Primary Prevention and Screening Strategies for Colorectal Cancer: Which Strategy Should Take?

Objective: To explore and define the utility of different strategies for primary prevention (ASA, diet, physical activity) and strategies of screening test (FOBT, sigmoidoscopy, colonoscopy, etc.) for colorectal cancer. Data source: Databases consulted were MEDLINE (1966 to 2006), DARE (1980 to 2006), Cochrane Central Register of Controlled Trials, Cochrane Collaboration’s Registry of Clinical Trials, Cochrane Database of Systematic Reviews and LILACS. Study selection: Studies such clinical trial, cohort and case-control studies of the effectiveness of tests for screening and primary prevention adenoma and colorectal cancer were identified by two reviewers. Data Extraction: The extraction of data and its evaluation is done in most of the process so paired. Limitations: Not strictly complies with the methodology of a systematic review and therefore reproducibility is questionable, the conclusions of this study should be extrapolated with caution. Conclusions: The major strategy of screening on the effectiveness of early detection of premalignant lesions or cancer is colonoscopy every 5 years, however it is necessary to evaluate this measure cost-effectiveness studies. For primary prevention, aspirin and cyclooxygenase-2 inhibitors reduce the incidence of colorectal adenomas. Aspirin can reduce colorectal cancer incidence. However, these medications may be associated with a significant risk of cardiovascular events and gastrointestinal bleeding. The balance between risks and benefits must be evaluated in future studies.

The use of music education in oral schools for children who are deaf and hard of hearing

This paper is a survey and discussion of the teaching methods, objectives, and benefits associated with music programs in oral schools for children who are deaf and hard of hearing.

Economic assessment of bovine tuberculosis and alternative policies

Break-even analyses of the costs and benefits of six alternative bovine tuberculosis (bTB) control strategies were undertaken. The results show that some strategies, such as zoning, would require relatively small reductions in bTB incidence as a result to be cost effective, whilst for others, such as proactive badger removal, the costs would require a substantial and relatively rapid reduction in bTB incidence to be worthwhile.

Categories of GM risk-benefit perceptions and their antecedents

The stated benefits and perceived risks of genetic modification (GM) cover very diverse issues, such as food safety, world food security, and the environment, that may differentially affect consumer acceptance. In this research, we hypothesize that consumers perceive up to eight dimensions: risks to business (farmers, agribusiness, etc.), benefits to business, risks and benefits to the environment, risks and benefits to the developing world, and risks and benefits to self and family. Moral concerns are also recognized. Using data collected in 2002 in the United States, France, and the UK, we investigate these different dimensions. Second, we analyze the extent to which the dimensions of risk-benefit perceptions can be explained by general attitudes widely used to explain food purchase behavior (such as general attitude to the environment, to technology, etc.), as well as by perceived knowledge of GM, level of education, and trust in various sources of information. In all locations, the majority of consumers only perceive a medium level of risk from GM products. Attitude to technology is the most important attitude variable—those with a positive attitude to technology in general also have a positive attitude to GM technology. More Americans than Europeans fall into this category. Those who trust government and the food industry tend to think GM technology is less risky, whereas those who trust activists believe the opposite. Americans are more trusting of the former, Europeans of the latter. Level of education is positively associated with benefit perceptions and negatively associated with moral concerns. Location continues to play a limited independent role in explaining perceptions even after these factors have been taken into account.

Communities of practice in construction case study organisations: questions and insights

