Wide Variation in Adenoma Detection Rates at Screening Flexible Sigmoidoscopy

Background & Aims: Wide between-center variation in adenoma detection rates (ADRs) was observed in the U.K. Flexible Sigmoidoscopy Screening Trial (overall, 12.1%; range, 8.6%-15.9%; P <0.0001). The aim of this study was to determine whether the observed differences could be attributed to varying performance by endoscopists, to examine the effect of experience on performance, and to identify an attainable, standard ADR to which endoscopists could aspire. 

Methods: Thirteen medical endoscopists, one per trial center, each performed about 3000 examinations (200 per month) using the same equipment and protocol. Overall and monthly ADRs were compared using multivariable logistic regression. 

Results: Differences in ADRs were not explained by patient characteristics, incidence of colorectal cancer in the local population, or the endoscopists' medical specialty or previous experience. Average ADRs increased significantly with screening experience (up to 400 examinations). Endoscopists were classified as higher, intermediate, or lower adenoma detectors, and performance levels were maintained over time. Higher detectors had ADRs of 15% overall (men, 20%; women, 10%) and also detected more adenomas per case (higher/lower detectors, 21.7/10.4 adenomas per :100 examinations). 

Conclusions: The differences in ADRs were due to variation in performance of the endoscopists. Long-term follow-up will determine whether this variation is clinically important. We suggest that the standards in higher detecting centers should be achievable by all endoscopists screening unscreened populations aged older than 55 years. Endoscopists should aim to stay above the lower 95% confidence interval band for 200 examinations (10% overall; 5% in women, 15% in men).

The VLT-FLAMES survey of massive stars: Observations in the Galactic clusters NGC 3293, NGC 4755 and NGC 6611

We introduce a new survey of massive stars in the Galaxy and the Magellanic Clouds using the Fibre Large Array Multi- Element Spectrograph ( FLAMES) instrument at the Very Large Telescope ( VLT). Here we present observations of 269 Galactic stars with the FLAMES- Giraffe Spectrograph ( R similar or equal to 25 000), in fields centered on the open clusters NGC3293, NGC4755 and NGC6611. These data are supplemented by a further 50 targets observed with the Fibre- Fed Extended Range Optical Spectrograph ( FEROS, R = 48 000). Following a description of our scientific motivations and target selection criteria, the data reduction methods are described; of critical importance the FLAMES reduction pipeline is found to yield spectra that are in excellent agreement with less automated methods. Spectral classifications and radial velocity measurements are presented for each star, with particular attention paid to morphological peculiarities and evidence of binarity. These observations represent a significant increase in the known spectral content of NGC3293 and NGC4755, and will serve as standards against which our subsequent FLAMES observations in the Magellanic Clouds will be compared.

The massive binary companion star to the progenitor of supernova 1993J

The massive star that underwent a collapse of its core to produce supernova (SN)1993J was subsequently identified as a non-variable red supergiant star in images of the galaxy M81 taken before explosion(1, 2). It showed an excess in ultraviolet and B-band colours, suggesting either the presence of a hot, massive companion star or that it was embedded in an unresolved young stellar association1. The spectra of SN1993J underwent a remarkable transformation from the signature of a hydrogen-rich type II supernova to one of a helium-rich (hydrogen-deficient) type Ib(3, 4). The spectral and photometric peculiarities were best explained by models in which the 13�20 solar mass supergiant had lost almost its entire hydrogen envelope to a close binary companion(5, 6, 7), producing a 'type IIb' supernova, but the hypothetical massive companion stars for this class of supernovae have so far eluded discovery. Here we report photometric and spectroscopic observations of SN1993J ten years after the explosion. At the position of the fading supernova we detect the unambiguous signature of a massive star: the binary companion to the progenitor.

Chemical abundances and winds of massive stars in M31: a B-type supergiant and a WC star in OB 10

We present high quality spectroscopic data for two massive stars in the OB 10 association of M31, OB 10-64 (B0 la) and OB 10-WRI (WC6). Medium resolution spectra of both stars were obtained using the ISIS spectrograph on the William Herschel Telescope. This is supplemented with Hubble Space Telescope STIS UV spectroscopy and Keck I HIRES data for OB 10-64. A non- local thermodynamic equilibrium (LTE) model atmosphere and abundance analysis for OB 10-64 is presented, indicating that this star has similar photospheric CNO, Mg and Si abundances to solar neighbourhood massive stars. A wind analysis of this early B-type supergiant reveals a mass-loss rate of (M)over dot = 1.6 x 10(-6) M-circle dot yr(-1), and v(infinity) = 1650 km s(-1). The corresponding wind momentum is in good agreement with the wind momentum-luminosity relationship found for Galactic early-B supergiants. Observations of OB 10-WRI are analysed using a non-LTE, line-blanketed code, to reveal approximate stellar parameters of log L/L-circle dot similar to 5.7, T-* - 75 kK, v(infinity) similar to 3000 km s(-1), (M)over dot/(M-circle dot yr(-1)) similar to 10(-4.3) adopting a clumped wind with a filling factor of 10 per cent. Quantitative comparisons are made with the Galactic WC6 star HD 92809 (WR23) revealing that OB 10-WR1 is 0.4 dex more luminous, though it has a much lower C/He ratio (similar to0.1 versus 0.3 for HD 92809). Our study represents the first detailed, chemical model atmosphere analysis for either a B-type supergiant or a Wolf- Rayet (WR) star in Andromeda, and shows the potential of how such studies can provide new information on the chemical evolution of galaxies and the evolution of massive stars in the local Universe.

