In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the ...detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average‐risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.
Advective processes that couple planetary waves with tides have long been proposed as sources of nonmigrating diurnal tides. This paper reports observations of short‐term variability in global ...observations of nonmigrating tides predicted to arise from the interaction of the migrating diurnal tide (DW1) with a quasi‐stationary planetary wave number one (PW1). PW1 and tidal definitions are extracted from satellite temperatures and high‐altitude meteorological analyses. During winter months, the evolution of westward traveling diurnal tides with zonal wave number 2 (DW2) generally tracks that of strong‐amplitude stratospheric PW1. DW1 and PW1 spectra are used to compute nonlinear tidal forcing terms arising from advection. We then examine the response of a primitive equation model to the observation‐based nonlinear forcing. The model experiments indicate that meridional advection of PW1 zonal momentum by DW1 is a significant source of lower thermospheric DW2. Modeled DW2 amplitudes are very consistent with observed DW2 amplitudes when stratospheric PW1 penetrates to equatorial latitudes. The model experiments also indicate that the interaction can imprint short‐term variability associated with wintertime PW1 upon DW2 in the summer hemisphere and the lower thermosphere.
Key Points
PW1‐DW1 interaction is an important source of DW2
The interaction couples the winter and the summer hemispheres
The interaction transmits PW1 influences to at least 90 km
Abstract
Recent studies suggest linkages between anomalously warm temperatures in the winter stratosphere, and the high-latitude summer mesopause. The summer temperature anomaly is manifested in the ...decline of polar mesospheric clouds. The 2-day wave is a strong-amplitude and transient summer feature that interacts with the background state so as to warm the high-latitude summer mesopause. This wave has been linked to a low-latitude phenomenon called inertial instability, which is organized by breaking planetary waves in the winter stratosphere. Hence, inertial instability has been identified as a possible nexus between the disturbed winter stratosphere, and summer mesopause warming. We investigate a sustained occurrence of inertial instability during 19 July–8 August 2014. During this period, stratospheric winter temperatures warmed by about 10 K, while a steep decline in polar mesospheric clouds was reported between 26 July and 6 August. We present, for the first time, wave driving associated with observed inertial instability. The effect of inertial instability is to export eastward momentum from the winter hemisphere across the equator into the summer hemisphere. Using a primitive equation model, we demonstrate that the wave stresses destabilize the stratopause summer easterly jet. The reconfigured wind profile excites the wavenumber-4 component of the 2-day wave, leading to enhanced warming of the summer mesopause. This work supports previous numerical investigations that identified planetary wave–driven inertial instability as a source of the 2-day wave.
Background Although anaphylaxis is recognized as an important life-threatening condition, data are limited regarding its prevalence and characteristics in the general population. Objective We sought ...to estimate the lifetime prevalence and overall characteristics of anaphylaxis. Methods Two nationwide, cross-sectional random-digit-dial surveys were conducted. The public survey included unselected adults, whereas the patient survey captured information from household members reporting a prior reaction to medications, foods, insect stings, or latex and idiopathic reactions in the previous 10 years. In both surveys standardized questionnaires queried anaphylaxis symptoms, treatments, knowledge, and behaviors. Results The public survey included 1,000 adults, of whom 7.7% (95% CI, 5.7% to 9.7%) reported a prior anaphylactic reaction. Using increasingly stringent criteria, we estimate that 5.1% (95% CI, 3.4% to 6.8%) and 1.6% (95% CI, 0.8% to 2.4%) had probable and very likely anaphylaxis, respectively. The patient survey included 1,059 respondents, of whom 344 reported a history of anaphylaxis. The most common triggers reported were medications (34%), foods (31%), and insect stings (20%). Forty-two percent sought treatment within 15 minutes of onset, 34% went to the hospital, 27% self-treated with antihistamines, 10% called 911, 11% self-administered epinephrine, and 6.4% received no treatment. Although most respondents with anaphylaxis reported 2 or more prior episodes (19% reporting ≥5 episodes), 52% had never received a self-injectable epinephrine prescription, and 60% did not currently have epinephrine available. Conclusions The prevalence of anaphylaxis in the general population is at least 1.6% and probably higher. Patients do not appear adequately equipped to deal with future episodes, indicating the need for public health initiatives to improve anaphylaxis recognition and treatment.
Colorectal cancer (CRC) is rapidly increasing in Asia, but screening guidelines are lacking. Through reviewing the literature and regional data, and using the modified Delphi process, the Asia ...Pacific Working Group on Colorectal Cancer and international experts launch consensus recommendations aiming to improve the awareness of healthcare providers of the changing epidemiology and screening tests available. The incidence, anatomical distribution and mortality of CRC among Asian populations are not different compared with Western countries. There is a trend of proximal migration of colonic polyps. Flat or depressed lesions are not uncommon. Screening for CRC should be started at the age of 50 years. Male gender, smoking, obesity and family history are risk factors for colorectal neoplasia. Faecal occult blood test (FOBT, guaiac-based and immunochemical tests), flexible sigmoidoscopy and colonoscopy are recommended for CRC screening. Double-contrast barium enema and CT colonography are not preferred. In resource-limited countries, FOBT is the first choice for CRC screening. Polyps 5-9 mm in diameter should be removed endoscopically and, following a negative colonoscopy, a repeat examination should be performed in 10 years. Screening for CRC should be a national health priority in most Asian countries. Studies on barriers to CRC screening, education for the public and engagement of primary care physicians should be undertaken. There is no consensus on whether nurses should be trained to perform endoscopic procedures for screening of colorectal neoplasia.
This study focuses on interannual variations of diurnal tropospheric heating and the response in the mesosphere observed by radars and predicted by a model. The work is prompted by reports of ...interannual variability in amplitudes of tidal variables at low latitudes. Diurnal tides observed at Hawaii and Christmas Island exhibit a pronounced “spike” in amplitude from late 1997 to early 1998. It has been speculated that this variability may be linked to the El Niño–Southern Oscillation phenomenon. We examine diurnal solar heating due to water vapor absorption, and diurnal latent heat release due to deep convection between 1988 and 2005. Both of these heating drives exhibit anomalously higher amplitudes in the tropical central and eastern Pacific during 1997–1998. The altered heating patterns result in a stronger forcing of the migrating diurnal tide by water vapor heating, and excitation of several weaker nonmigrating modes by latent heating. A primitive equation model is used to evaluate how these drives contribute to diurnal winds in the mesosphere. Anomalous water vapor heating results in about 15% increases in model meridional wind amplitudes over climatological values at subtropical latitudes between 300°E and the Greenwich meridian. While the timing of the model amplitude enhancements is consistent with observations at Hawaii, the observed increases are significantly stronger. Our study indicates that water vapor heating is the larger contributor to tidal enhancement observed during 1997–1998.
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