Abstract
Background and study aims
In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed ...adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR.
Methods
Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors.
Results
A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2,
P
= 0.0044), R
2
= 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR.
Conclusions
We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.
There is ongoing debate over whether authoritarian regimes can maintain control over information given the rise of social media and the Internet. In this debate, China is often cited as a prime ...example of how authoritarian regimes can retain control, but to date, there has been limited research on whether China's online censorship strategies can be replicated in other authoritarian regimes. This article shows that China's ability to censor social media rests on the dominance of domestic firms in China's market for Internet content. The absence of U.S. social media firms in China allows the Chinese government to engage in censorship through content removal, which can quickly and effectively suppress information. In contrast, for most other regimes, the market for social media is dominated by U.S. multinational firms, e.g., Facebook, YouTube, Twitter, and in these contexts, content removal is an immense challenge. This article then examines the prospects of instituting content removal by developing domestic social media or importing Chinese platforms, and finds that most authoritarian regimes are unlikely to be able to duplicate China's online censorship efforts.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A growing body of research suggests that authoritarian regimes are responsive to societal actors, but our understanding of the sources of authoritarian responsiveness remains limited because of the ...challenges of measurement and causal identification. By conducting an online field experiment among 2,103 Chinese counties, we examine factors that affect officials' incentives to respond to citizens in an authoritarian context. At baseline, we find that approximately one-third of county governments respond to citizen demands expressed online. Threats of collective action and threats of tattling to upper levels of government cause county governments to be considerably more responsive, whereas identifying as loyal, long-standing members of the Chinese Communist Party does not increase responsiveness. Moreover, we find that threats of collective action make local officials more publicly responsive. Together, these results demonstrate that top-down mechanisms of oversight as well as bottom-up societal pressures are possible sources of authoritarian responsiveness.
Abstract What happens to international media reporting when governments expel foreign journalists? Countries around the world expel foreign reporters, yet there is no consensus about the effects of ...such expulsions. We argue there are three possible outcomes of expulsion: a chilling effect, resilience, and backlash. Using China as a case study, we evaluate these competing theories by collecting a novel dataset of foreign news stories about China and applying time-series causal inference methods to measure the effects of expulsion on information origination, composition, and reach after March 2020, when the Chinese government expelled a large number of foreign correspondents. Results show that expelled media organizations did not experience a chilling effect or backlash on reporting and may have changed their production processes to account for expulsion. These findings suggest that news organizations can remain resilient to the impact of extraordinary events which target the organization and disrupt internal production processes.
The Familial Bowel Cancer Service at The Royal Melbourne Hospital was started in 1980 in order to offer bowel cancer screening services to those felt to be at a higher risk of CRC due to their family ...history, and upon registration in this service, patients gave consent for recording of their individual and familial medical history as pertaining to colorectal cancer in the FamBIS database. Using the FamBIS database, we sought to understand whether the subpopulation of individuals in whom both parents were diagnosed with colorectal cancer carried a higher risk of colorectal cancer or neoplastic polyps and should therefore undergo more intensive screening above that of the average-risk individual.
We conducted a single-centre retrospective cohort-study of adults (18 years of age and older) in the FamBIS database, with review of their medical histories as pertaining to CRC diagnosis, screening, and surveillance from 1980 to 2015.
We identified and reviewed the medical histories of 96 registrants from 62 unique families. Registrants began screening as early as 24 years of age, with the mean age of first screening being at 44.6 ± 10.7 years old. The mean duration of screening was 17.3 ± 10.1 years, and through their screening period, registrants underwent an average of 11.5 ± 9.1 FOBTs and 4.4 ± 3.1 colonoscopies or sigmoidoscopies.Over the course of screening, 41 (42.7%) registrants were found to have at least one neoplasm of any kind (including adenomas, advanced adenomas, and CRC) as their first positive colonoscopic finding. In total, 12 (12.5%) of the registrants were found to have an advanced neoplasm over the course of screening and surveillance, while only 2 patients were found to be diagnosed with CRC.
The prevalence rates for neoplasms, advanced neoplasms, and CRC in our current study were statistically significantly higher compared with those seen in average-risk populations. This supports the importance of more intensive screening for this subpopulation in preventing colorectal cancers, as well as pre-and early-cancerous neoplasms.
