The Twentieth Century Reanalysis Project Compo, G. P.; Whitaker, J. S.; Sardeshmukh, P. D. ...
Quarterly journal of the Royal Meteorological Society,
January 2011 Part A, 2011, 2011-01-00, 20110101, 2011-01-01, Letnik:
137, Številka:
654
Journal Article
IMPORTANCE Barrett esophagus containing low-grade dysplasia is associated with an increased risk of developing esophageal adenocarcinoma, a cancer with a rapidly increasing incidence in the western ...world. OBJECTIVE To investigate whether endoscopic radiofrequency ablation could decrease the rate of neoplastic progression. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial that enrolled 136 patients with a confirmed diagnosis of Barrett esophagus containing low-grade dysplasia at 9 European sites between June 2007 and June 2011. Patient follow-up ended May 2013. INTERVENTIONS Eligible patients were randomly assigned in a 1:1 ratio to either endoscopic treatment with radiofrequency ablation (ablation) or endoscopic surveillance (control). Ablation was performed with the balloon device for circumferential ablation of the esophagus or the focal device for targeted ablation, with a maximum of 5 sessions allowed. MAIN OUTCOMES AND MEASURES The primary outcome was neoplastic progression to high-grade dysplasia or adenocarcinoma during a 3-year follow-up since randomization. Secondary outcomes were complete eradication of dysplasia and intestinal metaplasia and adverse events. RESULTS Sixty-eight patients were randomized to receive ablation and 68 to receive control. Ablation reduced the risk of progression to high-grade dysplasia or adenocarcinoma by 25.0% (1.5% for ablation vs 26.5% for control; 95% CI, 14.1%-35.9%; P < .001) and the risk of progression to adenocarcinoma by 7.4% (1.5% for ablation vs 8.8% for control; 95% CI, 0%-14.7%; P = .03). Among patients in the ablation group, complete eradication occurred in 92.6% for dysplasia and 88.2% for intestinal metaplasia compared with 27.9% for dysplasia and 0.0% for intestinal metaplasia among patients in the control group (P < .001). Treatment-related adverse events occurred in 19.1% of patients receiving ablation (P < .001). The most common adverse event was stricture, occurring in 8 patients receiving ablation (11.8%), all resolved by endoscopic dilation (median, 1 session). The data and safety monitoring board recommended early termination of the trial due to superiority of ablation for the primary outcome and the potential for patient safety issues if the trial continued. CONCLUSIONS AND RELEVANCE In this randomized trial of patients with Barrett esophagus and a confirmed diagnosis of low-grade dysplasia, radiofrequency ablation resulted in a reduced risk of neoplastic progression over 3 years of follow-up. TRIAL REGISTRATION trialregister.nl Identifier: NTR1198
Previous reviews show that reporting guidelines have improved the quality of trial reports in medicine, yet existing guidelines may not be fully suited for social and psychological intervention ...trials.
We conducted a two-part study that reviewed (1) reporting guidelines for and (2) the reporting quality of social and psychological intervention trials.
(1) To identify reporting guidelines, we systematically searched multiple electronic databases and reporting guideline registries. (2) To identify trials, we hand-searched 40 journals with the 10 highest impact factors in clinical psychology, criminology, education, and social work. ELIGIBILITY: (1) Reporting guidelines consisted of articles introducing a checklist of reporting standards relevant to social and psychological intervention trials. (2) Trials reported randomised experiments of complex interventions with psychological, social, or health outcomes.
(1) We identified 19 reporting guidelines that yielded 147 reporting standards relevant to social and psychological interventions. Social and behavioural science guidelines included 89 standards not found in CONSORT guidelines. However, CONSORT guidelines used more recommended techniques for development and dissemination compared to other guidelines. (2) Our review of trials (n = 239) revealed that many standards were poorly reported, such as identification as a randomised trial in titles (20% reported the information) and abstracts (55%); information about blinding (15%), sequence generation (23%), and allocation concealment (17%); and details about actual delivery of experimental (43%) and control interventions (34%), participant uptake (25%), and service environment (28%). Only 11 of 40 journals referenced reporting guidelines in "Instructions to Authors."
