Risk prediction models for colorectal cancer in people with symptoms: a systematic review.

Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in Europe and the United States. Detecting the disease at an early stage improves outcomes. Risk prediction models which combine multiple risk factors and symptoms have the potential to improve timely diagnosis. The aim of this review is to systematically identify and compare the performance of models that predict the risk of primary CRC among symptomatic individuals. We searched Medline and EMBASE to identify primary research studies reporting, validating or assessing the impact of models. For inclusion, models needed to assess a combination of risk factors that included symptoms, present data on model performance, and be applicable to the general population. Screening of studies for inclusion and data extraction were completed independently by at least two researchers. Twelve thousand eight hundred eight papers were identified from the literature search and three through citation searching. 18 papers describing 15 risk models were included. Nine were developed in primary care populations and six in secondary care. Four had good discrimination (AUROC > 0.8) in external validation studies, and sensitivity and specificity ranged from 0.25 and 0.99 to 0.99 and 0.46 depending on the cut-off chosen. Models with good discrimination have been developed in both primary and secondary care populations. Most contain variables that are easily obtainable in a single consultation, but further research is needed to assess clinical utility before they are incorporated into practice.JUS is funded by a National Institute of Health Research (NIHR) Clinica

Risk prediction models for colorectal cancer in people with symptoms: a systematic review

Abstract Background Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in Europe and the United States. Detecting the disease at an early stage improves outcomes. Risk prediction models which combine multiple risk factors and symptoms have the potential to improve timely diagnosis. The aim of this review is to systematically identify and compare the performance of models that predict the risk of primary CRC among symptomatic individuals. Methods We searched Medline and EMBASE to identify primary research studies reporting, validating or assessing the impact of models. For inclusion, models needed to assess a combination of risk factors that included symptoms, present data on model performance, and be applicable to the general population. Screening of studies for inclusion and data extraction were completed independently by at least two researchers. Results Twelve thousand eight hundred eight papers were identified from the literature search and three through citation searching. 18 papers describing 15 risk models were included. Nine were developed in primary care populations and six in secondary care. Four had good discrimination (AUROC > 0.8) in external validation studies, and sensitivity and specificity ranged from 0.25 and 0.99 to 0.99 and 0.46 depending on the cut-off chosen. Conclusions Models with good discrimination have been developed in both primary and secondary care populations. Most contain variables that are easily obtainable in a single consultation, but further research is needed to assess clinical utility before they are incorporated into practice

Risk prediction models for colorectal cancer in people with symptoms: a systematic review

Abstract Background Colorectal cancer (CRC) is the fourth leading cause of cancer-related death in Europe and the United States. Detecting the disease at an early stage improves outcomes. Risk prediction models which combine multiple risk factors and symptoms have the potential to improve timely diagnosis. The aim of this review is to systematically identify and compare the performance of models that predict the risk of primary CRC among symptomatic individuals. Methods We searched Medline and EMBASE to identify primary research studies reporting, validating or assessing the impact of models. For inclusion, models needed to assess a combination of risk factors that included symptoms, present data on model performance, and be applicable to the general population. Screening of studies for inclusion and data extraction were completed independently by at least two researchers. Results Twelve thousand eight hundred eight papers were identified from the literature search and three through citation searching. 18 papers describing 15 risk models were included. Nine were developed in primary care populations and six in secondary care. Four had good discrimination (AUROC > 0.8) in external validation studies, and sensitivity and specificity ranged from 0.25 and 0.99 to 0.99 and 0.46 depending on the cut-off chosen. Conclusions Models with good discrimination have been developed in both primary and secondary care populations. Most contain variables that are easily obtainable in a single consultation, but further research is needed to assess clinical utility before they are incorporated into practice

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

BACKGROUND: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. METHODS AND FINDINGS: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n?=?863) at six, and 67% (n?=?810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. CONCLUSIONS: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions

On Renormalized Strong-Coupling Quenched QED in Four Dimensions

We study renormalized quenched strong-coupling QED in four dimensions in arbitrary covariant gauge. Above the critical coupling leading to dynamical chiral symmetry breaking, we show that there is no finite chiral limit. This behaviour is found to be independent of the detailed choice of photon-fermion proper vertex in the Dyson-Schwinger equation formalism, provided that the vertex is consistent with the Ward-Takahashi identity and multiplicative renormalizability. We show that the finite solutions previously reported lie in an unphysical regime of the theory with multiple solutions and ultraviolet oscillations in the mass functions. This study supports the assertion that in four dimensions strong coupling QED does not have a continuum limit in the conventional sense.Comment: REVTEX 3.0, 15 pages,including 4 eps files comprising 3 figures. Submitted to Phys. Rev.

