bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive mesh refinement method based investigation of the interaction between shock wave, boundary layer, and tip vortex in a transonic compressor
Authors: Gou Jinlan , Yuan Xin , Su Xinrong
Published: January 2017

Shock wave and tip leakage are important flow features at small length scales. These flow phenomena and their interactions play important roles in the performance of modern transonic fans and compressors. In most numerical predictions of these features, mesh convergence studies are conducted using overall performance data as criteria. However, less effort is made in assessing the quality of the predicted small-scale features using a mesh that yields a fairly accurate overall performance. In this work, this problem is addressed using the adaptive mesh refinement (AMR) method, which automatically refines the local mesh and provides very high resolution for the small-scale flow feature, at much less cost compared with globally refining the mesh. An accurate and robust AMR system suitable for turbomachinery applications is developed in this work and the widely studied NASA Rotor-37 case is investigated using the current AMR method. The complex interactions between the shock wave and the boundary layer, as well as those between the shock wave and the tip vortex, are accurately captured by AMR with a very high local grid resolution, and the flow mechanisms are analyzed in detail. The baseline mesh, which is considered to be “acceptable” according to the commonly used mesh convergence study, is unable to capture the detailed interaction between the shock wave and the boundary layer. Moreover, it falsely predicts the tip leakage vortex breakdown, which is a consequence of inadequate resolution in the tip region. Current work highlights the importance of a careful check of the mesh convergence, if small-scale features are the primary concern. The AMR method developed in this work successfully captures the flow details in the transonic compressor in an automatic fashion, and has been verified to be efficient compared with the globally mesh refinement or manually mesh regeneration.
Low-intensity vibrations normalize adipogenesis-induced morphological and molecular changes of adult mesenchymal stem cells
Authors: Baskan Oznur , Mese Gulistan , Ozcivici Engin
Published: January 2017

Bone marrow mesenchymal stem cells that are committed to adipogenesis were exposed daily to high-frequency low-intensity mechanical vibrations to understand molecular, morphological and ultrastructural adaptations to mechanical signals during adipogenesis. D1-ORL-UVA mouse bone marrow mesenchymal stem cells were cultured with either growth or adipogenic medium for 1 week. Low-intensity vibration signals (15 min/day, 90 Hz, 0.1 g) were applied to one group of adipogenic cells, while the other adipogenic group served as a sham control. Cellular viability, lipid accumulation, ultrastructure and morphology were determined with MTT, Oil-Red-O staining, phalloidin staining and atomic force microscopy. Semiquantitative reverse transcription polymerase chain reaction showed expression profile of the genes responsible for adipogenesis and ultrastructure of cells. Low-intensity vibration signals increased viability of the cells in adipogenic culture that was reduced significantly compared to quiescent controls. Low-intensity vibration signals also normalized the effects of adipogenic condition on cell morphology, including area, perimeter, circularization and actin cytoskeleton. Furthermore, low-intensity vibration signals reduced the expression of some adipogenic markers significantly. Mesenchymal stem cells are sensitive and responsive to mechanical loads, but debilitating conditions such as aging or obesity may steer mesenchymal stem cells toward adipogenesis. Here, daily application of low-intensity vibration signals partially neutralized the effects of adipogenic induction on mesenchymal stem cells, suggesting that these signals may provide an alternative and/or complementary option to reduce fat deposition.
Prevalence of Bacterial Vaginosis and its Association with Genital Infections, Inflammation, and Contraceptive Methods in Women Attending Sexually Transmitted Disease and Primary Health Clinics
Authors: Moi Harold
Published: January 2017

In an epidemiological survey of 2128 women attending a sexually transmitted diseases clinic for the first time and 200 attending two primary health clinics, 26% and 27% respectively were found to have bacterial vaginosis. The prevalence increased significantly with age, being diagnosed in 22.8% (326/1431) of women aged 14–24 years, and in 33.3% (232/697) of those aged >25 years. Bacterial vaginosis was associated with gonorrhoea and with chlamydial infection, but was negatively associated with genital papillomavirus infection and yeast infection. Women using barrier contraceptives had a significantly lower prevalence of bacterial vaginosis than those using an intrauterine device or no contraceptive. Women <24 years old using oral contraceptives had a significantly lower prevalence of bacterial vaginosis than those not using contraceptives. Patients without gonorrhoea or chlamydial infection but with vaginal or urethral inflammatory signs had a significantly higher prevalence of bacterial vaginosis than those without inflammatory signs. These findings may have implications regarding complications associated with lower genital tract infections and may strengthen the hypothesis that bacterial vaginosis is a risk factor for pelvic inflammatory disease.
Experience in Sheffield: Follow-Up of Abnormal Cervical Cytology
Authors: Woolley P D , Talbot M D
Published: January 2017

