Overdiagnosis and overtreatment of breast cancer: Overdiagnosis in randomised controlled trials of breast cancer screening

Data from randomised controlled trials of mammographic screening can be used to determine the extent of any overdiagnosis, as soon as either a time equivalent to the lead-time has elapsed after the final screen, or the control arm has been offered screening. This paper reviews those randomised trials for which breast cancer incidence data are available. In recent trials in which the control group has not been offered screening, an excess incidence of breast cancer remains after many years of follow-up. In those trials in which the control arm has been offered screening, although there is a possible shift from invasive to in situ disease, there is no evidence of overdiagnosis as a result of incident screens

A women’s worker in court: A more appropriate service for women defendants with mental health issues?

Aims Court liaison services aim to reduce mental illness in prison through early treatment and/or diversion into care of defendants negotiating their court proceedings. However, liaison services may inadvertently contribute to gender inequalities in mental health in the prison system. This is because women often do not access liaison services. This is attributed to services failing to recognise that women have different needs from men. To address this, it is essential that the needs of women in contact with the criminal justice system (CJS) are clearly articulated. However, there is a dearth of research that considers women’s needs at this stage of their journey through the CJS. This paper aims to identify these needs before women enter prison. It does so through an analysis of a pilot Women’s Support Service based at a Magistrates’ Court, a response to concerns that women were not accessing the local liaison service. Characteristics of women defendants attending the service are described, specifically their home environments, general and mental health needs. Their support needs when in contact with the CJS and the links the service must forge with local community organisations to provide this, are also presented. This knowledge will develop/ tailor existing services available to women defendants to improve their access to these and optimise the benefits they can derive from them. Methods Proformas were completed by a women specialist worker for 86 women defendants assessed in 4 months. Information was collected on characteristics including education, domestic violence, accommodation, physical and mental health.. This specialist worker recorded the range of needs identified by defendants at assessment and the services to which women were referred. Results Access to the Women’s Support Service is high, with only 11.3% of women refusing to use the service. Women attending have high levels of physical and mental health issues. Their mental health issues have not being addressed prior to accessing the service. Women often come from single households and environments high in domestic abuse. Women have multiple needs related to benefits, finance, housing, domestic abuse, education and career guidance. These are more frequent than those that explicitly link to mental health. The women’s worker providing the service referred women to 68 services from a wide variety of statutory and voluntary organisations. Conclusions The Women’s Support Service is accessed by a higher number of women, many more than access the local liaison service. It is suggested that this is due to their multiple and gender specific needs being adequately addressed by the former service and the organisations to whom they are referred. Mental health needs may also be secondary to other more basic needs, that makes the generic service provided but the Women’s support Service more appropriate than a liaison service that deals with mental health support alone

Course-based Science Research Promotes Learning in Diverse Students at Diverse Institutions

Course-based research experiences (CREs) are powerful strategies for spreading learning and improving persistence for all students, both science majors and nonscience majors. Here we address the crucial components of CREs (context, discovery, ownership, iteration, communication, presentation) found across a broad range of such courses at a variety of academic institutions. We also address how the design of a CRE should vary according to the background of student participants; no single CRE format is perfect. We provide a framework for implementing CREs across multiple institutional types and several disciplines throughout the typical four years of undergraduate work, designed to a variety of student backgrounds. Our experiences implementing CREs also provide guidance on overcoming barriers to their implementation

