Over-reassurance and undersupport after a 'false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking

This literature review examined research into the impact of a previous 'all-clear' or non-cancer diagnosis following symptomatic presentation ('false alarm') on symptom attribution and delays in help seeking for subsequent possible cancer symptoms

An Assessment of Modern Methods for Rotor Track and Balance

One routine maintenance item facing the helicopter industry today is the issue of rotor track and balance (RT&B). While the task of reducing vibrations is often overlooked as simply an unimportant maintenance concern, what should not be overlooked is the extensive amount of time and money committed by maintenance to smoothing an aircraft. If there were a way to make the process of rotor track and balance more efficient it would be a huge boost to the helicopter industry in both time and money. The first steps towards research into new and improved methods is to evaluate what is currently used in the field, determine if there is room for improvement and if so what can be improved. While each company may use a slightly different approach to correct the problem, each method has essentially the same objective--to reduce vibrations in the helicopter structure due to main and tail rotor rotation. This document reflects the findings of a study done to gather information and evaluate the different RT&B methods that currently exist, pinpointing the existing weaknesses in the process. In most all cases, a qualitative approach was used in determining problems and comparing current systems as the actual proprietary algorithms used by RT&B companies were unavailable

New approaches to probing Minkowski functionals

We generalize the concept of the ordinary skew-spectrum to probe the effect of non-Gaussianity on the morphology of cosmic microwave background (CMB) maps in several domains: in real space (where they are commonly known as cumulant-correlators), and in harmonic and needlet bases. The essential aim is to retain more information than normally contained in these statistics, in order to assist in determining the source of any measured non-Gaussianity, in the same spirit as Munshi & Heavens skew-spectra were used to identify foreground contaminants to the CMB bispectrum in Planck data. Using a perturbative series to construct the Minkowski functionals (MFs), we provide a pseudo-C based approach in both harmonic and needlet representations to estimate these spectra in the presence of a mask and inhomogeneous noise. Assuming homogeneous noise, we present approximate expressions for error covariance for the purpose of joint estimation of these spectra. We present specific results for four different models of primordial non-Gaussianity local, equilateral, orthogonal and enfolded models, as well as non-Gaussianity caused by unsubtracted point sources. Closed form results of nextorder corrections to MFs too are obtained in terms of a quadruplet of kurt-spectra. We also use the method of modal decomposition of the bispectrum and trispectrum to reconstruct the MFs as an alternative method of reconstruction of morphological properties of CMB maps. Finally, we introduce the odd-parity skew-spectra to probe the odd-parity bispectrum and its impact on the morphology of the CMB sky. Although developed for the CMB, the generic results obtained here can be useful in other areas of cosmology

Survey of public definitions of the term 'overdiagnosis' in the UK

Objectives: To determine how ‘overdiagnosis’ is currently conceptualised among adults in the United Kingdom (UK) in light of previous research, which has found that the term is difficult for the public to understand and awareness is low. This study aims to add to current debates on healthcare in which overdiagnosis is a prominent issue. Design: An observational, web-based survey was administered by a survey company. Setting: Participants completed the survey at a time and location of their choosing. Participants: 390 consenting UK adults aged 50-70 years. Quota sampling was used to achieve approximately equal numbers in three categories of education. Primary outcome measures: Participants were asked whether they had seen or heard the term ‘overdiagnosis’. If they had, they were then invited to explain in a free text field what they understood it to mean. If they had not previously encountered it, they were invited to say what they thought it meant. Responses were coded and interpreted using content analysis and descriptive statistics. Results: Data from 390 participants were analysed. Almost a third (30.0%) of participants reported having previously encountered the term. However, their responses often indicated that they had no knowledge of its meaning. The most prevalent theme consisted of responses related to the diagnosis itself. Subthemes indicated common misconceptions, including an ‘overly negative or complicated diagnosis’, ‘false positive diagnosis’ or ‘misdiagnosis’. Other recurring themes consisted of responses related to testing (i.e. ‘too many tests’), treatment (e.g. ‘overtreatment’), and patient psychology (e.g. ’overthinking’). Responses categorised as consistent with ‘overdiagnosis’ (defined as detection of a disease that would not cause symptoms or death) were notably rare (n=10; 2.6%). Conclusions: Consistent with previous research, public awareness of ‘overdiagnosis’ in the UK is low and its meaning is often misunderstood or misinterpreted

