Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR)

Abstract: Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions

New Faces and New Masks of Today's Consumer

In 1995, we proposed that consumption and contemporary consumerism could not be studied or understood separately from the world of work and production. We proposed that contemporary consumerism was built on the back of what we referred to as `the Fordist Deal'. This deal, pioneered by Henry Ford for his employees, was the promise of ever increasing standards of living in exchange for a quiescent labour force accepting alienating work. Since that deal was struck, consumerism came to signify a general pre-occupation with consumption standards and choice as well as a willingness to read meanings in material commodities and to equate happiness and success with material possessions. In this sense, Ford may be seen as the father both of mass production and mass consumption. Since the Fordist high noon of consumerism in the West, mass consumption is widely seen as having fragmented into a proliferation of highly individualized niche products. For its part, a considerable part of mass production has migrated to countries with lower wages and looser environmental and social controls, fueling their own variants of consumerism. In this article, we examine the gradual erosion of the Fordist Deal in the light of developments in the last 10 years or so, seeking to assess the future of consumerism at a global level. We also seek to identify and discuss some emerging conceptualizations of the consumer, some of the new faces and masks assumed by the archetypal character of our types. We analyse some of the tensions and contradictions lurking behind these conceptualizations and try to envisage some of the real choices facing consumers today and some of the processes of social change that hinge on the outcomes of these choices. The article identifies a fundamental paradox between the ubiquity of the consumer in contemporary discourses and the virtual impossibility of generalizing about consumers. We suggest, then, that the consumer may be viewed as one of those `essentially contested concepts' proposed by Gallie that defy domestication. The consumer, we argue, is unmanageable, both as a concept, since no-one can pin it down to one specific conceptualization at the expense of all others, and as an entity, since attempts to control and manage the consumer lead to the consumer mutating from one impersonation to another. It is precisely this paradox that we seek to capture in our article's title. The article concludes with a consideration of three basic challenges that are liable to lead to fundamental reorientation of consumption and production, as well as of our conceptualizations and theorizing about them. These challenges are the outcomes of environmental, demographic and social factors that, we argue, make the current situation unsustainable and will bring about its dissolution

What Would a Society Look Like Where Children’s Life Chances Were Really Fair?

A critical analysis of the prominence and significance of the term 'fair life chances' in recent UK policy, focusing on problems of definition and measurement, and proposing a plural measure. The article highlights three policy areas an appropriate commitment to tackling which is necessary (though not sufficient) for the promotion genuinely fair life chances for children: poverty, childcare, and the configuration of opportunities. The overall argument of the article is that a commitment to making life chances fairer requires a considerably more substantial change of policy direction than the term’s recent handling in political discourse would imply

Meta-analysis of the relation between European and American smokeless tobacco and oral cancer

<p>Abstract</p> <p>Background</p> <p>Smokeless tobacco is often referred to as a major contributor to oral cancer. In some regions, especially Southeast Asia, the risk is difficult to quantify due to the variety of products, compositions (including non-tobacco ingredients) and usage practices involved. In Western populations, the evidence of an increased risk in smokeless tobacco users seems unclear, previous reviews having reached somewhat differing conclusions. We report a detailed quantitative review of the evidence in American and European smokeless tobacco users, and compare our findings with previous reviews and meta-analyses.</p> <p>Methods</p> <p>Following literature review a meta-analysis was conducted of 32 epidemiological studies published between 1920 and 2005 including tests for homogeneity and publication bias.</p> <p>Results</p> <p>Based on 38 heterogeneous study-specific estimates of the odds ratio or relative risk for smokeless tobacco use, the random-effects estimate was 1.87 (95% confidence interval 1.40–2.48). The increase was mainly evident in studies conducted before 1980. No increase was seen in studies in Scandinavia. Restricting attention to the seven estimates adjusted for smoking and alcohol eliminated both heterogeneity and excess risk (1.02; 0.82–1.28). Estimates also varied by sex (higher in females) and by study design (higher in case-control studies with hospital controls) but more clearly in studies where estimates were unadjusted, even for age. The pattern of estimates suggests some publication bias. Based on limited data specific to never smokers, the random-effects estimate was 1.94 (0.88–4.28), the eight individual estimates being heterogeneous and based on few exposed cases.</p> <p>Conclusion</p> <p>Smokeless tobacco, as used in America or Europe, carries at most a minor increased risk of oral cancer. However, elevated risks in specific populations or from specific products cannot definitely be excluded.</p