Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice

Abstract Background Most randomized controlled trials of interventions designed to promote cancer screening, particularly those targeting poor and minority patients, enroll selected patients. Relatively little is known about the benefits of these interventions among unselected patients. Methods/Design "Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61). Discussion This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates. The trial was registered at Clinical Trials.gov NCT00818857http://deepblue.lib.umich.edu/bitstream/2027.42/78264/1/1472-6963-10-280.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78264/2/1472-6963-10-280.pdfPeer Reviewe

Selective incorporation of dissolved organic matter (DOM) during sea ice formation

This study investigated the incorporation of DOM from seawater into >2 day-old sea ice in tanks filled with seawater alone or amended with DOM extracted from the microalga, Chlorella vulgaris. Optical properties, including chromophoric DOM (CDOM) absorption and fluorescence, as well as concentrations of dissolved organic carbon (DOC), dissolved organic nitrogen (DON), dissolved carbohydrates (dCHOs) and dissolved uronic acids (dUAs) were measured. Enrichment factors (EFs), calculated from salinity-normalized concentrations of DOM in bulk ice, brine and frost flowers relative to under-ice water, were generally >1. The enrichment factors varied for different DOM fractions: EFs were the lowest for humic-like DOM (1.0–1.39) and highest for amino acid-like DOM (1.10–3.94). Enrichment was generally highest in frost flowers with there being less enrichment in bulk ice and brine. Size exclusion chromatography indicated that there was a shift towards smaller molecules in the molecular size distribution of DOM in the samples collected from newly formed ice compared to seawater. Spectral slope coefficients did not reveal any consistent differences between seawater and ice samples. We conclude that DOM is incorporated to sea ice relatively more than inorganic solutes during initial formation of sea ice and the degree of the enrichment depends on the chemical composition of DO

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Pre-settlement tree density in the eucalypt open-forest on the Brisbane tuff

A shallow soil has developed on the hard, impermeable ignimbrite, the Brisbane Tuff, which resulted from an ash-flow from a volcano north of Chermside during the late Triassic period. In comparison with the more permeable Brisbane Metamorphics (Neranleigh= Femvale Group and Bunya Phyllites) that dominate the landscape in the Greater Brisbane area, the lower water-retaining capacity of the soil on the Brisbane Tuff reduces evapotranspiration from the eucalypt open-forest on this soil. Survey records made around 1850 from Chermside to Yeerongpilly and Indooroopilly indicate that large trees (over about 30 cm diameter) in the eucalypt open-forest on the Brisbane Tuff were sparser (80 per hectare) than on the Brisbane Metamorphics (110 per hectare). Tree species were similar on both geological formations; Bloodwood (Corymbia intermedia), Mahogany (Eucalyptus acmenoides) and Stringybark (E. carnea) were somewhat more frequent on the Brisbane Tuff, while Gum (E. propinqua/E. major) and Ironbark (E. crebra) were more frequent on the Brisbane Metamorphics

The Legacy of the International Biological Program in Australia

Council of Scientific Unions (now the International Science Council, ISC) to promote the world-wide study of production on land, in freshwaters and in the seas, the potentialities and uses of new and existing natural resources, and human adaptability to changing conditions. The IBP was the first of a series of global initiatives created to promote international collaboration around big environmental science questions since the Second World War. We present a brief review of similar initiatives that preceded and followed it, and then describe the operations and outcome of the IBP in Australia based largely on the personal experience of Raymond L. Specht (RLS), who was convenor of the Australian PCT section: productivity of terrestrial com mu nities; pro-duction processes; and conservation of terrestrial communities. Despite the absence of any dedicated funding for the IBP in Australia, RLS was able to bring a team of inter disciplinary researchers to The University of Queensland and provide them with state-of-the art research facilities. This was the focus for many national and international exchanges, and several impor-tant outcomes. RLS, with the support of the Australian Academy of Science (AAS), enabled the first national survey of the conservation status of plant communities (a target of the IBP for each country) and developed it into an objective assessment long after the IBP itself had ended, lay-ing the foundations for a comprehensive, adequate and representative national reserve system. Much more could have been produced if adequate funding had been provided for the program, reducing the reliance on the commitment and enthusiasm of individual researchers.This article was published in Volume 128 of the Proceedings of the Royal Society of Queensland (ed A.H. Arthington): https://www.royalsocietyqld.org/proceedings-128/ . It is reproduced here to aid discovery for scholarly use only (CCBy 4.0

Biodiversity of terrestrial ecosystems in tropical to temperate Australia

During the short period of annual foliage growth in evergreen plant communities, aerodynamic fluxes (frictional, thermal, evaporative) in the atmosphere as it flows over and through a plant community determine the Foliage Projective Covers and leaf attributes in overstorey and understorey strata. The number of leaves produced on each vertical foliage shoot depends on available soil water and nutrients during this growth period. The area of all leaves exposed to solar radiation determines net photosynthetic fixation of the plant community throughout the year. In turn, the species richness (number of species per hectare) of both plants and resident vertebrates is determined. The species richness of unicellular algae and small multicellular isopods in permanent freshwater lagoons in Northern Australia may possibly have been increased by radiation released from nearby uranium deposits. Evolution of new angiosperms probably occurred in refugia during periods of extreme drought. When favourable climates were restored, the vegetation expanded to result in high Gamma Biodiversity (number of plant species per region) but with each major plant community having essentially the same species richness (number of plant species per hectare). The probable effects of pollution and Global Warming on biodiversity in Australian ecosystems, that experience seasonal drought, are discussed

Productivity studies on heath vegetation in Southern Australia a comment on sampling problems

The problems of obtaining satisfactory estimates of the growth rate by harvesting tops and roots of a natural plant community—the heath vegetation in southern Australia—are outlined. It is essential to develop non-destructive methods for studying rates of production such as recommended by the Section entitled “Production Processes of Terrestrial Communities” of the International Biological Programme