resistors. To increase the multiplexing factor from 8x for POLARBEAR-1 to 40x for POLARBEAR-2 requires additional bandwidth for SQUID readout and well-defined frequency channel spacing. Extending to these higher frequencies requires new components and design for the LC filters which define channel spacing. The LC filters are cold resonant circuits with an inductor and capacitor in series with each bolometer, and stray inductance in the wiring and equivalent series resistance from the capacitors can affect bolometer operation. We present results from characterizing these new readout components. Integration of the readout system is being done first on a small scale, to ensure that the readout system does not affect bolometer sensitivity or stability, and to validate the overall system before expansion into the full receiver. We present the status of readout integration, and the initial results and status of components for the full array.Comment: Presented at SPIE Astronomical Telescopes and Instrumentation 2014: Millimeter, Submillimeter, and Far-Infrared Detectors and Instrumentation for Astronomy VII. Published in Proceedings of SPIE Volume 915

Ucma/GRP inhibits phosphate-induced vascular smooth muscle cell calcification via SMAD-dependent BMP signalling

Vascular calcification (VC) is the process of deposition of calcium phosphate crystals in the blood vessel wall, with a central role for vascular smooth muscle cells (VSMCs). VC is highly prevalent in chronic kidney disease (CKD) patients and thought, in part, to be induced by phosphate imbalance. The molecular mechanisms that regulate VC are not fully known. Here we propose a novel role for the mineralisation regulator Ucma/GRP (Upper zone of growth plate and Cartilage Matrix Associated protein/Gla Rich Protein) in phosphate-induced VSMC calcification. We show that Ucma/GRP is present in calcified atherosclerotic plaques and highly expressed in calcifying VSMCs in vitro. VSMCs from Ucma/GRP(-/-) mice showed increased mineralisation and expression of osteo/chondrogenic markers (BMP-2, Runx2, beta-catenin, p-SMAD1/5/8, ALP, OCN), and decreased expression of mineralisation inhibitor MGP, suggesting that Ucma/GRP is an inhibitor of mineralisation. Using BMP signalling inhibitor noggin and SMAD1/5/8 signalling inhibitor dorsomorphin we showed that Ucma/GRP is involved in inhibiting the BMP-2-SMAD1/5/8 osteo/chondrogenic signalling pathway in VSMCs treated with elevated phosphate concentrations. Additionally, we showed for the first time evidence of a direct interaction between Ucma/GRP and BMP-2. These results demonstrate an important role of Ucma/GRP in regulating osteo/chondrogenic differentiation and phosphate-induced mineralisation of VSMCs.NWO ZonMw [MKMD 40-42600-98-13007]; FCT [SFRH/BPD/70277/2010]info:eu-repo/semantics/publishedVersio

CMB-S4 Science Book, First Edition

This book lays out the scientific goals to be addressed by the next-generation ground-based cosmic microwave background experiment, CMB-S4, envisioned to consist of dedicated telescopes at the South Pole, the high Chilean Atacama plateau and possibly a northern hemisphere site, all equipped with new superconducting cameras. CMB-S4 will dramatically advance cosmological studies by crossing critical thresholds in the search for the B-mode polarization signature of primordial gravitational waves, in the determination of the number and masses of the neutrinos, in the search for evidence of new light relics, in constraining the nature of dark energy, and in testing general relativity on large scales