Failure to re-attend for follow-up is a significant problem in patients attending genitourinary clinics. In this study, despite the efforts made to trace patients with cervical cytological abnormalities, adequate follow-up or further investigation was achieved in only 15.3% of women with inflammatory changes on initial cytology, 38.5% with herpes simplex virus changes, 34.5% with human papillomavirus changes, 60.8% with mild dyskaryosis, 79.9% with moderate dyskaryosis and 97% with severe dyskaryosis. Until the natural history of the minimal atypias is more fully understood, it may be that more vigorous surveillance in such women should be considered.
Sexually Transmitted Diseases in Men in Mogadishu, Somalia
Authors: Ismail S O , Ahmed H Jama , Grillner L , Hederstedt B , Issa A , Bygdeman S M
Published: January 2017

The prevalence of viral and bacterial sexually transmitted diseases were studied in 101 men attending a dermatovenereal outpatient clinic in Mogadishu. A control group of 103 healthy adult men were included for the serological part of the study. Serological markers of hepatitis B virus (HBV), human immunodeficiency virus (HIV), cytomegalovirus (CMV) and herpes simplex virus (HSV) were studied. All sera were tested for syphilis markers. HBV serum markers were detected in 84% of the men in the study group and 66% of the healthy controls ( P<0.005). Hepatitis B virus carriers were detected more frequently in the study group than among the controls. Also, 96% of the men in both groups had CMV antibodies and all of them had antibodies to HSV. No sera were found to contain HIV antibodies. The TPHA-positivity was 10% and 3% in the study and control groups respectively, and 5% of the patients had syphilis IgM antibodies. Sexual contact with prostitutes was recorded in 54% and 48% respectively of patients and controls, and such contact was correlated with TPHA-positivity in the study group. Chlamydia trachomatis antigen was detected in urogenital specimens of 14% of the men in the study group and gonococcal culture was positive in 53% of those with urethral discharge.
Human Immunodeficiency Virus Surveillance at a Sexually Transmitted Diseases Clinic in Copenhagen
Authors: Worm Anne-Marie , Kvinesdal Birgit
Published: January 2017

During four study periods, each of 3–4 weeks' duration in 1987 and 1988, all patients attending the Copenhagen outpatient Venereal Disease Clinic were encouraged to have a test for human immunodeficiency virus (HIV) antibody. Anonymous testing or testing for research purposes only without any data was also offered. Patients known to be HIV antibody-positive were not re-tested. A total of 1753 patients (1118 men, 635 women) were counselled and testing recommended. Testing was refused by 255 patients, 57 of whom had been tested (all negative) within the previous 3 months. HIV serology was therefore unknown in 11.7% (198 of 1696 persons), including 120 of 922 heterosexual men (13%), 16 of 159 homo/bisexual men (10%) and 62 of 615 women (10%). There was no substantial difference between the four study periods in the numbers refusing the test. Sixteen of the 1498 patients tested were HIV antibody-positive, including one woman and 3 men with a history of intravenous drug abuse and 11 homo/bisexual men; one heterosexual man with HIV antibodies had no known risk behaviour.

It is concluded that HIV testing with informed consent at a sexually transmitted disease clinic will not include all persons, and therefore will not exclude a self-selection bias. Surveillance studies using unlinked HIV testing are therefore necessary and it is recommended that they should be performed in Denmark. In this study, unlinked HIV testing of the serum specimens taken for syphilis serology would have decreased the percentage of non-attenders' from 12.4% to 0.8% during the final study period.
New Initiatives in a District AIDS Counselling Unit, 1988–89
Authors: Bor Robert , Elford Jonathan , Perry Lucy , Salt Heather , Miller Riva , Johnson Margaret
Published: January 2017

