Rural dwellers are less likely to survive cancer : An international review and meta-analysis

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.healthplace.2018.08.010.Peer reviewedPublisher PD

AI as a Medical Device for Ophthalmic Imaging in Europe, Australia, and the United States:Protocol for a Systematic Scoping Review of Regulated Devices

BACKGROUND: Artificial intelligence as a medical device (AIaMD) has the potential to transform many aspects of ophthalmic care, such as improving accuracy and speed of diagnosis, addressing capacity issues in high-volume areas such as screening, and detecting novel biomarkers of systemic disease in the eye (oculomics). In order to ensure that such tools are safe for the target population and achieve their intended purpose, it is important that these AIaMD have adequate clinical evaluation to support any regulatory decision. Currently, the evidential requirements for regulatory approval are less clear for AIaMD compared to more established interventions such as drugs or medical devices. There is therefore value in understanding the level of evidence that underpins AIaMD currently on the market, as a step toward identifying what the best practices might be in this area. In this systematic scoping review, we will focus on AIaMD that contributes to clinical decision-making (relating to screening, diagnosis, prognosis, and treatment) in the context of ophthalmic imaging.OBJECTIVE: This study aims to identify regulator-approved AIaMD for ophthalmic imaging in Europe, Australia, and the United States; report the characteristics of these devices and their regulatory approvals; and report the available evidence underpinning these AIaMD.METHODS: The Food and Drug Administration (United States), the Australian Register of Therapeutic Goods (Australia), the Medicines and Healthcare products Regulatory Agency (United Kingdom), and the European Database on Medical Devices (European Union) regulatory databases will be searched for ophthalmic imaging AIaMD through a snowballing approach. PubMed and clinical trial registries will be systematically searched, and manufacturers will be directly contacted for studies investigating the effectiveness of eligible AIaMD. Preliminary regulatory database searches, evidence searches, screening, data extraction, and methodological quality assessment will be undertaken by 2 independent review authors and arbitrated by a third at each stage of the process.RESULTS: Preliminary searches were conducted in February 2023. Data extraction, data synthesis, and assessment of methodological quality commenced in October 2023. The review is on track to be completed and submitted for peer review by April 2024.CONCLUSIONS: This systematic review will provide greater clarity on ophthalmic imaging AIaMD that have achieved regulatory approval as well as the evidence that underpins them. This should help adopters understand the range of tools available and whether they can be safely incorporated into their clinical workflow, and it should also support developers in navigating regulatory approval more efficiently.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52602.</p

A cancer geography paradox?:Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study

This study was funded by Cancer Research UK (Grant number = C10673/A17593). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. All authors are independent of Cancer Research UK.Peer reviewedPublisher PD

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Safe and Effective Treatment of Intracranial Infantile Hemangiomas with Beta-Blockers

Infantile hemangiomas are common benign vascular tumors but are rarely found in an intracranial location. Our literature review identified 41 reported cases. There is no general consensus on management of these rare lesions and until recently, treatment was limited to surgery or pharmacological management with steroids or interferon. Although beta-blockers have been widely prescribed in the treatment of cutaneous infantile hemangiomas since 2008, their use in the treatment of intracranial infantile hemangiomas has been minimal. We present a case of infantile hemangioma affecting the right orbit, associated with intracranial extension, causing intermittent right facial nerve palsy. The patient achieved an excellent outcome following combined treatment with oral propranolol and topical timolol maleate 0.5%, with complete regression of the lesion by 4 months. We conclude that beta-blockers are a safe and effective treatment of intracranial infantile hemangiomas and can be employed as first-line management of these lesions

Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis

Purpose: Existing research hints that people living with and beyond cancer are at an increased risk of stroke. However, there is insufcient evidence to appropriately inform guidelines for specifc stroke prevention or management for cancer patients. We conducted a systematic review and meta-analysis to describe and quantify stroke incidence in people living with and beyond cancer. Methods: Medline, CINAHL, and EMBASE were searched for epidemiological studies comparing stroke incidence between cancer and non-cancer patients. Reviewers independently extracted data; random-efects meta-analyses and quality assessment were performed. Results: Thirty-six studies were narratively synthesised. Meta-analysis was conducted using seven studies. Methodological quality was high for most studies. Study populations were heterogeneous, and the length of follow-up and risk factors varied. There was a variation in risk between diferent cancer types and according to stroke type: pancreatic (HR 2.85 (95% CI 2.43–3.36), ischaemic) (HR 2.28 (95% CI 1.43–3.63), haemorrhagic); lung (HR 2.33 (95% CI 1.63–3.35), ischaemic) (HR 2.14 (95% CI 1.45–3.15), haemorrhagic); and head and neck (HR 1.54 (95% CI 1.40–1.69), haemorrhagic) cancers were associated with signifcantly increased incidence of stroke. Risk is highest within the frst 6 months of diagnosis. Narrative synthesis indicated that several studies also showed signifcantly increased incidence of stroke in individuals with colorectal cancer, breast cancer, ovarian cancer, nasopharyngeal cancer, leukaemia, and myeloma, and those who have received radiotherapy for head and neck cancers and platinum-based chemotherapy may also have higher stroke incidence. Conclusions: Stroke incidence is signifcantly increased after diagnosis of certain cancers. Implications: for Cancer Survivors Cardiovascular risk should be assessed during cancer survivorship care, with attention to modifying shared cancer/cardiovascular risk factors

Evaluating in-use vehicle emissions using air quality monitoring stations and on-road remote sensing systems

© 2020 Elsevier B.V. This study investigated real world in-use vehicle emissions using two regulatory techniques simultaneously, namely on-road remote sensing (RS) systems and air quality (AQ) monitoring stations, aiming to provide a full pollution profile from tailpipe to roadside and atmosphere. Two large AQ and RS datasets collected during 2012–2018 were analyzed. The effects of various emission control programmes on the trends of tailpipe emissions and air quality were evaluated. Correlations between tailpipe emissions and roadside and ambient air quality were also explored. The results showed a decreasing trend of NO2 at both roadside and ambient AQ stations from 2013 to 2016, which was attributed to the intensive implementation of a series of vehicle emissions control programmes. Although NO2 was decreasing, O3 was generally increasing for all AQ stations. AQ data showed that O3 had little correlation with either NO2 or NOx, but was mainly determined by NO2/NOx ratio. Roadside NO2/NOx ratio increased first and then decreased or stabilized after 2014, while ambient NO2/NOx ratio increased steadily. RS data showed that the overall NO decreased quickly during 2012–2015 and then decreased moderately after 2015. The decrease was mainly attributed to the effective NO reduction from LPG vehicles. However, diesel NO remained high and reduced relatively slowly during the study period. Gasoline vehicles were relatively clean compared with LPG and diesel vehicles. Finally, good correlations were demonstrated between NO measured by RS sites and NOx measured by roadside AQ stations, indicating that vehicle emissions were the major contributor to roadside NOx pollution. Ambient NOx emissions could be affected by various sources, leading to different correlation levels between RS and ambient AQ results