Which interval is most crucial to presentation and survival in gastroesophageal cancer: a systematic review

Aim: The aim of this study was to identify the most crucial interval to encourage earlier diagnosis in with gastroesophageal cancer and to identify potential factors effecting this interval. Background: Gastroesophageal malignancy is the eighth most commonly presenting cancer with one of the worst survival rates. Identifying the most crucial period for intervention to inform earlier diagnosis is an important step towards improving survival. Design: Mixed methods literature review. Data Sources: CINAHL, MEDLINE and Academic search primer online databases were searched using keywords and inclusion/exclusion criteria. Empirical evidence published between 2000–2016 with a focus on gastroesophageal cancer presentation and survival was reviewed to inform this study. Review methods: Twelve studies were extracted for further review. Selected studies were appraised and presented through Olensen's “delay interval” framework to inform the most crucial interval to survival in gastroesophageal cancer. Results: The findings identify the patient interval as the most critical period for encouraging earlier presentation and reducing advanced stage presentation in gastroesophageal cancer. The article also highlighted some methodological limitations to cancer research, such as a lack of consensus in definitions which prevent statistical meta-analysis of cancer data, survivor bias in gastroesophageal cancer studies and a significant lack of qualitative evidence to reveal patient experience in presenting with this cancer. Conclusion: Further research into the patient interval is required to elicit information on how and why patients present with their cancer symptoms

Somatostatin interneurons recruit pre- and postsynaptic GABAB receptors in the adult mouse dentate gyrus

The integration of spatial information in the mammalian dentate gyrus (DG) is critical to navigation. Indeed, DG granule cells (DGCs) rely upon finely balanced inhibitory neurotransmission in order to respond appropriately to specific spatial inputs. This inhibition arises from a heterogeneous population of local GABAergic interneurons (INs) that activate both fast, ionotropic GABAA receptors (GABAAR) and slow, metabotropic GABAB receptors (GABABR), respectively. GABABRs in turn inhibit pre- and postsynaptic neuronal compartments via temporally long-lasting G-protein-dependent mechanisms. The relative contribution of each IN subtype to network level GABABR signal setting remains unknown. However, within the DG, the somatostatin (SSt) expressing IN subtype is considered crucial in coordinating appropriate feedback inhibition on to DGCs. Therefore, we virally delivered channelrhodopsin 2 to the DG in order to obtain control of this specific SSt IN subpopulation in male and female adult mice. Using a combination of optogenetic activation and pharmacology, we show that SSt INs strongly recruit postsynaptic GABABRs to drive greater inhibition in DGCs than GABAARs at physiological membrane potentials. Furthermore, we show that in the adult mouse DG, postsynaptic GABABR signaling is predominantly regulated by neuronal GABA uptake and less so by astrocytic mechanisms. Finally, we confirm that activation of SSt INs can also recruit presynaptic GABABRs, as has been shown in neocortical circuits. Together, these data reveal that GABABR signaling allows SSt INs to control DG activity and may constitute a key mechanism for gating spatial information flow within hippocampal circuits

On the Indeterministic Nature of Star Formation on the Cloud Scale

Molecular clouds are turbulent structures whose star formation efficiency (SFE) is strongly affected by internal stellar feedback processes. In this paper we determine how sensitive the SFE of molecular clouds is to randomised inputs in the star formation feedback loop, and to what extent relationships between emergent cloud properties and the SFE can be recovered. We introduce the yule suite of 26 radiative magnetohydrodynamic (RMHD) simulations of a 10,000 solar mass cloud similar to those in the solar neighbourhood. We use the same initial global properties in every simulation but vary the initial mass function (IMF) sampling and initial cloud velocity structure. The final SFE lies between 6 and 23 percent when either of these parameters are changed. We use Bayesian mixed-effects models to uncover trends in the SFE. The number of photons emitted early in the cluster's life and the length of the cloud provide are the strongest predictors of the SFE. The HII regions evolve following an analytic model of expansion into a roughly isothermal density field. The more efficient feedback is at evaporating the cloud, the less the star cluster is dispersed. We argue that this is because if the gas is evaporated slowly, the stars are dragged outwards towards surviving gas clumps due to the gravitational attraction between the stars and gas. While star formation and feedback efficiencies are dependent on nonlinear processes, statistical models describing cloud-scale processes can be constructed.Comment: 24 pages, 16 figures, 6 tables. Accepted to MNRAS, version updated with published titl

Gastroesophageal cancer patients need earlier palliative intervention - Using data to inform appropriate care

PurposeTo evaluate demographics of survival in patients with gastroesophageal cancer so that it informs nursing practice.MethodData on 2215 patients diagnosed with gastroesophageal cancer who presented to a specialist referral centre between the years 2000 and 2011 were extracted from a Public Health repository. Survival time was calculated and analysed against clinical and lifestyle factors to reveal whether they had an impact on survival outcomes.ResultsOver 60% of patients had died within the first year, 39% of these died within the first 6 months. Survival outcomes reduce with advancing age, and in those patients who present as ‘emergency’ cases. One quarter of patients were seen by a GP, but were not referred urgently through the two week wait system, to specialist care.Thus, gastroesophageal cancer patients need specific and appropriate treatment options, including earlier referrals to palliative care provision. There is also a need for cancer specific education and information at community and clinical levels.ConclusionsThe globally applied one and five-year statistics applied to cancer survival studies do not adequately capture rates of early demise with gastroesophageal cancer. This study presents a novel approach to statistical analysis, based on patient derived data. It identifies factors linked to earlier deaths. However, rather than a focus on early presentation and diagnosis (which are essential) - it also reveals a significant need to consider early referrals for palliative care and nursing interventions to alleviate pain and suffering in patients with poor prognosis

Web-Based Instruction & Online Delivery Of Classes: Where Are We Now?

