Are 90% of deaths from cancer caused by metastases?

Numerous publications have stated that metastases are responsible for 90% of cancer deaths, but data underlying this assertion has been lacking. Our objective was to determine what proportions of cancer deaths are caused by metastases. Population‐based data from the Cancer Registry of Norway for the years 2005‐2015 was analyzed. We compared all deaths in the Norwegian population where a cancer diagnosis was registered as cause of death. Deaths caused by cancer, with and without metastases, were analyzed, by sex and tumor group. For solid tumors, 66.7% of cancer deaths were registered with metastases as a contributing cause. Proportions varied substantially between tumor groups. Our data support the idea that the majority of deaths from solid tumors are caused by metastases. Thus, a better understanding of the biology of metastases and identification of druggable targets involved in growth at the metastatic site is a promising strategy to reduce cancer mortality.publishedVersio

Politikken og det imaginære : Cornelius Castoriadis' bidrag til et politisk danningsbegrep

Spørsmålet om borgernes danning i et demokrati er et klassisk tema i den pedagogiske filosofien. Demokratiet kan ses som en styreform for reflektert, kollektiv selvbinding, der borgernes danning legitimerer det klassiske prinsipp om at enhver stemme teller likt. Disse ideene er gitt en spesiell form av den gresk-franske filosofen og psykoanalytikeren Cornelius Castoriadis. Til forskjell fra de mer tradisjonelle (liberale) teoriene om utdanning i et demokrati er Castoriadis’ tenkning orientert mot politisering, sosial nyskaping og forandring. Avhandlingen tar spesielt for seg begrepene om "det imaginære", "individuell og kollektiv autonomi" og vilkår for politisk aktørskap. Gjennom belysning og videreutvikling av Castoriadis' tenkning, reformuleres pedagogikkens klassiske paradoks – hvordan fremme autonomi? – til å gjelde både på subjekts- og samfunnsnivå. Dette "dobbelte pedagogiske paradoks" representerer dermed både en radikalisering og en utvidelse av pedagogikkens gjenstandsområde

The impact of SCIAMACHY near-infrared instrument calibration on CH4 and CO total columns

The near-infrared spectra measured with the SCIAMACHY instrument on board the ENVISAT satellite suffer from several instrument calibration problems. The effects of three important instrument calibration issues on the retrieved methane (CH4) and carbon monoxide (CO) total columns have been investigated: the effects of the growing ice layer on the near-infrared detectors, the effects of the orbital variation of the instrument dark signal, and the effects of the dead/bad detector pixels. Corrections for each of these instrument calibration issues have been defined. The retrieved CH4 and CO total columns including these corrections show good agreement with CO measurements from the MOPITT satellite instrument and with CH4 model calculations by the chemistry transport model TM3. Using a systematic approach, it is shown that all three instrument calibration issues have a significant effect on the retrieved CH4 and CO total columns. However, the impact on the CH4 total columns is more pronounced than for CO, because of its smaller variability. Results for three different wavelength ranges are compared and show good agreement. The growing ice layer and the orbital variation of the dark signal show a systematic, but time-dependent effect on the retrieved CH4 and CO total columns, whereas the effect of the dead/bad pixels is rather unpredictable: some dead pixels show a random effect, some more systematic, and others no effect at all. The importance of accurate corrections for each of these instrument calibration issues is illustrated using examples where inaccurate corrections lead to a wrong interpretation of the results

Ki-67 expression is superior to mitotic count and novel proliferation markers PHH3, MCM4 and mitosin as a prognostic factor in thick cutaneous melanoma

<p>Abstract</p> <p>Background</p> <p>Tumor cell proliferation is a predictor of survival in cutaneous melanoma. The aim of the present study was to evaluate the prognostic impact of mitotic count, Ki-67 expression and novel proliferation markers phosphohistone H3 (PHH3), minichromosome maintenance protein 4 (MCM4) and mitosin, and to compare the results with histopathological variables.</p> <p>Methods</p> <p>202 consecutive cases of nodular cutaneous melanoma were initially included. Mitotic count (mitosis per mm²) was assessed on H&E sections, and Ki-67 expression was estimated by immunohistochemistry on standard sections. PHH3, MCM4 and mitosin were examined by staining of tissue microarrays (TMA) sections.</p> <p>Results</p> <p>Increased mitotic count and elevated Ki-67 expression were strongly associated with increased tumor thickness, presence of ulceration and tumor necrosis. Furthermore, high mitotic count and elevated Ki-67 expression were also associated with Clark's level of invasion and presence of vascular invasion. High expression of PHH3 and MCM4 was correlated with high mitotic count, elevated Ki-67 expression and tumor ulceration, and increased PHH3 frequencies were associated with tumor thickness and presence of tumor necrosis. Univariate analyses showed a worse outcome in cases with elevated Ki-67 expression and high mitotic count, whereas PHH3, MCM4 and mitosin were not significant. Tumor cell proliferation by Ki-67 had significant prognostic impact by multivariate analysis.</p> <p>Conclusions</p> <p>Ki-67 was a stronger and more robust prognostic indicator than mitotic count in this series of nodular melanoma. PHH3, MCM4 and mitosin did not predict patient survival.</p

A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established