Purpose – At the heart of knowledge management (KM) are the people – an organisation's important knowledge asset. Although this is widely acknowledged, businesses seldom understand this axiom in terms of the communities through which individuals develop and share the capacity to create and use knowledge. It is the collective learning that takes place within the social systems, i.e. communities of practice (CoP) that are of particular significance to an organisation from a KM perspective. This paper aims to review, critique, and raise some pertinent questions on the role of CoPs; and with the help of case studies shed light on the “goings-on” in construction practices. Design/methodology/approach – After critically reviewing the literature on CoPs and querying some underlying assertions, this research investigates how these issues are addressed in practice. A case study approach is adopted. Three organisations operating in the construction sector are interviewed for the purpose of this paper. Findings – Case study findings highlight the potential challenges and benefits of CoPs to a construction organisation, the role they play in generating and delivering value to the organisation and their contribution towards the collective organisational intelligence. From the findings, it is clear that the question is not whether communities exist within organisations, but how they deliver value to the organisation. From an organisational perspective, the key challenge is to provide an environment that is conducive to developing and nurturing such communities as opposed to merely creating them. Practical implications – Challenges and benefits demonstrated through the case studies should be taken in context. The findings are not intended to be prescriptive in nature, but are intentionally descriptive to provide contextual data that allow readers to draw their own inferences in the context of their organisations. They should be applied taking into account an organisation's unique characteristics and differentiators, the dynamics of the environment in which it operates and the culture it harbours within. Originality/value – Investigating the role of CoPs in the context of case study construction organisations forms the prime focus of this paper.

The influence of changing nicotine to tar ratios on human puffing behaviour and perceived sensory response

Rationale. Smokers modify their smoking behaviour when switching from their usual product to higher or lower tar and nicotine-yield cigarettes. Objective. The aims of the current study were to assess the influence of varying nicotine yields at constant tar yield on human puffing measures, nicotine deliveries under human smoking conditions and the sensory response to mainstream cigarette smoke. These assessments would allow an evaluation of the degree of compensation and the various possible causes of changes, if any. Methods. The participants were 13 regular smokers of commercial or hand-rolled cigarettes. They were tested with four cigarettes, which exhibited a wide range of nicotine to 'tar' ratios at a relatively constant 'tar' yield. Their smoking behaviour was monitored by placing the test cigarettes into an orifice-type holder/flowmeter attached to a custom-built smoker behaviour analyser. In addition, a comprehensive sensory evaluation of the products was carried out. Results. The differences in the nicotine to tar ratios of the samples did not significantly influence the puffing behaviour patterns, i.e. puff number and interval, total and average puff volume, integrated pressure and puff duration. Additionally the pre- to post-exhaled CO boosts were not significantly influenced by the experimental samples used in the study. However, the nicotine yields obtained by the smokers were significantly influenced by the machine-smoked nicotine yields or the nicotine to tar ratios of the samples. The machine-smoked nicotine yields were highly correlated with the nicotine yields obtained under human smoking conditions. For the sensory evaluation, there was only a significant difference between the samples in the intensity of the impact. Conclusion. These observations imply that these puffing variables are not controlled by the nicotine yield of the cigarette.

Patients' understanding of risk associated with medication use: impact of European Commission guidelines and other risk scales

Patients want and need comprehensive and accurate information about their medicines so that they can participate in decisions about their healthcare: In particular, they require information about the likely risks and benefits that are associated with the different treatment options. However, to provide this information in a form that people can readily understand and use is a considerable challenge to healthcare professionals. One recent attempt to standardise the Language of risk has been to produce sets of verbal descriptors that correspond to specific probability ranges, such as those outlined in the European Commission (EC) Pharmaceutical Committee guidelines in 1998 for describing the incidence of adverse effects. This paper provides an overview of a number of studies involving members of the general public, patients, and hospital doctors, that evaluated the utility of the EC guideline descriptors (very common, common, uncommon, rare, very rare). In all studies it was found that people significantly over-estimated the likelihood of adverse effects occurring, given specific verbal descriptors. This in turn resulted in significantly higher ratings of their perceived risks to health and significantly lower ratings of their likelihood of taking the medicine. Such problems of interpretation are not restricted to the EC guideline descriptors. Similar levels of misinterpretation have also been demonstrated with two other recently advocated risk scales (Caiman's verbal descriptor scale and Barclay, Costigan and Davies' lottery scale). In conclusion, the challenge for risk communicators and for future research will be to produce a language of risk that is sufficiently flexible to take into account different perspectives, as well as changing circumstances and contexts of illness and its treatments. In the meantime, we urge the EC and other legislative bodies to stop recommending the use of specific verbal labels or phrases until there is a stronger evidence base to support their use.