The VLT-FLAMES survey of massive stars: stellar parameters and rotational velocities in NGC 3293, NGC 4755 and NGC 6611

An analysis is presented of VLT-FLAMES spectroscopy for three Galactic clusters, NGC3293, NGC4755 and NGC6611. Non-LTE model atmosphere calculations have been used to estimate effective temperatures (from either the helium spectrum or the silicon ionization equilibrium) and gravities (from the hydrogen spectrum). Projected rotational velocities have been deduced from the helium spectrum (for fast and moderate rotators) or the metal line spectrum (for slow rotators). The origin of the low gravity estimates for apparently near main sequence objects is discussed and is related to the stellar rotational velocity. The atmospheric parameters have been used to estimate cluster distances (which are generally in good agreement with previous determinations) and these have been used to estimate stellar luminosities and evolutionary masses. The observed Hertzsprung-Russell diagrams are compared with theoretical predictions and some discrepancies including differences in the main sequence luminosities are discussed. Cluster ages have been deduced and evidence for non-coeval star formation is found for all three of the clusters. Projected rotational velocities for targets in the older clusters, NGC3293 and NGC4755, have been found to be systematically larger than those for the field, confirming recent results in other similar age clusters. The distribution of projected rotational velocities are consistent with a Gaussian distribution of intrinsic rotational velocities. For the relatively unevolved targets in the older clusters, NGC3293 and NGC4755, the peak of the velocity distribution would be 250 km s(-1) with a full-width-half-maximum of approximately 180 km s(-1). For NGC6611, the sample size is relatively small but implies a lower mean rotational velocity. This may be evidence for the spin-down effect due to angular momentum loss through stellar winds, although our results are consistent with those found for very young high mass stars. For all three clusters we deduce present day mass functions with Gamma-values in the range of -1.5 to -1.8, which are similar to other young stellar clusters in the Milky Way.

The VLT-FLAMES survey of massive stars: mass loss and rotation of early-type stars in the SMC

We have studied the optical spectra of a sample of 31 O- and early B-type stars in the Small Magellanic Cloud, 21 of which are associated with the young massive cluster NGC 346. Stellar parameters are determined using an automated fitting method (Mokiem et al. 2005, A&A, 441, 711), which combines the stellar atmosphere code FASTWIND (Puls et al. 2005, A&A, 435, 669) with the genetic algorithm based optimisation routine PIKAIA (Charbonneau 1995, ApJS, 101, 309). Comparison with predictions of stellar evolution that account for stellar rotation does not result in a unique age, though most stars are best represented by an age of 1-3 Myr. The automated method allows for a detailed determination of the projected rotational velocities. The present day v(r) sin i distribution of the 21 dwarf stars in our sample is consistent with an underlying rotational velocity (v(r)) distribution that can be characterised by a mean velocity of about 160-190 km s(-1) and an effective half width of 100-150 km s(-1). The vr distribution must include a small percentage of slowly rotating stars. If predictions of the time evolution of the equatorial velocity for massive stars within the environment of the SMC are correct (Maeder & Meynet 2001, A&A, 373, 555), the young age of the cluster implies that this underlying distribution is representative for the initial rotational velocity distribution. The location in the Hertzsprung-Russell diagram of the stars showing helium enrichment is in qualitative agreement with evolutionary tracks accounting for rotation, but not for those ignoring vr. The mass loss rates of the SMC objects having luminosities of log L-star/L-circle dot greater than or similar to 5.4 are in excellent agreement with predictions by Vink et al. (2001, A&A, 369, 574). However, for lower luminosity stars the winds are too weak to determine. M accurately from the optical spectrum. Three targets were classified as Vz stars, two of which are located close to the theoretical zero-age main sequence. Three lower luminosity targets that were not classified as Vz stars are also found to lie near the ZAMS. We argue that this is related to a temperature effect inhibiting cooler from displaying the spectral features required for the Vz luminosity class.