Preferences for cancer investigation:a vignette-based study of primary-care attendees

SummaryBackgroundThe UK lags behind many European countries in terms of cancer survival. Initiatives to address this disparity have focused on barriers to presentation, symptom recognition, and referral for specialist investigation. Selection of patients for further investigation has come under particular scrutiny, although preferences for referral thresholds in the UK population have not been studied. We investigated preferences for diagnostic testing for colorectal, lung, and pancreatic cancers in primary-care attendees.MethodsIn a vignette-based study, researchers recruited individuals aged at least 40 years attending 26 general practices in three areas of England between Dec 6, 2011, and Aug 1, 2012. Participants completed up to three of 12 vignettes (four for each of lung, pancreatic, and colorectal cancers), which were randomly assigned. The vignettes outlined a set of symptoms, the risk that these symptoms might indicate cancer (1%, 2%, 5%, or 10%), the relevant testing process, probable treatment, possible alternative diagnoses, and prognosis if cancer were identified. Participants were asked whether they would opt for diagnostic testing on the basis of the information in the vignette.Findings3469 participants completed 6930 vignettes. 3052 individuals (88%) opted for investigation in their first vignette. We recorded no strong evidence that participants were more likely to opt for investigation with a 1% increase in risk of cancer (odds ratio [OR] 1·02, 95% CI 0·99–1·06; p=0·189), although the association between risk and opting for investigation was strong when colorectal cancer was analysed alone (1·08, 1·03–1·13; p=0·0001). In multivariable analysis, age had an effect in all three cancer models: participants aged 60–69 years were significantly more likely to opt for investigation than were those aged 40–59 years, and those aged 70 years or older were less likely. Other variables associated with increased likelihood of opting for investigation were shorter travel times to testing centre (colorectal and lung cancers), a family history of cancer (colorectal and lung cancers), and higher household income (colorectal and pancreatic cancers).InterpretationParticipants in our sample expressed a clear preference for diagnostic testing at all risk levels, and individuals want to be tested at risk levels well below those stipulated by UK guidelines. This willingness should be considered during design of cancer pathways, particularly in primary care. The public engagement with our study should encourage general practitioners to involve patients in referral decision making.FundingThe National Institute for Health Research Programme Grants for Applied Research programme

Editorial: methods and protocols in brain stimulation

The use of non-invasive brain stimulation (NIBS) techniques to study the brain has increased significantly in recent decades. It has become one of the most accepted therapeutic approaches and powerful tools in treating neurological and psychiatric disorders. NIBS, such as Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), have been proven effective in several clinical conditions, such as major depressive disorders, stroke, and to improve addition/craving and cognition, in both young and geriatric populations (Yavari et al., 2016; Lefaucheur et al., 2020; Fregni et al., 2021; Teixeira-Santos et al., 2022). However, methods and protocols of brain stimulation are very heterogeneous and further research is needed to fine tune the modulatory effects of NIBS in the brain. In this research topic of methods and protocols of brain stimulation, five original research articles address various protocols of NIBS, such a study protocol for geriatric depression, a perspective article on how to test the association between baseline performance and effects of NIBS, and clinical trials discussing methods of brain stimulation on stroke and sleep quality.publishe

Has Public Health Insurance for Older Children Reduced Disparities in Access to Care and Health Outcomes?

This paper investigates the effects of expanding public health insurance eligibility for older children. Using data from the National Health Interview Surveys from 1986 to 2005, we first show that although income continues to be an important predictor of children’s health status, the importance of income for predicting health has fallen for children 9 to 17 in recent years. We then investigate the extent to which the dramatic expansions in public health insurance coverage for these children in the past decade are responsible for the decline in the importance of income. We find that while eligibility for public health insurance unambiguously improves current utilization of preventive care, it has little effect on current health status. However, we find some evidence that Medicaid eligibility in early childhood has positive effects on future health. This may indicate that adequate medical care early on puts children on a better health trajectory, resulting in better health as they grow.