The literature on Web-based instruction (WBI) is reviewed, focusing initially on the terminology, history, and commentary (pro and con) related to the topic. The advantages and disadvantages associated with WBI are then discussed and an overview of the empirical work on WBI, paying particular attention to studies on student satisfaction and learning outcomes, is provided

The Interaction of Goal Orientation and Stage of Change on Exercise Behavior in College Students

The purpose of this study was to develop and examine the reliability and validity of the Perceptions of Success Questionnaire for Exercise (POSQ-E), and to link goal orientations to self-reported physical activity patterns and perceptions. The final sample consisted of 569 recreation center participants who utilized the facility 3.77 days a week (SD = 1.94) and were active for an average of 70.18 minutes (SD = 33.3) per session. Sixty-three percent of respondents (n = 358) self-reported meeting adult guidelines for regular exercise (150 minutes per week). Using a single-item ladder, participants were assigned across the five stages of exercise readiness respectively: precontemplation (6.8%); contemplation (4.9%); preparation (26.2%); action (23.8%); and maintenance (38.3%). Task scores were shown to increase across the stages of change while ego scores decreased slightly. An extreme median split of the goal orientation scores yielded a sub-sample of 235 participants with 76 (32.3%) in the high task/high ego, 49 (20.9%) in the high task/low ego, 47 (20%) in the high ego/low task, and 63 (26.8%) in the low ego/low task group. The POSQ-E was shown to have good internal reliability, factor validity and convergent validity. Convergent validity linking the transtheoretical model and self-reported physical activity behavior with goal orientation theory may provide a new direction for applied research in exercise behavior

Agricultural Best Management Practices and Treatment Wetlands in the Gabilan Watershed: Project Asessment and Evaluation Plan

Several local groups have come together for this project to addresses water quality concerns in the Gabilan Watershed – also known as the Reclamation Ditch Watershed (Fig. 1.1). These are Moss Landing Marine Laboratories (MLML), the Resource Conservation District of Monterey County (RCDMC), Central Coast Watershed Studies (CCoWS), Return of the Natives (RON), Community Alliance with Family Farmers (CAFF), and Coastal Conservation and Research (CC&R). The primary goal is to reduce non-point source pollution – particularly suspended sediment, nutrients, and pesticides – and thereby improve near-shore coastal waters of Moss Landing Harbor and the Monterey Bay. (Document contains 33 pages

Exploring Randomly Wired Neural Networks for Climate Model Emulation

Exploring the climate impacts of various anthropogenic emissions scenarios is key to making informed decisions for climate change mitigation and adaptation. State-of-the-art Earth system models can provide detailed insight into these impacts, but have a large associated computational cost on a per-scenario basis. This large computational burden has driven recent interest in developing cheap machine learning models for the task of climate model emulation. In this manuscript, we explore the efficacy of randomly wired neural networks for this task. We describe how they can be constructed and compare them to their standard feedforward counterparts using the ClimateBench dataset. Specifically, we replace the serially connected dense layers in multilayer perceptrons, convolutional neural networks, and convolutional long short-term memory networks with randomly wired dense layers and assess the impact on model performance for models with 1 million and 10 million parameters. We find average performance improvements of 4.2% across model complexities and prediction tasks, with substantial performance improvements of up to 16.4% in some cases. Furthermore, we find no significant difference in prediction speed between networks with standard feedforward dense layers and those with randomly wired layers. These findings indicate that randomly wired neural networks may be suitable direct replacements for traditional dense layers in many standard models

A Partnership Approach to Higher Educational Accreditation of the UK’s National Direct Entry Superintendents Programme

The evolution of the UK’s high profile and first ever Direct-Entry (DE) Superintendents programme followed the recommendations for policing identified by Winsor (2012) and the UK Government’s vision of enabling “fresh thinking and fresh blood [to be] brought in from outside the profession” (Green, 2013). The eighteen�month DE programme aims to attract highly talented and proven leaders from alternative sectors directly into executive policing roles. The College of Policing’s (2015) own review identifies the importance for executive leaders to demonstrate on-going personal development. As a result a joint College of Policing and Teesside University team worked together to develop the Post Graduate Certificate in Strategic Police Leadership which was mapped onto the new DE education and training programme, resulting in the provision of an educational award which meets the needs of the contemporary police service. The programme has been designed primarily to be both academically and vocationally challenging, recognising the education and training previously completed by direct entry superintendents, who may not have any previous policing experience, who are joining the police service in senior executive roles. The aim being that on successful completion of the eighteen-month mandatory higher educational programme, learners will be able to operate independently across a wide range of strategic leadership deployments as competent uniformed superintendents, bringing with them a range of new skills and ideas to the service