Last Glacial Maximum CO2 and δ13C successfully reconciled

During the Last Glacial Maximum (LGM, ∼21,000 years ago) the cold climate was strongly tied to low atmospheric CO2 concentration (∼190 ppm). Although it is generally assumed that this low CO2 was due to an expansion of the oceanic carbon reservoir, simulating the glacial level has remained a challenge especially with the additional δ13C constraint. Indeed the LGM carbon cycle was also characterized by a modern-like δ13C in the atmosphere and a higher surface to deep Atlantic δ13C gradient indicating probable changes in the thermohaline circulation. Here we show with a model of intermediate complexity, that adding three oceanic mechanisms: brine induced stratification, stratification-dependant diffusion and iron fertilization to the standard glacial simulation (which includes sea level drop, temperature change, carbonate compensation and terrestrial carbon release) decreases CO2 down to the glacial value of ∼190 ppm and simultaneously matches glacial atmospheric and oceanic δ13C inferred from proxy data. LGM CO2 and δ13C can at last be successfully reconciled.

Access to the countryside of England and Wales: popular leisure; commodified culture

Risk and uncertainty are, to say the least, poorly considered by most individuals involved in real estate analysis - in both development and investment appraisal. Surveyors continue to express 'uncertainty' about the value (risk) of using relatively objective methods of analysis to account for these factors. These methods attempt to identify the risk elements more explicitly. Conventionally this is done by deriving probability distributions for the uncontrolled variables in the system. A suggested 'new' way of "being able to express our uncertainty or slight vagueness about some of the qualitative judgements and not From its modern origins, associated with the urbanising effect of industrialisation, walking has remained a popular form of outdoor recreation. It has, furthermore, remained an important site of class struggle, with the 'landless' seeking to establish their moral 'citizen' right to roam over open country in contradistinction to the 'landed', who have successfully limited this right to legally-defined public rights of way. In the face of declining farm incomes, however, farmers and landowners have, apparently, modified their attitudes towards public access, but only in return for compensation and management payments under grant schemes such as Countryside Stewardship and the Countryside Premium Scheme. With the Ministry of Agriculture, Fisheries and Food now seeking to extend paid access arrangements to other grant schemes, as part of its response to the European Union's Agri-Environment Regulations, access 'rights' are assuming an increasingly commodified form, thereby questioning, if not undermining, the former citizen claims. For rather than being a benefit of citizenship, the existence of limited, often poorly maintained and inadequately signposted, public rights of way has tied inextricably the extension of legally-enforceable access to the needs of the landowners and farmers. At a time of falling prosperity in agriculture, therefore, they have now exercised their discretion by annexing the populism of consumer culture to reproduce the bourgeois liberal values of the market as a principal determinant of the extension of citizen rights of access to the countryside.

Moving the nanoscience and technology (NST) debate forwards: short-term impacts, long-term uncertainty and the social constitution

Nanoscience and technology (NST) are widely cited to be the defining technology for the 21st century. In recent years, the debate surrounding NST has become increasingly public, with much of this interest stemming from two radically opposing long-term visions of a NST-enabled future: ‘nano-optimism’ and ‘nano-pessimism’. This paper demonstrates that NST is a complex and wide-ranging discipline, the future of which is characterised by uncertainty. It argues that consideration of the present-day issues surrounding NST is essential if the public debate is to move forwards. In particular, the social constitution of an emerging technology is crucial if any meaningful discussion surrounding costs and benefits is to be realised. An exploration of the social constitution of NST raises a number of issues, of which unintended consequences and the interests of those who own and control new technologies are highlighted.

A climate of control: flooding, displacement and planned resettlement in the Lower Zambezi River valley, Mozambique

