Prostate cancer : population-based screening and markers for long-term clinical outcome

In 1988 and 1989 a large screening study for prostate cancer was launched in Stockholm, Sweden. At the time approximately 27 000 men between 55 and 70 years of age resided within a defined area of southern Stockholm. 2400 men were randomly selected to participate in the trial and those accepting (n=1782), were examined with digital rectal exam (DRE), transrectal ultrasound (TRUS) and a PSA test. If DRE or TRUS indicated suspicious findings or if PSA levels were 10 ng/mL or greater quadrant core biopsies of the prostate were performed. Additionally, the screening algorithm employed stipulated reexamination with DRE and TRUS if PSA concentrations were between 7 ng/L and 10 ng/mL. The initial screening yielded 65 cases of prostate cancer. In this thesis the screening material have been assessed after 20 years (paper I) and 30 years (paper II-IV). In paper I the result of the one-time screening was evaluated after linking the background population, the participants of the study and the invited but not participating cohort to the Swedish cause of death registry and the Swedish cancer registry. Estimating the possible cancer-specific mortality reduction using the Poisson regression model resulted in no difference in prostate cancer-specific mortality between the screened population and the unscreened population, IRR= 0.97 (0.71-1.23; 95% CI). Paper II evaluated the association between the androgen DHT and prostate cancer incidence and mortality. High levels of DHT protected from lethal prostate cancer HR= 0.44 (0.25‐0.77; 95% CI), p=0.004 after 30 years of follow up. The association remained significant both for men seemingly heathy at time of inclusion HR=0.25 (0.07‐0.88; 95% CI), p= 0.032 and for those with a recently diagnosed cancer HR= 0.50 (0.26‐0.94; 95% CI), p=0.031. In paper III the threshold for PSA was examined and the proportions of its isoforms – free/bound PSA that is indicative for low, or negligible risk for prostate cancer death. The associations between both PSA and the ratio free/bound PSA and lethal prostate cancer were strong at long-term follow up. A baseline PSA of 2 ng/mL or less combined with ratio free/bound PSA of 0.25 or greater indicated a very low long-term risk for prostate cancer death and further screening in this cohort can be abstained or continued with lower frequency. In paper IV thawed serum from 330 men including 36 men with lethal prostate cancer was analysed. The aim was to estimate association between elevated levels of the enzyme Thymidine kinase (TK1), a phosphorylation enzyme important in DNA synthesis, and future risk for prostate cancer-specific mortality and overall mortality. The analyses were performed with a commercially available western blot kit. Preliminary estimates indicate that high levels of TK1 is associated with an increased risk for overall mortality irrespective of whether death occurred shortly after blood draw or after a period of follow up

Thrimage: An Empathy-Oriented Discussion Tool for Classroom Use

Thrimage is a class-application where pupils choose and rank images in relation to a given word or notion. In seeing who else chose similarly, as well as in a debriefing teacher-led discussion, pupils gain insight in others' way of thinking, and learn to argument for their own opinion but also to respect others, both of which supports the development of empathy and mutual understanding. The design is part of a long-running design exploration on designing of collaborative, co-located experiences using mobile devices, in combination with an educational need

Designing mobile experiences for collocated interaction

Many of our everyday social interactions involve mobile devices. Yet, these tend to only provide good support for distributed social interactions. Although much HCI and CSCW research has explored how we might support collocated, face-to-face situations using mobile devices, much of this work exists as isolated exemplars of technical systems and / or interaction designs. This paper draws on a range of such exemplars to develop a practical design framework intended for guiding the design of new mobile experiences for collocated interaction as well as analysing existing ones. Our framework provides four relational perspectives for designing the complex interplay between: the social situation in which it takes place; the technology used and the mechanics inscribed; the physical environment; and the temporal elements of design. Moreover, each perspective is features some core properties, which are highly relevant when designing these systems. As part of presenting the framework we also explain the process of its construction along with practical advice on how to read and apply it