Existing reporting guidelines have important limitations in content, development, and/or dissemination. Important details are routinely missing from trial publications; most leading journals in social and behavioural sciences do not ask authors to follow reporting standards. Findings demonstrate a need to develop a CONSORT extension with updated standards for social and psychological intervention trials.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
The accurate harvesting of a sentinel node in breast cancer includes a sequence of procedures with components from different medical specialities, including nuclear medicine, radiology, ...surgical oncology and pathology. The aim of this document is to provide general information about sentinel lymph node detection in breast cancer patients.
Methods
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) have written and approved these guidelines to promote the use of nuclear medicine procedures with high quality. The final result has been discussed by distinguished experts from the EANM Oncology Committee, the SNMMI and the European Society of Surgical Oncology (ESSO).
Conclusion
The present guidelines for nuclear medicine practitioners offer assistance in optimizing the diagnostic information from the SLN procedure. These guidelines describe protocols currently used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary.
Comprehensive assessments of species' extinction risks have documented the extinction crisis
and underpinned strategies for reducing those risks
. Global assessments reveal that, among tetrapods, ...40.7% of amphibians, 25.4% of mammals and 13.6% of birds are threatened with extinction
. Because global assessments have been lacking, reptiles have been omitted from conservation-prioritization analyses that encompass other tetrapods
. Reptiles are unusually diverse in arid regions, suggesting that they may have different conservation needs
. Here we provide a comprehensive extinction-risk assessment of reptiles and show that at least 1,829 out of 10,196 species (21.1%) are threatened-confirming a previous extrapolation
and representing 15.6 billion years of phylogenetic diversity. Reptiles are threatened by the same major factors that threaten other tetrapods-agriculture, logging, urban development and invasive species-although the threat posed by climate change remains uncertain. Reptiles inhabiting forests, where these threats are strongest, are more threatened than those in arid habitats, contrary to our prediction. Birds, mammals and amphibians are unexpectedly good surrogates for the conservation of reptiles, although threatened reptiles with the smallest ranges tend to be isolated from other threatened tetrapods. Although some reptiles-including most species of crocodiles and turtles-require urgent, targeted action to prevent extinctions, efforts to protect other tetrapods, such as habitat preservation and control of trade and invasive species, will probably also benefit many reptiles.
To quantify the impact of antiretroviral therapy (ART) on mortality in HIV-positive people during tuberculosis (TB) treatment.
We conducted a systematic literature review and meta-analysis. Studies ...published from 1996 through February 15, 2013, were identified by searching electronic resources (Pubmed and Embase) and conference books, manual searches of references, and expert consultation. Pooled estimates for the outcome of interest were acquired using random effects meta-analysis.
The study population included individuals receiving ART before or during TB treatment.
Main outcome measures were: (i) TB-case fatality ratio (CFR), defined as the proportion of individuals dying during TB treatment and, if mortality in HIV-positive people not on ART was also reported, (ii) the relative risk of death during TB treatment by ART status.
Twenty-one studies were included in the systematic review. Random effects pooled meta-analysis estimated the CFR between 8% and 14% (pooled estimate 11%). Among HIV-positive TB cases, those receiving ART had a reduction in mortality during TB treatment of between 44% and 71% (RR = 0.42, 95%CI: 0.29-0.56).
Starting ART before or during TB therapy reduces the risk of death during TB treatment by around three-fifths in clinical settings. National programmes should continue to expand coverage of ART for HIV positive in order to control the dual epidemic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Previous examinations of fully convective M-dwarf stars have highlighted enhanced rates of nanoflare activity on these distant stellar sources. However, the specific role the convective ...boundary, which is believed to be present for spectral types earlier than M2.5V, plays on the observed nanoflare rates is not yet known. Here, we utilize a combination of statistical and Fourier techniques to examine M-dwarf stellar lightcurves that lie on either side of the convective boundary. We find that fully convective M2.5V (and later subtypes) stars have greatly enhanced nanoflare rates compared with their pre-dynamo mode-transition counterparts. Specifically, we derive a flaring power-law index in the region of 3.00 ± 0.20, alongside a decay timescale of 200 ± 100 s for M2.5V and M3V stars, matching those seen in prior observations of similar stellar subtypes. Interestingly, M4V stars exhibit longer decay timescales of 450 ± 50 s, along with an increased power-law index of 3.10 ± 0.18, suggesting an interplay between the rate of nanoflare occurrence and the intrinsic plasma parameters, e.g., the underlying Lundquist number. In contrast, partially convective (i.e., earlier subtypes from M0V to M2V) M-dwarf stars exhibit very weak nanoflare activity, which is not easily identifiable using statistical or Fourier techniques. This suggests that fully convective stellar atmospheres favor small-scale magnetic reconnection, leading to implications for the flare-energy budgets of these stars. Understanding why small-scale reconnection is enhanced in fully convective atmospheres may help solve questions relating to the dynamo behavior of these stellar sources.
