COVID-19 disruption to cervical cancer screening in England

INTRODUCTION: In England, routine invitations for cervical screening were reduced between April 2020 and June 2020 due to the COVID-19 pandemic. We quantify the impact of COVID-19 disruptions on attendance and excess diagnoses of cervical cancer (CC). METHODS: Using Public Health England CC screening data on laboratory samples received in 2018 as a baseline we quantify the reduction in screening attendances due to the COVID-19 pandemic between April 2020 and March 2021 for women aged 25–64. We model the impact on excess CC diagnoses assuming once invitations resume 87.5% of women attend within 12 months and 12.5% delay screening for 3 or 5 years (depending on age). RESULTS: The number of samples received at laboratories was 91% lower than expected during April, 85% during May and 43% during June 2020 compared to the same period in 2018. Although on average laboratories received 12.6% more samples between August 2020 and April 2021 than over the same months in 2018, by April 2021 there was a short fall of 200,949 samples (6.4% fewer than in 2018). An excess of 41 CC (4.0 per 100,000 women with a maximum screening delay of 12 months) are predicted to occur among the estimated 1,024,794 women attending this screening round with a delay. An excess of 60 CC (41.0 per 100,000 women) are predicted to occur among the estimated 146,391 women who do not attend this screening round. CONCLUSION: Prompt restoration of cervical screening services limited the impact on excess CC diagnoses. However, in 2020 a 6.4% shortfall of screening samples was observed. Every effort should be made to reassure these women that services are open and safe to attend

Customized television: Standards compliant advanced digital television

This correspondence describes a European Union supported collaborative project called CustomTV based on the premise that future TV sets will provide all sorts of multimedia information and interactivity, as well as manage all such services according to each user’s or group of user’s preferences/profiles. We have demonstrated the potential of recent standards (MPEG-4 and MPEG-7) to implement such a scenario by building the following services: an advanced EPG, Weather Forecasting, and Stock Exchange/Flight Information

Threats to seabirds: A global assessment

We present the first objective quantitative assessment of the threats to all 359 species of seabirds, identify the main challenges facing them, and outline priority actions for their conservation. We applied the standardised Threats Classification Scheme developed for the IUCN Red List to objectively assess threats to each species and analysed the data according to global IUCN threat status, taxonomic group, and primary foraging habitat (coastal or pelagic). The top three threats to seabirds in terms of number of species affected and average impact are: invasive alien species, affecting 165 species across all the most threatened groups; bycatch in fisheries, affecting fewer species (100) but with the greatest average impact; and climate change/severe weather, affecting 96 species. Overfishing, hunting/trapping and disturbance were also identified as major threats to seabirds. Reversing the top three threats alone would benefit two-thirds of all species and c. 380 million individual seabirds (c. 45% of the total global seabird population). Most seabirds (c. 70%), especially globally threatened species, face multiple threats. For albatrosses, petrels and penguins in particular (the three most threatened groups of seabirds), it is essential to tackle both terrestrial and marine threats to reverse declines. As the negative effects of climate change are harder to mitigate, it is vital to compensate by addressing other major threats that often affect the same species, such as invasive alien species, bycatch and overfishing, for which proven solutions exist

Evaluating the effectiveness of a large multi-use MPA in protecting Key Biodiversity Areas for marine predators

Marine protected areas can serve to regulate harvesting and conserve biodiversity. Within large multi‐use MPAs, it is often unclear to what degree critical sites of biodiversity are afforded protection against commercial activities. Addressing this issue is a prerequisite if we are to appropriately assess sites against conservation targets. We evaluated whether the management regime of a large MPA conserved sites (Key Biodiversity Areas, KBAs) supporting the global persistence of top marine predators

Differential trends in the rising incidence of endometrial cancer by type: data from a UK population-based registry from 1994 to 2006

BACKGROUND: Endometrial cancer is the most common gynaecological cancer in the western world, the incidence increasing in the United Kingdom by over 40 % since 1993. Two types of endometrial cancer exist – oestrogen-dependent type 1 with good prognosis and non-oestrogen-dependent type 2 with poor prognosis. The histopathological distribution of the increase in endometrial cancer is unknown. This study investigates the observed incidence trends of the two types, the age, stage, and socioeconomic distribution of this increase and survival outcome. METHODS: Data were analysed from 6867 women with endometrial cancer registered between 1994 and 2006, at a UK population-based cancer registry. RESULTS: Increased endometrial cancer incidence is confined to type 1 cancers with a significant increase in age standardised incidenc

Marine important bird and biodiversity areas for penguins in Antarctica: Targets for conservation action

Global targets for area-based conservation and management must move beyond threshold-based targets alone and must account for the quality of such areas. In the Southern Ocean around Antarctica, a region where key biodiversity faces unprecedented risks from climate change and where there is a growing demand to extract resources, a number of marine areas have been afforded enhanced conservation or management measures through two adopted marine protected areas (MPAs). However, evidence suggests that additional high quality areas could benefit from a proposed network of MPAs. Penguins offer a particular opportunity to identify high quality areas because these birds, as highly visible central-place foragers, are considered indicator species whose populations reflect the state of the surrounding marine environment. We compiled a comprehensive dataset of the location of penguin colonies and their associated abundance estimates in Antarctica. We then estimated the at-sea distribution of birds based on information derived from tracking data and through the application of a modified foraging radius approach with a density decay function to identify some of the most important marine areas for chick-rearing adult penguins throughout waters surrounding Antarctica following the Important Bird and Biodiversity Area (IBA) framework. Additionally, we assessed how marine IBAs overlapped with the currently adopted and proposed network of key management areas (primarily MPAs), and how the krill fishery likely overlapped with marine IBAs over the past five decades. We identified 63 marine IBAs throughout Antarctic waters and found that were the proposed MPAs to be adopted, the permanent conservation of high quality areas for penguin species would increase by between 49 and 100% depending on the species. Furthermore, our data show that, despite a generally contracting range of operation by the krill fishery in Antarctica over the past five decades, a consistently disproportionate amount of krill is being harvested within marine IBAs compared to the total area in which the fishery operates. Our results support the designation of the proposed MPA network and offer additional guidance as to where decision-makers should act before further perturbation occurs in the Antarctic marine ecosystem