Sequence Decoding of 1D to 2D Self-Assembling Cyclic Peptides

This is the peer reviewed version of the following article: S. Díaz, I. Insua, G. Bhak, J. Montenegro, Chem. Eur. J. 2020, 26, 14765, which has been published in final form at https://doi.org/10.1002/chem.202003265. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.The inherent ability of peptides to self-assemble with directional and rationally predictable interactions has fostered a plethora of synthetic two-dimensional (2D) supramolecular biomaterials. However, the design of peptides with hierarchical assembly in different dimensions across mesoscopic lengths remains a challenging task. We here describe the structural exploration of a d/l-alternating cyclic octapeptide capable of assembling one-dimensional (1D) nanotubes in water, which subsequently pack laterally to form giant 2D nanosheets up to 500 μm long with a constant 3.2 nm thickness. Specific amino acid mutations allowed the mapping of structure–assembly relationships that determine 2D self-assembly. Nine peptide modifications were studied, revealing key features in the peptide sequence that nanosheets tolerated, while a total of three peptide variants included modifications that compromised their 2D arrangement. These lessons will serve as guide and inspiration for new 2D supramolecular peptide designsThis work was partially supported by the Spanish Agencia Estatal de Investigación (AEI) [SAF2017-89890-R], Xunta de Galicia (AD031 2016, ED431C 2017/25 and ED431G2019/03) and the European Commission (EC) (European Regional Development Fund-ERDF) Instituto de Salud Carlos III (COV20/00297). I.I. thanks the European Commission (EC) and AEI for MSCA-IF (2018-843332) and Juan de la Cierva (FJCI-2017-31795) fellowships, respectively. J.M. thanks the Ramón y Cajal (RYC-2013-13784), ERC- STG (DYNAP, 2016-677786), ERC-POC (TraffikGene, 2019-838002) and Human Frontier Science Programme Young Investigator Grant (RGY0066/2017) for fundingS

Undergraduates’ speaking anxiety in English as second language (ESL) classrooms / Kimberley Lau Yih Long ... [et al.]

Many students exhibit fear of speaking in English in the English as Second Language (ESL) classrooms. Additionally, there are limited studies in this area of concern among the undergraduates in Sarawak. Hence, this study aimed to identify the students‟ anxiety level towards speaking English based on four components, namely communication apprehension, test anxiety, fear of negative evaluation, and comfort in using English in the classrooms. This study also examined whether there is any significant difference in the level of anxiety in terms of gender. A total of 592 undergraduates from two public institutions of higher learning in Sarawak were involved in this study. A Public Speaking Class Anxiety Scale (PSCAS) by Yaikhong and Usaha (2012) was adopted in this study to measure anxiety in the ESL speaking classes. The results gathered through the questionnaires were analysed using SPSS package to determine the students‟ speaking anxiety levels and the significant difference in the level of anxiety in speaking English in terms of gender. Thefindings revealed that undergraduates experienced an average level of speaking anxiety. T-test analysis of the findings in the study also portrayed that generally the female undergraduates experienced higher speaking anxiety as compared to the male undergraduates in all the four factors of ESL speaking anxiety. Among the four factors of speaking anxiety, only the factor of „comfort in using English‟ in the classrooms showed a statistically significant difference between male and female undergraduates. Findings of this study would be significant as knowing the level of anxiety among the undergraduates in ESL classrooms will provide the basis for educators to plan better strategies or techniques to help students in overcoming their English speaking anxiety and to improve their oral English proficiency. It will also help students to be aware of their own speaking anxiety level so that they can seek for measures to overcome their speaking anxiety

Collaboration in a peer response group / Sandra Sim Phek Lin

Writing is a complex task which students frequently encounter much difficulty in not knowing how and where to begin to write. Despite the paradigm shift, most teachers still cling to their traditional belief of assigning a topic and leaving students to write the composition on their own. They fail to understand that writing is a process in which 'scaffolding' is much needed from an adult and even peers to help student writers to explore and discover meanings. Collaboration between student-student helps to promote team co-operation through the sharing of ideas amongst students within the group. Learners play an active role throughout the learning process rather than depending on the traditional teacher evaluation of the end products(Alesandrini & Larson, 2002). This provides them the opportunity to take leadership of their own decisions through meaningful dialogue. According to Shor and Freire (1987), "[voice] is a means to transform social relations in the classroom and to raise awareness about relations in the society at large" (p. 11)

