Variation in use of surveillance colonoscopy among colorectal cancer survivors in the United States.

BACKGROUND: Clinical practice guidelines recommend colonoscopies at regular intervals for colorectal cancer (CRC) survivors. Using data from a large, multi-regional, population-based cohort, we describe the rate of surveillance colonoscopy and its association with geographic, sociodemographic, clinical, and health services characteristics. METHODS: We studied CRC survivors enrolled in the Cancer Care Outcomes Research and Surveillance (CanCORS) study. Eligible survivors were diagnosed between 2003 and 2005, had curative surgery for CRC, and were alive without recurrences 14 months after surgery with curative intent. Data came from patient interviews and medical record abstraction. We used a multivariate logit model to identify predictors of colonoscopy use. RESULTS: Despite guidelines recommending surveillance, only 49% of the 1423 eligible survivors received a colonoscopy within 14 months after surgery. We observed large regional differences (38% to 57%) across regions. Survivors who received screening colonoscopy were more likely to: have colon cancer than rectal cancer (OR = 1.41, 95% CI: 1.05-1.90); have visited a primary care physician (OR = 1.44, 95% CI: 1.14-1.82); and received adjuvant chemotherapy (OR = 1.75, 95% CI: 1.27-2.41). Compared to survivors with no comorbidities, survivors with moderate or severe comorbidities were less likely to receive surveillance colonoscopy (OR = 0.69, 95% CI: 0.49-0.98 and OR = 0.44, 95% CI: 0.29-0.66, respectively). CONCLUSIONS: Despite guidelines, more than half of CRC survivors did not receive surveillance colonoscopy within 14 months of surgery, with substantial variation by site of care. The association of primary care visits and adjuvant chemotherapy use suggests that access to care following surgery affects cancer surveillance.

Contrast in intracardiac acoustic radiation force impulse images of radiofrequency ablation lesions.

We have previously shown that intracardiac acoustic radiation force impulse (ARFI) imaging visualizes tissue stiffness changes caused by radiofrequency ablation (RFA). The objectives of this in vivo study were to (1) quantify measured ARFI-induced displacements in RFA lesion and unablated myocardium and (2) calculate the lesion contrast (C) and contrast-to-noise ratio (CNR) in two-dimensional ARFI and conventional intracardiac echo images. In eight canine subjects, an ARFI imaging-electroanatomical mapping system was used to map right atrial ablation lesion sites and guide the acquisition of ARFI images at these sites before and after ablation. Readers of the ARFI images identified lesion sites with high sensitivity (90.2%) and specificity (94.3%) and the average measured ARFI-induced displacements were higher at unablated sites (11.23 ± 1.71 µm) than at ablated sites (6.06 ± 0.94 µm). The average lesion C (0.29 ± 0.33) and CNR (1.83 ± 1.75) were significantly higher for ARFI images than for spatially registered conventional B-mode images (C = -0.03 ± 0.28, CNR = 0.74 ± 0.68).

Survival in 176 patients with inoperable non small cell lung cancer treated initially with chemotherapy in a district general hospital

In advanced non-small cell lung cancer (NSCLC) platinum based chemotherapy with second generation drugs improves median survival (MS) to 8 months and 29% and 10% at 1 and 2 years. Platinum with a third generation drug can improve survival further (BMJ 1995;311: 899) (Spiro et al. Thorax 2004;59:828 Big Lung Trial; N Engl J Med 2003;346:92 ECOG study). NICE now recommends chemotherapy with platinum and a third generation drug for inoperable NSCLC as the first treatment modality. Methods: We audited survival of 176/461 consecutive patients referred for at least 3 courses of platinum and either gemcitabine or vinorelbine from July 2001 to December 2005. Minimal follow up 17 months. Chemotherapy was given on site. Radical radiotherapy for stage IIIA, palliative radiotherapy and second line drugs were given as felt appropriate. Results: 64% were male. 30 (17%) were <55 years ; 66 (37.5%) age 55–65 years; 63 (35.8%) aged 66–75 and 16 (9.1%) >75 years. 5 (2.8%) were stage II; 46 (26%) stage IIIA; 68 (38%) stage IIIB and 55 (30.8%) stage IV. 68 (38%) had 0– 2 courses; 63 (36%) 3 courses and 44 (25%) had 4 or more.