Serum thymidine kinase 1 concentration as a predictive biomarker in prostate cancer

Background Thymidine kinase 1 (TK1) recycles DNA before cell division. We do not know if baseline blood concentrations of TK1 predict death in prostate cancer within 30 years. Our objective is to determine if there is an association between baseline levels of TK1 and future prostate cancer-specific mortality. Methods With a "proof of concept" approach, we performed a nested case-control study among 1782 individuals screened for prostate cancer between 1988 and 1989. The concentration of TK1 was measured in frozen serum from 330 men, 36 of whom have died of prostate cancer. The primary endpoint was prostate cancer-specific mortality and outcomes after 30 years were analyzed using logistic regression modeling odds ratios (Ors). Results The estimated OR (adjusted for age) for dying from prostate cancer among the men who had a TK1 value in the upper tertile was 2.39 (95% confidence interval 1.02-5.63). The corresponding OR, regardless of the cause of death, was 2.81 (1.24-6.34). Conclusions High levels of TK1 predicts death in prostate cancer within 30 years of follow-up

Designing Mobile Experiences for Collocated Interaction

Many of our everyday social interactions involve mobile devices. Yet, these tend to only provide good support for distributed social interactions. Although much HCI and CSCW research has explored how we might support collocated, face-to-face situations using mobile devices, much of this work exists as isolated exemplars of technical systems or interaction designs. This paper draws on a range of such exemplars to develop a practical design framework intended for guiding the design of new mobile experiences for collocated interaction as well as analysing existing ones. Our framework provides four relational perspectives for designing the complex interplay between: the social situation in which it takes place; the technology used and the mechanics inscribed; the physical environment; and the temporal elements of design. Moreover, each perspective features some core properties, which are highly relevant when designing these systems. As part of presenting the framework we also explain the process of its construction along with practical advice on how to read and apply it

Effect of commercial breakfast fibre cereals compared with corn flakes on postprandial blood glucose, gastric emptying and satiety in healthy subjects: a randomized blinded crossover trial

<p>Abstract</p> <p>Background</p> <p>Dietary fibre food intake is related to a reduced risk of developing diabetes mellitus. However, the mechanism of this effect is still not clear. The aim of this study was to evaluate the effect of commercial fibre cereals on the rate of gastric emptying, postprandial glucose response and satiety in healthy subjects.</p> <p>Methods</p> <p>Gastric emptying rate (GER) was measured by standardized real time ultrasonography. Twelve healthy subjects were assessed using a randomized crossover blinded trial. The subjects were examined after an 8 hour fast and after assessment of normal fasting blood glucose level. Satiety scores were estimated and blood glucose measurements were taken before and at 0, 20, 30, 40, 60, 80, 100 and 120 min after the end of the meal. GER was calculated as the percentage change in the antral cross-sectional area 15 and 90 min after ingestion of sour milk with corn flakes (GER1), cereal bran flakes (GER2) or wholemeal oat flakes (GER3).</p> <p>Results</p> <p>The median value was, respectively, 42% for GER1, 33 % for GER2 and 51% for GER3. The difference between the GER after ingestion of bran flakes compared to wholemeal oat flakes was statistically significant (p = 0.023). The postprandial delta blood glucose level was statistically significantly lower at 40 min (p = 0.045) and 120 min (p = 0.023) after the cereal bran flakes meal. There was no statistical significance between the areas under the curve (AUCs) of the cereals as far as blood glucose and satiety were concerned.</p> <p>Conclusion</p> <p>The result of this study demonstrates that the intake of either bran flakes or wholemeal oat flakes has no effect on the total postprandial blood glucose response or satiety when compared to corn flakes. However, the study does show that the intake of cereal bran flakes slows the GER when compared to oat flakes and corn flakes, probably due to a higher fibre content. Since these products do not differ in terms of glucose response and satiety on healthy subjects, they should be considered equivalent in this respect.</p> <p>Trial registration</p> <p>ISRCTN90535566</p