Chemotherapy-induced peripheral neuropathy (CIPN) is a common phenomenon, often resulting in serious limitations in daily functioning and comprosised quality of life. Currently available toxicity ...grading systems typically use a combination of clinical and paraclinical parameters and relies on the judgment of clinicians and/or nurses. However, because many of the symptoms of CIPN are subjective in nature, it is only logical that an assessment of CIPN be based, at least in part, on patient self-report data. We report on the development of a patient self-report questionnaire, the CIPN20, intended to supplement the core quality of life questionnaire of the European Organization for Research and Treatment of Cancer (EORTC). Following EORTC guidelines, relevant CIPN-related issues were identified from a literature survey and interviews with health professionals (
n
=
15) and patients (
n
=
112). The resulting 20-item questionnaire was pre-tested in three languages and four countries and is currently being examined in a large, international clinical trial. The EORTC CIPN20 should provide valuable information on CIPN-related symptoms and functional limitations of patients exposed to potentially neurotoxic chemotherapeutic and/or neuroprotective agents.
Summary
Background
An epidemic of basal cell carcinoma (BCC) has led to a significant healthcare burden in white populations.
Objectives
To provide an update on incidence rates and tumour burden in ...an unselected, geographically isolated population that is exposed to a low level of ultraviolet radiation.
Methods
This was a whole‐population study using a cancer registry containing records of all cases of BCC in 1981–2017. We assessed BCC incidence according to age, residence and multiplicity and assessed trends using join‐point analysis. Age‐standardized and age‐specific incidence rates were calculated along with cumulative and lifetime risks.
Results
During the study period, the age‐standardized incidence rates increased from 25·7 to 59·9 for men, and from 22·2 to 83·1 for women (per 100 000). Compared with the single‐tumour burden, the total tumour burden in the population was 1·72 times higher when accounting for multiplicity. At the beginning of the study period, the world‐standardized rates in men and women were similar, but by the end of the study period the rates were 39% higher in women (83·1 per 100 000, 95% confidence interval 77·9–88·3) than in men (59·9 per 100 000, 95% confidence interval 55·6–64·2). This increase was most prominent in women on sites that are normally not exposed to ultraviolet radiation in Iceland: the trunk and legs.
Conclusions
This is the only reported population in which the incidence of BCC is significantly higher in women than in men. The period of notable increase in BCC lesions correlates with the period of an increase in tanning beds and travel popularity. The high multiplicity rates suggest that the total tumour burden worldwide might be higher than previously thought.
What is already known about this topic?
Basal cell carcinoma (BCC) is becoming an increasing healthcare burden worldwide, especially in white populations.
Recent population studies have reported a rapid increase in incidence among younger individuals, especially women.
What does this study add?
Iceland is the only reported population in which the incidence of BCC is significantly higher in women than in men, and there does not seem to be a clear relationship between latitude and BCC incidence in Europe.
Men might be comparatively protected in the northern low‐ultraviolet environment, with tanning beds and travel abroad likely playing important roles in the observed incidence increase, especially in women.
The high multiplicity rates suggest that the total tumour burden worldwide might be higher than previously thought.
Linked Comment: Pandeya. Br J Dermatol 2020; 183:799–800.
What is already known about this topic?
Basal cell carcinoma (BCC) is becoming an increasing healthcare burden worldwide, especially in white populations.
Recent population studies have reported a rapid increase in incidence among younger individuals, especially women.
What does this study add?
Iceland is the only reported population in which the incidence of BCC is significantly higher in women than in men, and there does not seem to be a clear relationship between latitude and BCC incidence in Europe.
Men might be comparatively protected in the northern low‐ultraviolet environment, with tanning beds and travel abroad likely playing important roles in the observed incidence increase, especially in women.
The high multiplicity rates suggest that the total tumour burden worldwide might be higher than previously thought.
Linked Comment: Pandeya. Br J Dermatol 2020; 183:799–800.
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