The frequency, nature and impact of GP-assessed avoidable delays in a population-based cohort of cancer patients

Background: There is a growing emphasis on the speed of diagnosis as an aspect of cancer prognosis. While epidemiological data in the last decade have quantified diagnostic timeliness and its variation, whether and how often prolonged diagnostic intervals can be considered avoidable is unknown. // Methods: We used data from the English National Cancer Diagnosis Audit (NCDA) on 17,042 patients diagnosed with cancer in 2014. Participating primary care physicians were asked to identify delays in diagnosis that they deemed avoidable, together with the ‘setting’ of the avoidable delay and key attributable factors. We used descriptive analysis and regression frameworks to assess validity and examine variation in the frequency and nature of avoidable delays. // Results: Among 14,259 patients, 24% were deemed to have had an avoidable delay to their diagnosis. Patients with a reported avoidable delay had a longer median diagnostic interval (92 days) than those without (30 days). Of all avoidable delays, 13% were deemed to have occurred pre-consultation, 49% within primary care, and 38% within secondary care. Avoidable delays were mostly attributed to the test request/performance phase (25%). Multimorbidity was associated with greater odds of avoidable delay (OR for 3+ vs no comorbidity: 1.43 (95% CI 1.25–1.63)), with heterogeneous associations with cancer site. // Conclusion: We have shown that GP-identified instances of avoidable delay have construct validity. Whilst the causes of avoidable diagnostic delays are multi-factorial and occur in different settings and phases of the diagnostic process, their analysis can guide improvement initiatives and enable the examination of any prognostic implications

Manual / Issue 1 / Hand in Hand

Manual, a journal about art and its making. Hand in Hand. The inaugural issue of The Manual, a twice-yearly publication by the RISD Museum. The theme of this first issue is “hand in hand,” a phrase first recorded in the 16th century. Its early usage described the clasping of palm to palm, but the term has since come to encompass more than this literal meaning. To be hand in hand is also to be connected, joined, concurrent, well matched. Thumb through these pages to find rigorous, imaginative musings as artists and academics make solid contact, gesture wildly, and put their fingers on the pulse of new ideas. In your grasp, an open invitation to explore objects and materials, and the meanings and makings of things. Softcover, 48 pages. Published 2013 by the RISD Museum. Proceeds from RISD Museum publications support the work of the museum. Manual 1 (Hand in Hand) contributors include Sheila Bonde, Robert Brinkerhoff, Kate Irvin, James McShane, Maureen C. O’Brien, and Elizabeth A. Williams.https://digitalcommons.risd.edu/risdmuseum_journals/1000/thumbnail.jp

Manual / Issue 2 / Lorem Ipsum

Manual, a journal about art and its making. Lorem Ipsum.The second issue. In potently meaningful and deliberately meaningless ways, this issue, “Lorem ipsum,” celebrates text. The standard placeholder text used by designers and printers, lorem ipsum isn’t really Latin. Mangled over centuries of use, the passage has become meaningless and untranslatable—and yet it is highly useful in that in its incomprehensibility, it occupies space. Over the centuries and across many inventions and innovations in type and printing, lorem ipsum has acted as a space filler and form shaper in conventional printing, desktop publishing, and electronic typesetting. Join us as we read and read into calls to action, incantations, prayers, portrayals, missives, notes, proclamations, and musings. Softcover, 60 pages. Published 2014 by the RISD Museum. Manual 2 (Lorem Ipsum) contributors include James Allen, Alison W. Chang, Kenneth Goldsmith, Cyrus Highsmith, Jan Howard, Kate Irvin, Antoine Revoy, and Nancy Skolos.https://digitalcommons.risd.edu/risdmuseum_journals/1001/thumbnail.jp

Manual / Issue 3 / Circus

Manual, a journal about art and its making. Circus. The third issue centers on the theme of Circus. Includes analyses of various pieces in the museum\u27s archive, a fold-out poster by Jim Drain, and a selection of artworks owned by the museum that loosely address said theme. Softcover, 62 pages. Published 2014 by the RISD Museum. Manual 3 (Circus) contributors include Gina Borromeo, Alison W. Chang, Michelle Clayton, Jim Drain, Daniel Heyman, Andrew Martinez, Ellen McBreen, Thangam Ravindranathan, Rebecca Schneider, Susan Smulyan, and Gwen Strahle.https://digitalcommons.risd.edu/risdmuseum_journals/1002/thumbnail.jp

EXPRESS: Differential IL-1 signalling induced by BMPR2 deficiency drives pulmonary vascular remodelling

Background: Bone morphogenetic protein receptor type 2 (BMPR2) mutations are present in patients with heritable and idiopathic pulmonary arterial hypertension (PAH). Circulating levels of Interleukin-1 (IL-1) are raised in patients and animal models. Whether interplay between BMP and IL- 1 signalling can explain the local manifestation of PAH in the lung remains unclear. Methods: Cell culture, siRNA and mRNA microarray analysis of RNA isolated from human Pulmonary artery (PASMC) and Aortic (AoSMC) smooth muscle cells were used. R899X+/- BMPR2 transgenic mice fed western diet for six weeks were given daily injections of IL-1ß prior to assessment for PAH and tissue collection. Results: PASMC have reduced inflammatory activation in response to IL-1ß compared with AoSMCs, however PASMC with reduced BMPR2 demonstrated an exaggerated response. Mice treated with IL-1ß had higher white blood cell counts, and significantly raised serum protein levels of IL-6 and OPG plasma levels recapitulating in vitro data. Phenotypically, IL-1ß treated mice demonstrated increased pulmonary vascular remodelling. Conclusions: IL-1ß induces an exaggerated pulmonary artery specific transcriptomic inflammatory response when BMPR2 signalling is reduced

Manual / Issue 6 / Assemblage

Manual, a journal about art and its making. Assemblage. The sixth issue. An assemblage is both an act and a result-the work of gathering and conjoining as well as the state of having been gathered and conjoined. This issue of Manual pieces together works made out of practical necessity and others that marry dazzling embellishments for optimal effect, examining how history (or one version of it) was (and is) pastiched from disparate sources, how fashionable textile samples were collected, and more (always more). An assembly of assemblages, an assortment of intended and unintended interrelationships, Manual issue six is the sum of its parts and the parts themselves, a dynamic gathering of artists and authors, objects and interpretations, mash-ups and remixes, lemons and lightbulbs, vibrantly inter-animating each other. Softcover, 68 pages. Published 2016 by the RISD Museum. Manual 6 (Assemblage) contributors include Eric Anderson, Taylor Elyse Anderson, Bob Dilworth, Christina Hemauer, Roman Keller, Mariani Lefas-Tetenes, Simone Leigh, Leora Maltz-Leca, Ingrid A. Neuman, Tara Nummedal, Todd Oldham, and Britany Salsbury.https://digitalcommons.risd.edu/risdmuseum_journals/1032/thumbnail.jp

Interaction of a supersonic, radiatively cooled plasma jet with an ambient medium

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