This paper describes the workload of the AIDS Counselling Unit in Hampstead District Health Authority during its second year of service. Between April 1988 and March 1989, the average number of patients seen each month by the Unit doubled. It is anticipated that the caseload in the district will continue to increase, both among those with human immunodeficiency virus (HIV) infection and those without. New initiatives were developed within the district during the year. These included a new inpatient facility for patients with the acquired immunodeficiency syndrome (AIDS), the appointment of a designated HIV/AIDS consultant, and counselling services for people attending the antenatal clinic as well as those entering drug trials. Appropriate counselling services will need to be established in other health districts to meet local demand.
Characteristics of a Population Volunteering for Human Immunodeficiency Virus Immunization
Authors: Westblom T U , Belshe R B , Gorse G J , Anderson E L , Berry C F ,   NIAID AIDS Clinical Trials Network
Published: January 2017

A total of 166 volunteers for an AIDS vaccine study (VaxsynR baculovirus produced recombinant GP160; MicroGeneSys Inc, West Haven, Connecticut, USA) were interviewed and examined. Blood was collected for routine laboratory testing as well as T-cell counts, HIV ELISA (EIA), Western blot (WB) and p24 Ag. Eighty-five men (mean age 22.2 years, range 18–42) and 81 women (mean age 23.9 years, range 17–50) volunteered; 130/166 (78%) were university students. Most had learned of the study from news media (55%), friends or workplace (37%). The most common causes for exclusion were the presence of indeterminate WB (26.5%) or a change of mind after the initial interview (24%). Other causes were abnormal cell count and differential (7.2%), elevated alanine aminotransferase (3.6%), positive hepatitis B antibody (3.6%), abnormal urinalysis (3.4%), recent venereal disease (3.0%), T4 cell count <400 (1.9%), abnormal chest X-ray (1.7%), recognized high-risk behaviour (1.7%), multiple sex partners (1.2%), positive rapid plasma reagin test (1.2%), failure to meet age criteria (1.2%), unable to be available for entire study (1.2%), abnormal physical examination (0.6%) and positive p24 Ag (0.6%). No volunteers had positive EIA, but 14.5% had more than one reason for exclusion. Even in a community with low prevalence for HIV, a large majority of healthy heterosexual volunteers can be expected to be ineligible for enrolment in HIV vaccine trials. An average of 4.8 volunteers were screened for each of 12 vaccinees chosen.
Disappearance of Anti-Pl7 Correlates with Successful Isolation of Human Immunodeficiency Virus and Deterioration in Clinical Status
Authors: Kageyama Seiji , Kurimura Takashi
Published: January 2017

Anti-pl7 was examined as a human immunodeficiency virus (HIV) marker predicting the onset of the acquired immunodeficiency syndrome (AIDS). Two different comparisons were done: (1)anti-pl7 negativity and successful HIV isolation; and (2)anti-pl7 negativity and clinical status, using the Centers for Disease Control classification. Anti-p17 negativity was not only significantly correlated with deterioration in clinical status ( P<0.01), but also with successful HIV isolation ( P<0.05). HIV isolation was affected by several drugs, e.g. zidovudine. However, the results of the antibody test were not affected. It is significant that anti-pl7 can compensate for the defects of virus isolation.
A 2-Year Quantitative Assessment of Chlamydia Trachomatis in a Sexually Transmitted Diseases Clinic Population by the Microtrak Direct Smear Immunofluorescence Test
Authors: Thomas B J , Osborn M F , Munday P E , Evans R T , Taylor-Robinson D
Published: January 2017

The MicroTrak direct smear immunofluorescence test was used to determine the prevalence of Chlamydia trachomatis elementary bodies (EBs) in groups of patients in various clinical categories, most of whom were seen in a clinic for sexually transmitted diseases (STD). Overall, 8138 adequate specimens were tested, of which 14.3% were found to contain chlamydial EBs. Of the samples from patients seen in the STD clinic, over 70% were from women and 14.9% of these were positive, as were 15.7% of those from men. EBs were detected in 27% of samples from infants and in 7.0% of those from adults with conjunctivitis. EBs were detected most often in men with nongonococcal urethritis (40.2%), infants with conjunctivitis (30%) and contacts of chlamydiae-positive patients (24.5%) and least often in ‘prostatitis’ (2.9%) and patients tested to determine the success of treatment (2.7%). Over 40% of samples from both the male urethra and the cervix contained 10 or fewer EBs, highlighting the importance of recognizing small numbers and the sensitivity required of other detection procedures.
Human Papillomavirus DNA in Unselected Pregnant and Non-Pregnant Women
Authors: Soares V R X , Nieminen P , Aho M , Vesterinen E , Vaheri A , Paavonen J
Published: January 2017

