Evaluation of a stage II screening protocol for prostate cancer

In 2003, prostate cancer (PCa) is estimated to be the most commonly diagnosed cancer and third leading cause of cancer death in Canada. During PCa population screening, approximately 25% of patients with a normal digital rectal examination (DRE) and intermediate serum prostate specific antigen (PSA) level have PCa. Since all patients typically undergo biopsy, it is expected that approximately 75% of these procedures are unnecessary. The purpose of this study was to compare the degree of efficacy of clinical tests and algorithms in stage II screening for PCa while preventing unnecessary biopsies from occurring. The sample consisted of 201 consecutive men who were suspected of PCa based on the results of a DRE and serum PSA. These men were referred for venipuncture and transrectal ultrasound (TRUS). Clinical tests included TRUS, agespecific reference range PSA (Age-PSA), prostate specific antigen density (PSAD), and free-to-total prostate specific antigen ratio (%fPSA). Clinical results were evaluated individually and within algorithms. Cutoffs of 0.12 and 0.15 ng/ml/cc were employed for PSAD. Cutoffs that would provide a minimum sensitivity of 0.90 and 0.95, respectively were utilized for %fPSA. Statistical analysis included ROC curve analysis, calculated sensitivity (Sens), specificity (Spec), and positive likelihood ratio (LR), with corresponding confidence intervals (Cl). The %fPSA, at a 23% cutoff ({ Sens=0.92; CI, 0.06}, {Spec=0.4l; CI, 0.09}, {LR=1.56; CI, O.ll}), proved to be the most efficacious independent clinical test. The combination of PSAD (cutoff 0.15 ng/ml/cc) and %fPSA (cutoff 23%) ({Sens=0.93; CI, 0.06}, {Spec=0.38; CI, 0.08}, {LR=1.50; CI, 0.10}) was the most efficacious clinical algorithm. This study advocates the use of %fPSA at a cutoff of 23% when screening patients with an intermediate serum PSA and benign DRE.

Reality status evaluations in mediated experiences /

This paper explores the cognitive functions of the Reality Status Evaluation (RSE) system in our experiences of narrative mediated messages (NMM) (fictional, narrative, audio-visual one-way input and moving picture messages), such as fictional TV programs and films. We regard reality in mediated experiences as a special mental and emotional construction and a multi-dimensional concept. We argue that viewers' reality sense in NMM is influenced by many factors with "real - on" as the default value. Some of these factors function as primary mental processes, including the content realism factors of those messages such as Factuality (F), Social Realism (SR), Life Relevance (LR), and Perceptual Realism - involvement (PR), which would have direct impacts on reality evaluations. Other factors, such as Narrative Meaning (NM), Emotional Responses, and personality trait Absorption (AB), will influence the reality evaluations directly or through the mediations of these main dimensions. I designed a questionnaire to study this theoretical construction. I developed items to form scales and sub-scales measuring viewers' subjective experiences of reality evaluations and these factors. Pertinent statistical techniques, such as internal consistency and factorial analysis, were employed to make revisions and improve the quality of the questionnaire. In the formal experiment, after viewing two short films, which were selected as high or low narrative structure messages from previous experiments, participants were required to answer the questionnaire, Absorption questionnaire, and SAM (Self-Assessment Manikin, measuring immediate emotional responses). Results were analyzed using the EQS, structural equation modeling (SEM), and discussed in terms oflatent relations among these subjective factors in mediated experience. The present results supported most of my theoretical hypotheses. In NMM, three main jactors, or dimensions, could be extracted in viewers' subjective reality evaluations: Social Realism (combining with Factuality), Life Relevance and Perceptual Realism. I designed two ways to assess viewers' understanding of na"ative meanings in mediated messages, questionnaire (NM-Q) and rating (NM-R) measurement, and its significant influences on reality evaluations was supported in the final EQS models. Particularly in high story stnlcture messages, the effect of Narrative Meaning (NM) can rarely be explained by only these dimensions of reality evaluations. Also, Empathy seems to playa more important role in RSE of low story structure messages. Also, I focused on two other factors that were pertinent to RSE in NMM, the personality trait Absorption, and Emotional Responses (including two dimensions: Valence and Intensity). Final model results partly supported my theoretical hypotheses about the relationships among Absorption (AB), Social Realism (SR) and Life Relevance (LR); and the immediate impact of Emotional Responses on Perceptual Realism cPR).