The Chinese government has long been suspected of hiring as many as 2 million people to surreptitiously insert huge numbers of pseudonymous and other deceptive writings into the stream of real social ...media posts, as if they were the genuine opinions of ordinary people. Many academics, and most journalists and activists, claim that these so-called 50c party posts vociferously argue for the government’s side in political and policy debates. As we show, this is also true of most posts openly accused on social media of being 50c. Yet almost no systematic empirical evidence exists for this claim or, more importantly, for the Chinese regime’s strategic objective in pursuing this activity. In the first large-scale empirical analysis of this operation, we show how to identify the secretive authors of these posts, the posts written by them, and their content. We estimate that the government fabricates and posts about 448 million social media comments a year. In contrast to prior claims, we show that the Chinese regime’s strategy is to avoid arguing with skeptics of the party and the government, and to not even discuss controversial issues. We show that the goal of this massive secretive operation is instead to distract the public and change the subject, as most of these posts involve cheerleading for China, the revolutionary history of the Communist Party, or other symbols of the regime. We discuss how these results fit with what is known about the Chinese censorship program and suggest how they may change our broader theoretical understanding of “common knowledge” and information control in authoritarian regimes.
We explored the role of antigen valency in B cell receptor (BCR) activation and rearrangement of intracellular MHC class II compartments as factors that contribute to the efficacy of antigen ...presentation. Using primary B cells that express a hen egg lysozyme (HEL)-specific BCR, we found that oligomeric HEL more efficiently promoted both BCR activation and internalization than did monovalent HEL, although monovalent HEL, unlike monovalent Fab fragments of anti-lg, readily triggered the BCR. Nonetheless, oligovalent ligation positions the BCR in a membrane microdomain that is distinct from one engaged in the course of monovalent ligation, as judged by detergent extraction of the BCR. Furthermore, oligovalent HEL induced more pronounced rearrangement of MHC class II-containing antigen-processing compartments. Using videomicroscopy we observed in real time the rearrangement of MHC class II compartments as well as delivery of antigen in primary B cells. The observed increase in rearrangement of MHC class II-positive compartments and the disposition of antigen-bound BCRs therein correlates with improved presentation of a HEL-derived epitope. Although monomeric HEL efficiently engages the BCR, presentation of HEL-derived epitopes is impaired compared to oligovalent antigens. This trait may help explain the known ability of soluble, disaggregated antigen to induce a state of B cell tolerance.
There is a significant unmet need for a blood test with adequate sensitivity to detect colorectal cancer (CRC) and adenomas. We describe a novel circulating tumor cell (CTC) platform to capture ...colorectal epithelial cells associated with CRC and adenomas.
Blood was collected from 667 Taiwanese adults from 2012 to 2018 before a colonoscopy. The study population included healthy control subjects, patients with adenomas, and those with stage I-IV CRC. CTCs were isolated from the blood using the CellMax platform. The isolated cells were enumerated, and an algorithm was used to determine the likelihood of detecting adenoma or CRC. Nominal and ordinal logistic regression demonstrated that CTC counts could identify adenomas and CRC, including CRC stage.
The CellMax test demonstrated a significant association between CTC counts and worsening disease status (Cuzick's P value < 0.0001) with respect to the adenoma-carcinoma sequence. The test showed high specificity (86%) and sensitivity across all CRC stages (95%) and adenomatous lesions (79%). The area under the curve was 0.940 and 0.868 for the detection of CRC and adenomas, respectively.
The blood-based CTC platform demonstrated high sensitivity in detecting adenomas and CRC, as well as reasonable specificity in an enriched symptomatic patient population.
If these results are reproduced in an average risk population, this test has the potential to prevent CRC by improving patient compliance and detecting precancerous adenomas, eventually reducing CRC mortality.
China's Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little ...experience in HIV/AIDS treatment and care and resource limitations, China's efforts to provide widespread access to free antiretroviral therapy has been a process fraught with difficulty. However, the Free ART Program is progressing from an emergency response to a standardized treatment and care system. The development of national guidelines, training programs, a laboratory support network, a national patient database, programs for special populations such as children and patients living with co-infections, and operational research has improved the scope and quality of the free treatment program. As of June 30, 2005, a total of 19,456 patients in 28 provinces, autonomous regions, and special municipalities had received free ART. Challenges stemming from the nature of China's health system and patient population persist, but with strong government support and a diverse set of resources, China has the capacity to overcome these challenges and to provide nationwide access to high quality treatment and care.
PDF