Understanding heterogeneity in Genesis diamond-like carbon film using SIMS analysis of implants

An amorphous diamond-like carbon film deposited on silicon made at Sandia National Laboratory by pulsed laser deposition was one of several solar wind (SW) collectors used by the Genesis Mission (NASA Discovery Class Mission #5). The film was ~1 μm thick, amorphous, anhydrous, and had a high ratio of sp^3–sp^2 bonds (>50%). For 27 months of exposure to space at the first Lagrange point, the collectors were passively irradiated with SW (H fluence ~2 × 10^(16) ions cm^(−2); He fluence ~8 × 10^(14) ions cm^(−2)). The radiation damage caused by the implanted H ions peaked at 12–14 nm below the surface of the film and that of He about 20–23 nm. To enable quantitative measurement of the SW fluences by secondary ion mass spectroscopy, minor isotopes of Mg (^(25)Mg and ^(26)Mg) were commercially implanted into flight-spare collectors at 75 keV and a fluence of 1 × 10^(14) ions cm^(−2). The shapes of analytical depth profiles, the rate at which the profiles were sputtered by a given beam current, and the intensity of ion yields are used to characterize the structure of the material in small areas (~200 × 200 ± 50 μm). Data were consistent with the hypothesis that minor structural changes in the film were induced by SW exposure

Raising the participation age in historical perspective : Policy learning from the past?

The raising of the participation age (RPA) to 17 in 2013 and 18 in 2015 marks a historic expansion of compulsory education. Despite the tendency of New Labour governments to eschew historical understanding and explanation, RPA was conceived with the benefit of an analysis of previous attempts to extend compulsion in schooling. This paper assesses the value of a historical understanding of education policy. The period from inception to the projected implementation of RPA is an extended one which has crossed over the change of government, from Labour to Coalition, in 2010. The shifting emphases and meanings of RPA are not simply technical issues but connect to profound historical and social changes. An analysis of the history of the raising of the school leaving age reveals many points of comparison with the contemporary situation. In a number of key areas it is possible to gain insights into the ways in which the study of the past can help to comprehend the present: the role of human capital, the structures of education, in curriculum development and in terms of preparations for change

Regularization-independent study of renormalized non-perturbative quenched QED

A recently proposed regularization-independent method is used for the first time to solve the renormalized fermion Schwinger-Dyson equation numerically in quenched QED$_4$. The Curtis-Pennington vertex is used to illustrate the technique and to facilitate comparison with previous calculations which used the alternative regularization schemes of modified ultraviolet cut-off and dimensional regularization. Our new results are in excellent numerical agreement with these, and so we can now conclude with confidence that there is no residual regularization dependence in these results. Moreover, from a computational point of view the regularization independent method has enormous advantages, since all integrals are absolutely convergent by construction, and so do not mix small and arbitrarily large momentum scales. We analytically predict power law behaviour in the asymptotic region, which is confirmed numerically with high precision. The successful demonstration of this efficient new technique opens the way for studies of unquenched QED to be undertaken in the near future.Comment: 20 pages,5 figure

Search for CP Violation in the Decay Z -> b (b bar) g

About three million hadronic decays of the Z collected by ALEPH in the years 1991-1994 are used to search for anomalous CP violation beyond the Standard Model in the decay Z -> b \bar{b} g. The study is performed by analyzing angular correlations between the two quarks and the gluon in three-jet events and by measuring the differential two-jet rate. No signal of CP violation is found. For the combinations of anomalous CP violating couplings, ${\hat{h}}_b = {\hat{h}}_{Ab}g_{Vb}-{\hat{h}}_{Vb}g_{Ab}$ and $h^{\ast}_b = \sqrt{\hat{h}_{Vb}^{2}+\hat{h}_{Ab}^{2}}$, limits of \hat{h}_b < 0.59$and$h^{\ast}_{b} < 3.02$ are given at 95\% CL.Comment: 8 pages, 1 postscript figure, uses here.sty, epsfig.st