Notes and memoranda

Hermit crabs and anemones Grayling and Loch Leven trout in salt water Eels and sticklebacks in sea water Phoronis at Plymouth Oyster culture in the River Yealm Notes on Ray's bream

Transregional linkages in the North-Eastern Atlantic - An ‘end-to-end ’ analysis of pelagic ecosystems

This review examines interregional linkages and gives an overview perspective on marine ecosystem functioning in the north-eastern Atlantic. It is based on three of the 'systems' considered by the European Network of Excellence for Ocean Ecosystems Analysis (EUR-OC EANS was established in 2004 under the European Framework VI funding programme to promote integration of marine ecological research within Europe), the Arctic and Nordic Seas, North Atlantic shelf seas and North Atlantic. The three systems share common open boundaries and the transport of water, heat, nutrients and particulates across these boundaries modifies local processes. Consistent with the EUR-OC EANS concept of 'end-to-end' analyses of marine food webs, the review takes an integrated approach linking ocean physics, lower trophic levels and working up the food web to top predators such as marine mammals. We begin with an overview of the regions focusing on the major physical patterns and their implications for the microbial community, phytoplankton, zooplankton, fish and top predators. Human-induced links between the regional systems are then considered and finally possible changes in the regional linkages over the next century are discussed. Because of the scale of potential impacts of climate change, this issue is considered in a separate section. The review demonstrates that the functioning of the ecosystems in each of the regions cannot be considered in isolation and the role of the atmosphere and ocean currents in linking the North Atlantic Ocean, North Atlantic shelf seas and the Arctic and Nordic Seas must be taken into account. Studying the North Atlantic and associated shelf seas as an integrated 'basin-scale' system will be a key challenge for the early twenty-first century. This requires a multinational approach that should lead to improved ecosystem-based approaches to conservation of natural resources, the maintenance of biodiversity, and a better understanding of the key role of the north-eastern Atlantic in the global carbon cycle.

Video games in the classrooms: implications of a disruptive innovation to develop the Multiple Intelligences

The present study aims to identify the framework of personal, organizational and technical variables that contribute to the viability and successful of innovative educational practices with video games within the school context to enhance the multiple intelligences. For this purpose, advantage was taken on the information previously collected through a questionnaire about the views, thoughts and experiences of a group of teachers of childhood and primary education (N=25) who voluntarily participated in a blended training activity from Center of Teachers (CEFIRE) of Valencia, around a community of practice aimed at promoting and advising projects for implementing educational video games in the classroom. The mixed methodology adopted has allowed the following: a) describe the relationship between their degree of development and daily use made of ICT in the classroom, their level of familiarity with video games,  their previous experience to integrate them for educational purposes..., and their participation in projects that focus on game-based learning; b) conduct content analysis of the opinions and thoughts expressed in a forum for teachers on innovation on and methodological strategies adopted reflected in a virtual board; and c) develop a SWOT analysis: Strengths, Weaknesses, Opportunities and Threats inherent in the implementation of experience with video games in the classroom. Among the conclusions, it is highlighted that, even though most did not have specific training or enough technological resources and the planning and implementation of innovation required them a great investment of time, their personal interest, the support given by members of the online community of practice, helped to encourage their activity, along with receptivity, positive attitude and high motivation of students with the experience. These aspects have been crucial to promote successful innovative practices with video games.

Funciones de la fotografía en las relaciones interculturales entre familias inmigrantes

En este artículo presentamos los resultados y el análisis de uno de los objetivos del proyecto I+D+i aprobado por el Ministerio de Economía y Competitividad de España titulado Mediaciones audiovisuales en las relaciones entre escuela y familias inmigrantes. Concretamente, el dirigido a conocer las funciones que tienen las imágenes fotográficas en las relaciones de un grupo de padres inmigrantes en el colegio al que asisten sus hijos e hijas. Los datos presentados corresponden a las narraciones biográfico-culturales y visuales iniciadas en las aulas por estas familias junto a la tutora del grupo, y continuadas en sus contextos personal y social. Concluimos que las fotografías en los relatos han tenido las funciones de: fuente de información, soporte de análisis, reflexión y debate y, finalmente, medio para comunicar el conocimiento experiencial generado. Dentro de esta última, se han utilizado tres procedimientos que hemos denominado: denotativo autorreferencial, connotativo texto-visual y secuencial.

Social Networks Usage Profile: Descriptive study with students in the University of Murcia

Telematic tools are very important for our lives in the present era and moreover this idea is made more evident if we analyse young people behaviours. However, it seems that the possibilities that these tools allow subjects from a professional point of view, beyond the purely playful aspects, are still not fully exploited both by subjects, neither by educational institutions where they learn. Our work studies the uses of social media in the context of university students. In order to this we have designed a research based on quantitative methodology with a survey. We have applied a questionnaire to students in the University of Murcia. The questionnaire was answered by 487 students in the first half of 2014. The survey results confirm our hypothesis that social networks are part of the basic and habitual tools of communication between the youth of our university and eminently used for leisure purposes, and that the tools used for more academic activities are those allowing greater control of privacy.