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

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

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

Providing Feedback Following Leadership Walkrounds is Associated with Better Patient Safety Culture, Higher Employee Engagement and Lower Burnout

Background There is a poorly understood relationship between Leadership WalkRounds (WR) and domains such as safety culture, employee engagement, burnout and work-life balance. Methods This cross-sectional survey study evaluated associations between receiving feedback about actions taken as a result of WR and healthcare worker assessments of patient safety culture, employee engagement, burnout and work-life balance, across 829 work settings. Results 16 797 of 23 853 administered surveys were returned (70.4%). 5497 (32.7% of total) reported that they had participated in WR, and 4074 (24.3%) reported that they participated in WR with feedback. Work settings reporting more WR with feedback had substantially higher safety culture domain scores (first vs fourth quartile Cohen’s d range: 0.34–0.84; % increase range: 15–27) and significantly higher engagement scores for four of its six domains (first vs fourth quartile Cohen’s d range: 0.02–0.76; % increase range: 0.48–0.70). Conclusion This WR study of patient safety and organisational outcomes tested relationships with a comprehensive set of safety culture and engagement metrics in the largest sample of hospitals and respondents to date. Beyond measuring simply whether WRs occur, we examine WR with feedback, as WR being done well. We suggest that when WRs are conducted, acted on, and the results are fed back to those involved, the work setting is a better place to deliver and receive care as assessed across a broad range of metrics, including teamwork, safety, leadership, growth opportunities, participation in decision-making and the emotional exhaustion component of burnout. Whether WR with feedback is a manifestation of better norms, or a cause of these norms, is unknown, but the link is demonstrably potent

Measuring geometric phases of scattering states in nanoscale electronic devices

We show how a new quantum property, a geometric phase, associated with scattering states can be exhibited in nanoscale electronic devices. We propose an experiment to use interference to directly measure the effect of the new geometric phase. The setup involves a double path interferometer, adapted from that used to measure the phase evolution of electrons as they traverse a quantum dot (QD). Gate voltages on the QD could be varied cyclically and adiabatically, in a manner similar to that used to observe quantum adiabatic charge pumping. The interference due to the geometric phase results in oscillations in the current collected in the drain when a small bias across the device is applied. We illustrate the effect with examples of geometric phases resulting from both Abelian and non-Abelian gauge potentials.Comment: Six pages two figure

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

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

Cisplatin-induced emesis: systematic review and meta-analysis of the ferret model and the effects of 5-HT3 receptor antagonists

PURPOSE: The ferret cisplatin emesis model has been used for ~30 years and enabled identification of clinically used anti-emetics. We provide an objective assessment of this model including efficacy of 5-HT(3) receptor antagonists to assess its translational validity. METHODS: A systematic review identified available evidence and was used to perform meta-analyses. RESULTS: Of 182 potentially relevant publications, 115 reported cisplatin-induced emesis in ferrets and 68 were included in the analysis. The majority (n = 53) used a 10 mg kg(−1) dose to induce acute emesis, which peaked after 2 h. More recent studies (n = 11) also used 5 mg kg(−1), which induced a biphasic response peaking at 12 h and 48 h. Overall, 5-HT(3) receptor antagonists reduced cisplatin (5 mg kg(−1)) emesis by 68% (45–91%) during the acute phase (day 1) and by 67% (48–86%) and 53% (38–68%, all P < 0.001), during the delayed phase (days 2, 3). In an analysis focused on the acute phase, the efficacy of ondansetron was dependent on the dosage and observation period but not on the dose of cisplatin. CONCLUSION: Our analysis enabled novel findings to be extracted from the literature including factors which may impact on the applicability of preclinical results to humans. It reveals that the efficacy of ondansetron is similar against low and high doses of cisplatin. Additionally, we showed that 5-HT(3) receptor antagonists have a similar efficacy during acute and delayed emesis, which provides a novel insight into the pharmacology of delayed emesis in the ferret