In recent years, the potential role of planned, internal resettlement as a climate change adaptation measure has been highlighted by national governments and the international policy community. However, in many developing countries, resettlement is a deeply political process that often results in an unequal distribution of costs and benefits amongst relocated persons. This paper examines these tensions in Mozambique, drawing on a case study of flood-affected communities in the Lower Zambezi River valley. It takes a political ecology approach – focusing on discourses of human-environment interaction, as well as the power relationships that are supported by such discourses – to show how a dominant narrative of climate change-induced hazards for small-scale farmers is contributing to their involuntary resettlement to higher-altitude, less fertile areas of land. These forced relocations are buttressed by a series of wider economic and political interests in the Lower Zambezi River region, such dam construction for hydroelectric power generation and the extension of control over rural populations, from which resettled people derive little direct benefit. Rather than engaging with these challenging issues, most international donors present in the country accept the ‘inevitability’ of extreme weather impacts and view resettlement as an unfortunate and, in some cases, necessary step to increase people’s ‘resilience’, thus rationalising the top-down imposition of unpopular social policies. The findings add weight to the argument that a depoliticised interpretation of climate change can deflect attention away from underlying drivers of vulnerability and poverty, as well as obscure the interests of governments that are intent on reordering poor and vulnerable populations.

A normative method to analyse workarounds in a healthcare environment: motivations, consequences, and constraints

Healthcare information systems have the potential to enhance productivity, lower costs, and reduce medication errors by automating business processes. However, various issues such as system complexity and system abilities in a relation to user requirements as well as rapid changes in business needs have an impact on the use of these systems. In many cases failure of a system to meet business process needs has pushed users to develop alternative work processes (workarounds) to fill this gap. Some research has been undertaken on why users are motivated to perform and create workarounds. However, very little research has assessed the consequences on patient safety. Moreover, the impact of performing these workarounds on the organisation and how to quantify risks and benefits is not well analysed. Generally, there is a lack of rigorous understanding and qualitative and quantitative studies on healthcare IS workarounds and their outcomes. This project applies A Normative Approach for Modelling Workarounds to develop A Model of Motivation, Constraints, and Consequences. It aims to understand the phenomenon in-depth and provide guidelines to organisations on how to deal with workarounds. Finally the method is demonstrated on a case study example and its relative merits discussed.

A new scenario framework for climate change research: background, process, and future directions

The scientific community is developing new global, regional, and sectoral scenarios to facilitate interdisciplinary research and assessment to explore the range of possible future climates and related physical changes that could pose risks to human and natural systems; how these changes could interact with social, economic, and environmental development pathways; the degree to which mitigation and adaptation policies can avoid and reduce risks; the costs and benefits of various policy mixes; residual impacts under alternative pathways; and the relationship of future climate change and adaptation and mitigation policy responses with sustainable development. This paper provides the background to and process of developing the conceptual framework for these scenarios, as described in the three subsequent papers in this Special Issue (Van Vuuren et al.; O’Neill et al.; Kriegler et al.). The paper also discusses research needs to further develop and apply this framework. A key goal of the current framework design and its future development is to facilitate the collaboration of climate change researchers from a broad range of perspectives and disciplines to develop policy- and decision-relevant scenarios and explore the challenges and opportunities human and natural systems could face with additional climate change.

Flood inundation dynamics and socioeconomic vulnerability under environmental change

Floods are a major threat to human existence and historically have both caused the collapse of civilizations and forced the emergence of new cultures. The physical processes of flooding are complex. Increased population, climate variability, change in catchment and channel management, modified landuse and land cover, and natural change of floodplains and river channels all lead to changes in flood dynamics, and as a direct or indirect consequence, social welfare of humans. Section 5.16.1 explores the risks and benefits brought about by floods and reviews the responses of floods and floodplains to climate and landuse change. Section 5.08.2 reviews the existing modeling tools, and the top–down and bottom–up modeling frameworks that are used to assess impacts on future floods. Section 5.08.3 discusses changing flood risk and socioeconomic vulnerability based on current trends in emerging or developing countries and presents an alternative paradigm as a pathway to resilience. Section 5.08.4 concludes the chapter by stating a portfolio of integrated concepts, measures, and avant-garde thinking that would be required to sustainably manage future flood risk.

Building the web: the Internet and the property profession

The report examines the development of the Internet and Intranets in the world of business and commerce, drawing on previous literature and research. The new technology is explained, and key issues examined, such as the impact of the Internet on the surveyor's role as 'information broker' and its likely effect on clients' property requirements. The research is based on an analysis of 261 postal questionnaire responses and eight case study interviews from a sample of general practice and quantity surveying practices and corporates. For the first time the property profession is examined in detail and the key drivers, barriers and benefits of Internet use are identified for a range of different sized organisations.