Patterns of Complex Comorbidity in Older Patients with Heart Failure

Background Heart failure (HF) carries a high burden of comorbidity with approximately one half of patients with HF having at least one additional comorbid condition present. Rates of comorbidity in patients with HF have steadily increased over the past 2 decades. Objective To examine patterns of comorbidity among older patients with HF in the Cardiovascular Research Network PRESERVE cohort. Methods PRESERVE Cohort Data are from the CVRN PRESERVE cohort which is a multicenter cohort of 37,054 patients [mean age = 74 years (SD = 12.4 yrs); 46% female] with HF diagnosed between 2005 and 2008 currently being conducted at 4 CVRN sites: KPNC, KPCO, KPNW, and FCHP. The primary data source for the PRESERVE cohort was the HMO Research Network Virtual Data Warehouse. Identification of Coexisting Diseases Coexisiting illnesses at the time of HF diagnosis were based on diagnoses and procedures mapped to relevant International Classification of Diseases, Ninth Edition (ICD-9) codes. For the purposes of characterizing clusters of comorbidities, we focused on coexisting conditions with a prevalence rate of ≥3%. Statistical Analysis We used the Agglomerative Clustering technique to characterize patterns of comorbidity. Over multiple iterations, each condition is clustered with the condition with which it has the highest squared correlation. This process is repeated to determine whether assigning a condition to a different cluster increases the amount of explained variance [ranging from 1.0 (all variance explained) to 0.0 (no variance explained)]. The conditions in each cluster are as correlated as possible among themselves and as uncorrelated as possible with conditions in other clusters. Results Burden of Comorbidity There was a high degree of comorbidity and multi-morbidity among patients with HF. (Table 1) Hypertension and arrhythmias were the comorbidities of HF that occurred most often in the absence of other chronic conditions (4.8% and 4.7%, respectively). The average number of comorbid conditions varied from 3.5 to 5.2. Patients with HF and unstable angina or other thromboembolic disorders had the highest multi-morbidity (mean = 5.2 conditions), whereas those with HF and hypertension had the lowest (mean = 3.5). Clustering of Comorbiditites A five-cluster structure was derived. Cluster 1: Dyslipidemia, Hypertension, Diabetes Mellitus, Visual Impairment Cluster 2: Acute Myocardial Infarction, Unstable Angina, Thromboembolic Disorder, Dementia Cluster 3: Aortic Valvular Disease, Cancer, Hearing Impairment, Arrthythmia Cluster 4: Peripheral Arterial Disease, Stroke Cluster 5: Lung Disease, Liver Disease, Depression Discussion and Conclusions Cluster analysis is an innovative approach to examining the co-occurrence of diseases and allows for identification of broad patterns of multi-morbidity beyond the pairings of diseases or disease counts. Patients with HF have a high rate of multi-morbidity, with an average of 4 co-occurring conditions. Intuitive and unintuitive patterns of clustering were identified. Randomized clinical trials in HF will need to include more diverse patient populations in order to adapt to the increasingly complex patient population. A cluster analysis approach to characterizing patterns of comorbidity may help indentify important patient subgroups

Cultural basis of social ‘deficits’ in autism spectrum disorders

There is very little research that specifically looks at how autism spectrum disorders are perceived in various communities. This qualitative research was conducted with parents who had children on the autistic spectrum belonging to four different ethnic communities (White British, Somali, West African and South Asian- 63 in total) and living in the UK. The study found that the importance that the parents give to various social skills varied on the basis of their cultural background and the gender of the parent. This is an important aspect to consider while providing support and services to individuals on the autism spectrum and their family members if the services have to be appropriate for their needs. This consideration would also enable the individuals on the autism spectrum to develop appropriate social skills required within their cultural groups. This is a preliminary study and further research on the topic is required

Reliability and Validity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai Version

This study examines the Thai version of the Multidimensional Scale of Perceived Social Support (MSPSS) for its psychometric properties

On a class of invariant coframe operators with application to gravity

Let a differential 4D-manifold with a smooth coframe field be given. Consider the operators on it that are linear in the second order derivatives or quadratic in the first order derivatives of the coframe, both with coefficients that depend on the coframe variables. The paper exhibits the class of operators that are invariant under a general change of coordinates, and, also, invariant under the global SO(1,3)-transformation of the coframe. A general class of field equations is constructed. We display two subclasses in it. The subclass of field equations that are derivable from action principles by free variations and the subclass of field equations for which spherical-symmetric solutions, Minkowskian at infinity exist. Then, for the spherical-symmetric solutions, the resulting metric is computed. Invoking the Geodesic Postulate, we find all the equations that are experimentally (by the 3 classical tests) indistinguishable from Einstein field equations. This family includes, of course, also Einstein equations. Moreover, it is shown, explicitly, how to exhibit it. The basic tool employed in the paper is an invariant formulation reminiscent of Cartan's structural equations. The article sheds light on the possibilities and limitations of the coframe gravity. It may also serve as a general procedure to derive covariant field equations

Implementation of an ST-Segment Elevation Myocardial Infraction Bypass Protocol in the Northern United Arab Emirates

Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infraction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE). Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed. Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016-August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48-124), and 81% of patients had a D2B time \u3c90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation. Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of \u3c90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events

Why Are There So Few Female Leaders in Higher Education: A Case of Structure or Agency?

A significant gender imbalance remains at executive management level within higher education despite a number of initiatives to increase the number of women in the leadership pipeline and ensure they are better prepared for these roles. This article presents findings from a recent study on the appointment of deputy and pro vice chancellors in pre-1992 English universities that provide fresh insights into why this might be the case. These findings challenge the notion of women’s missing agency - characterised by a lack of confidence or ambition and a tendency to opt out of applying for the top jobs - as an explanation for their continued under-representation. Rather, they highlight the importance of three structural factors associated with the selection process: mobility and external career capital, conservatism, and homosociability. An approach of ‘fixing’ the women is therefore unlikely to be sufficient in redressing the current gender imbalance within university executive management teams