Information on 'overdiagnosis' in breast cancer screening on prominent United Kingdom- and Australia-oriented health websites

Objectives: Health-related websites are an important source of information for the public. Increasing public awareness of overdiagnosis and ductal carcinoma in situ (DCIS) in breast cancer screening may facilitate more informed decision-making. This study assessed the extent to which such information was included on prominent health websites oriented towards the general public, and evaluated how it was explained. Design: Cross-sectional study. Setting: Websites identified through Google searches in England (United Kingdom) and New South Wales (Australia) for “breast cancer screening” and further websites included based on our prior knowledge of relevant organisations. Main outcomes: Content analysis was used to determine whether information on overdiagnosis or DCIS existed on each site, how the concepts were described, and what statistics were used to quantify overdiagnosis. Results: After exclusions, ten UK websites and eight Australian websites were considered relevant and evaluated. They originated from charities, health service providers, government agencies, and an independent health organisation. Most contained some information on overdiagnosis (and/or DCIS). Descriptive information was similar across websites. In the UK sample, statistical information was often based on estimates from the Independent UK Panel on Breast Cancer Screening; the most commonly provided statistic was the ratio of breast cancer deaths prevented to overdiagnosed cases (1:3). A range of other statistics was included, such as the yearly number of overdiagnosed cases and the proportion of women screened who would be overdiagnosed. Information on DCIS and statistical information were found less commonly on the Australian websites. Conclusions: Online information about overdiagnosis has become more widely available in 2015-16 compared with the limited accessibility indicated by older research. However, there may be scope to offer more information on DCIS and overdiagnosis statistics on Australian websites. Moreover, the variability in how estimates are presented across UK websites may be confusing for the general public

Comparing perceived clarity of information on overdiagnosis used for breast and prostate cancer screening in England: an experimental survey.

OBJECTIVES: 'Overdiagnosis', detection of disease that would never have caused symptoms or death, is a public health concern due to possible psychological and physical harm but little is known about how best to explain it. This study evaluated public perceptions of widely used information on the concept to identify scope for improving communication methods. DESIGN: Experimental survey carried out by a market research company via face-to-face computer-assisted interviews. SETTING: Interviews took place in participants' homes. PARTICIPANTS: 2111 members of the general public in England aged 18-70 years began the survey; 1616 were eligible for analysis. National representativeness was sought via demographic quota sampling. INTERVENTIONS: Participants were allocated at random to receive a brief description of overdiagnosis derived from written information used by either the NHS Breast Screening Programme or the prostate cancer screening equivalent. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was how clear the information was perceived to be (extremely/very clear vs less clear). Other measures included previous exposure to screening information, decision-making styles and demographic characteristics (eg, education). Binary logistic regression was used to assess predictors of perceived clarity. RESULTS: Overdiagnosis information from the BSP was more likely to be rated as more clear compared with the prostate screening equivalent (adjusted OR: 1.43, 95% CI 1.17 to 1.75; p=0.001). Participants were more likely to perceive the information as more clear if they had previously encountered similar information (OR: 1.77, 1.40 to 2.23; p<0.0005) or a screening leaflet (OR: 1.35, 1.04 to 1.74; p=0.024) or had a more 'rational' decision-making style (OR: 1.06, 1.02 to 1.11; p=0.009). CONCLUSIONS: Overdiagnosis information from breast screening may be a useful template for communicating the concept more generally (eg, via organised campaigns). However, this information may be less well-suited to individuals who are less inclined to consider risks and benefits during decision-making

Olfactory Sensory Axons Expressing a Dominant–Negative Semaphorin Receptor Enter the CNS Early and Overshoot Their Target