Large scale clinical trials: lessons from the COVID-19 pandemic

Background The COVID-19 pandemic has presented substantial new challenges to clinical and research teams. Our objective was to analyse the experience of investigators and research delivery staff regarding the research response to COVID-19 in order to identify these challenges as well as solutions for future pandemic planning. Methods We conducted a survey of diverse research staff involved in delivery of COVID-19 clinical trials across the UK. This was delivered online across centres linked to the NIHR Respiratory Translational Research Collaboration. Responses were analysed using a formal thematic analysis approach to identify common themes and recommendations. Results 83 survey participants from ten teaching hospitals provided 922 individual question responses. Respondents were involved in a range of research delivery roles but the largest cohort (60%) was study investigators. A wide range of research experiences were captured, including early and late phase trials. Responses were coded into overarching themes. Among common observations, complex protocols without adaptation to a pandemic were noted to have hampered recruitment. Recommendations included the need to develop and test pandemic-specific protocols, and make use of innovations in information technology. Research competition needs to be avoided and drug selection processes should be explicitly transparent. Conclusions Delivery of clinical trials, particularly earlier phase trials, in a pandemic clinical environment is highly challenging, and was reactive rather than anticipatory. Future pandemic studies should be designed and tested in advance, making use of pragmatic study designs as far as possible and planning for integration between early and later phase trials and regulatory frameworks

Global political responsibility for the conservation of albatrosses and large petrels

Migratory marine species cross political borders and enter the high seas, where the lack of an effective global management framework for biodiversity leaves them vulnerable to threats. Here, we combine 10,108 tracks from 5775 individual birds at 87 sites with data on breeding population sizes to estimate the relative year-round importance of national jurisdictions and high seas areas for 39 species of albatrosses and large petrels. Populations from every country made extensive use of the high seas, indicating the stake each country has in the management of biodiversity in international waters. We quantified the links among national populations of these threatened seabirds and the regional fisheries management organizations (RFMOs) which regulate fishing in the high seas. This work makes explicit the relative responsibilities that each country and RFMO has for the management of shared biodiversity, providing invaluable information for the conservation and management of migratory species in the marine realm

A labelled discrete choice experiment adds realism to the choices presented: preferences for surveillance tests for Barrett esophagus

<p>Abstract</p> <p>Background</p> <p>Discrete choice experiments (DCEs) allow systematic assessment of preferences by asking respondents to choose between scenarios. We conducted a labelled discrete choice experiment with realistic choices to investigate patients' trade-offs between the expected health gains and the burden of testing in surveillance of Barrett esophagus (BE).</p> <p>Methods</p> <p>Fifteen choice scenarios were selected based on 2 attributes: 1) type of test (endoscopy and two less burdensome fictitious tests), 2) frequency of surveillance. Each test-frequency combination was associated with its own realistic decrease in risk of dying from esophageal adenocarcinoma. A conditional logit model was fitted.</p> <p>Results</p> <p>Of 297 eligible patients (155 BE and 142 with non-specific upper GI symptoms), 247 completed the questionnaire (84%). Patients preferred surveillance to no surveillance. Current surveillance schemes of once every 1–2 years were amongst the most preferred alternatives. Higher health gains were preferred over those with lower health gains, except when test frequencies exceeded once a year. For similar health gains, patients preferred video-capsule over saliva swab and least preferred endoscopy.</p> <p>Conclusion</p> <p>This first example of a labelled DCE using realistic scenarios in a healthcare context shows that such experiments are feasible. A comparison of labelled and unlabelled designs taking into account setting and research question is recommended.</p

Patients' and urologists' preferences for prostate cancer treatment: A discrete choice experiment

__Abstract__ Background: Patients' preferences are important for shared decision making. Therefore, we investigated patients' and urologists' preferences for treatment alternatives for early prostate cancer (PC). Methods: A discrete choice experiment was conducted among 150 patients who were waiting for their biopsy results, and 150 urologists. Regression analysis was used to determine patients' and urologists' stated preferences using scenarios based on PC treatment modality (radiotherapy, surgery, and active surveillance (AS)), and risks of urinary incontinence and erectile dysfunction.Results:The response rate was 110 out of 150 (73%) for patients and 50 out of 150 (33%) for urologists. Risk of urinary incontinence was an important determinant of both patients' and urologists' stated preferences for PC treatment (P<0.05). Treatment modality also influenced patients' stated preferences (P<0.05), whereas the risk of erectile dysfunction due to radiotherapy was mainly important to urologists (P<0.05). Both patients and urologists preferred AS to radical treatment, with the exception of patients with anxious/depressed feelings who preferred radical treatment to AS. Conclusion: Although patients and urologists generally may prefer similar treatments for PC, they showed different trade-offs between various specific treatment aspects. This implies that urologists need to be aware of potential differences compared with the patient's perspective on treatment decisions in shared decision making on PC treatment