Bioink properties before, during and after 3D bioprinting

Bioprinting is a process based on additive manufacturing from materials containing living cells. These materials, often referred to as bioink, are based on cytocompatible hydrogel precursor formulations, which gel in a manner compatible with different bioprinting approaches. The bioink properties before, during and after gelation are essential for its printability, comprising such features as achievable structural resolution, shape fidelity and cell survival. However, it is the final properties of the matured bioprinted tissue construct that are crucial for the end application. During tissue formation these properties are influenced by the amount of cells present in the construct, their proliferation, migration and interaction with the material. A calibrated computational framework is able to predict the tissue development and maturation and to optimize the bioprinting input parameters such as the starting material, the initial cell loading and the construct geometry. In this contribution relevant bioink properties are reviewed and discussed on the example of most popular bioprinting approaches. The effect of cells on hydrogel processing and vice versa is highlighted. Furthermore, numerical approaches were reviewed and implemented for depicting the cellular mechanics within the hydrogel as well as for prediction of mechanical properties to achieve the desired hydrogel construct considering cell density, distribution and material–cell interaction

Using willingness-to-pay to establish patient preferences for cancer testing in primary care.

BACKGROUND: Shared decision making is a stated aim of several healthcare systems. In the area of cancer, patients' views have informed policy on screening and treatment but there is little information about their views on diagnostic testing in relation to symptom severity. METHODS: We used the technique of willingness-to-pay to determine public preferences around diagnostic testing for colorectal, lung, and pancreatic cancer in primary care in the UK. Participants were approached in general practice waiting rooms and asked to complete a two-stage electronic survey that described symptoms of cancer, the likelihood that the symptoms indicate cancer, and information about the appropriate diagnostic test. Part 1 asked for a binary response (yes/no) as to whether they would choose to have a test if it were offered. Part 2 elicited willingness-to-pay values of the tests using a payment scale followed by a bidding exercise, with the aim that these values would provide a strength of preference not detectable using the binary approach. RESULTS: A large majority of participants chose to be tested for all cancers, with only colonoscopy (colorectal cancer) demonstrating a risk gradient. In the willingness-to-pay exercise participants placed a lower value on an X-ray (lung cancer) than the tests for colorectal or pancreatic cancer and X-ray was the only test where risk was clearly related to the willingness-to-pay value. CONCLUSION: Willingness-to-pay values did not enhance the binary responses in the way intended; participants appeared to be motivated differently when responding to the two parts of the questionnaire. More work is needed to understand how participants perceive risk in this context and how they respond to questions about willingness-to-pay. Qualitative methods could provide useful insights

Screening Arrays of Laminin Peptides on Modified Cellulose for Promotion of Adhesion of Primary Endothelial and Neural Precursor Cells

Neural precursor cells (NPC) are primary cells intensively used in the context of research on adult neurogenesis and modeling of neuronal development in health and diseased states. Substrates that can facilitate NPC adhesion will be very useful for culturing these cells. Due to the presence of laminin in basal lamina as well as their involvement in differentiation, migration, and adhesion of many types of cells, surfaces modified with laminin-derived peptides are focused upon and compared with the widely used fibronectin-derived Arg-Gly-Asp (RGD) peptides. An array of 46 peptides is synthesized on cellulose paper (SPOT) to identify laminin-derived peptides that promote short-term adhesion of murine NPC and human primary endothelial cells. Various previously reported peptide sequences are re-evaluated in this work. Initial adhesion experiments show NPC preferred several laminin-derived peptides by up to 5-time higher cell numbers, compared to the well-known promiscuous integrin binding RGD peptide. Importantly, screening of cell adhesion has revealed a synergetic effect of filamentous matrix, peptide sequence, surface property, ligand density, and the dynamic process of NPC adhesion. © The Authors. Advanced Biology published by Wiley-VCH Gmb