AbstractSensory axons extend from the chick olfactory epithelium to the telencephalon well before the maturation of their target, the olfactory bulb. During a waiting period of several days, olfactory axons arrive and accumulate outside the CNS while the bulb differentiates beneath them. Semephorin-3A is expressed in the telencephalon during this period and has been proposed to prevent their entry into the CNS. We show that the misexpression of a dominant–negative neuropilin-1 that blocks SEMA-3A-mediated signaling in olfactory sensory axons induces many of them to enter the telencephalon prematurely and to overshoot the olfac tory bulb. These results suggest that chemorepellents can prevent the premature innervation of immature targets

Olfactory Sensory Axons Expressing a Dominant–Negative Semaphorin Receptor Enter the CNS Early and Overshoot Their Target

AbstractSensory axons extend from the chick olfactory epithelium to the telencephalon well before the maturation of their target, the olfactory bulb. During a waiting period of several days, olfactory axons arrive and accumulate outside the CNS while the bulb differentiates beneath them. Semephorin-3A is expressed in the telencephalon during this period and has been proposed to prevent their entry into the CNS. We show that the misexpression of a dominant–negative neuropilin-1 that blocks SEMA-3A-mediated signaling in olfactory sensory axons induces many of them to enter the telencephalon prematurely and to overshoot the olfac tory bulb. These results suggest that chemorepellents can prevent the premature innervation of immature targets

The impact of body vigilance on help-seeking for cancer 'alarm' symptoms: a community-based survey.

BACKGROUND: The act of detecting bodily changes is a pre-requisite for subsequent responses to symptoms, such as seeking medical help. This is the first study to explore associations between self-reported body vigilance and help-seeking in a community sample currently experiencing cancer 'alarm' symptoms. METHODS: Using a cross-sectional study design, a 'health survey' was mailed through primary care practices to 4913 UK adults (age ≥50 years, no cancer diagnosis), asking about symptom experiences and medical help-seeking over the previous three months. Body vigilance, cancer worry and current illness were assessed with a small number of self-report items derived from existing measures. RESULTS: The response rate was 42% (N = 2042). Almost half the respondents (936/2042; 46%) experienced at least one cancer alarm symptom. Results from logistic regression analysis revealed that paying more attention to bodily changes was significantly associated with help-seeking for cancer symptoms (OR = 1.44; 1.06-1.97), after controlling for socio-demographics, current illness and cancer worry. Being more sensitive to bodily changes was not significantly associated with help-seeking. CONCLUSIONS: Respondents who paid attention to their bodily changes were more likely to seek help for their symptoms. Although the use of a cross-sectional study design and the limited assessment of key variables preclude any firm conclusions, encouraging people to be body vigilant may contribute towards earlier cancer diagnosis. More needs to be understood about the impact this might have on cancer-related anxiety

Do comorbidities influence help-seeking for cancer alarm symptoms? A population-based survey in England

Background: We examined associations between different chronic morbidities and help-seeking for possible cancer symptoms. / Methods: Postal survey of individuals aged>50 years in England. Participants could report prior morbidities in respect of 12 pre-defined conditions. Among patients experiencing possible cancer symptoms we examined associations between specific morbidities and self-reported help-seeking (i.e. contacted versus not contacted a GP) for each alarm symptom using regression analyses. / Results: Among 2042 respondents (42% response rate), 936 (46%) recently experienced one of 14 possible cancer symptoms considered in our analysis. Of them, 80% reported one or more morbidities, most frequently hypertension/hypercholesterolemia (40%), osteomuscular (36%) and heart diseases (21%). After adjustment for socio-demographic characteristics, patients with hypertension/hypercholesterolemia were more likely to report help-seeking for possible cancer symptoms, such as unexplained cough (OR=2.0; 95%CI 1.1-3.5), pain (OR=2.2; 95%CI 1.0-4.5) and abdominal bloating (OR=2.3; 95%CI 1.1-4.8). Urinary morbidity was associated with increased help-seeking for abdominal bloating (OR=5.4; 95%CI 1.2-23.7) or rectal bleeding (OR=5.8; 95%CI 1.4-23.8). In contrast, heart problems reduced help-seeking for change in bowel habits (OR=0.4; 95%CI 0.2-1.0). / Conclusions: Comorbidities are common and may facilitate help-seeking for possible cancer symptoms, but associations vary for specific symptom-comorbidity pairs. The findings can contribute to the design of future cancer symptom awareness campaigns