Human papillomavirus (HPV) DNA is associated with genital squamous cell neoplasia, especially types 16, 18 and 31. Several studies, using histopathology and DNA hybridization, have shown an increased prevalence of cervical HPV DNA in pregnant women. We determined the prevalence of HPV DNA and the distribution of specific HPV DNA types in exfoliated cervical cells from 748 randomly selected pregnant and 503 non-pregnant women, using a dot blot DNA hybridization technique. The prevalence of HPV DNA was 9.6% in pregnant women and 8.9% in non-pregnant women. Thus, we found no evidence of higher prevalence of HPV DNA in pregnant women. HPV DNA types 16/18 and 31/33/35 were more common than types 6/11. The prevalence of HPV DNA was highest (15%) in the youngest age groups suggesting an association between young age and the prevalence of HPV DNA.
Self-Medication by Women Attending a Genitourinary Medicine Clinic
Authors: Russell J M , Barton S E , Lawrence A G
Published: January 2017

A questionnaire was completed by 103 symptomatic women attending a busy, walk-in genitourinary medicine clinic in London before seeing a doctor. This questionnaire asked about the patients' own diagnosis of symptoms, previous remedies and their source. The answers were compared to their past history and current diagnosis.

Of symptomatic women 56% had used a self-administered remedy prior to attending the clinic. This was significantly associated with a history of a previous episode of genital infection which had produced similar symptoms to the current problem. Forty-three percent of those who used self-medication reported some improvement in symptoms and more than 50% tolerated longer than 10 days of symptoms before attending the clinic.
HIV/AIDS in Poland: A Society in Need of the State
Authors: Misztal Barbara A.
Published: January 2017

Eastern Europe's recent revolutions theoretically should provide a new opportunity for communities affected by HIV. By looking at the Polish case I will try to evaluate how these opportunities have been utilized. Although, compared with the numbers of the AIDS cases and the HIV-infected in the West, Polish numbers are small, a lack of proper medical infrastructure and a lack of basic equipment to prevent the spread of AIDS has made the situation dramatic. Until the end of the 1980s responses to HIV/AIDS were carried out according to the prevailing old bureaucratic mode without any co-operation with affected groups.

The new situation after the revolution has provided opportunities for members of affected groups to emerge and organize. However, at the same time, the increase in public intolerance and indifference towards the fate of its weakest members has been, to some degree, facilitated by many aspects of transitional period. In the process of breaking the state's monopoly on power and in the creation of local community structures, the danger of excessive parochialism and struggles for power emerges. New authorities, trying to preserve some social cohesion in the face of economic hardship, are faced with a society which lost the ability to recognize where the demarcation line runs between rights and demands to protect egoistic interests.
Welfare State Regimes and Welfare Citizenship
Authors: Taylor-Gooby Peter
Published: January 2017

This article links together three themes in recent discussion of welfare. First, the extent to which current patterns of state welfare provision are likely to continue has been called into question. Disillusion with the traditional model derives in part from government response to economic pressures, in part from the likelihood that changes in demography, employment and popular expectations will increase demands on the state, and in part from the tendency of theorists to advocate pluralist, decentralized, mixed economy and civil society-based solutions to problems. Secondly, traditional notions of welfare citizenship have been challenged because they fail to take into account the wide variety of paths which different systems have pursued in their development and because they fail to include the impact of state policy on the private sphere of home and family in their analysis. Thirdly, vigorous controversy about the categorization of welfare states surrounds the work of Esping-Andersen (1990).

The claim that state welfare cannot be sustained is found to be unconvincing. However, the arguments do focus attention on issues of social care and the impact of policy on women. This has strong implications for the way in which theories of welfare citizenship discuss the relation between state policy and the public and private spheres of social life. Esping-Andersen's model uses the extent of decommodification in relation to formal wage-labour to distinguish the ideal types of liberal, social democratic and conservative/corporatist regimes. State intervention is limited in the liberal model, extensive in the social democratic model and substantial but directed at maintaining the stratification order of the market in the conservative model. An analysis that includes both uncommodified care work in the home and the position of women in the formal labour market implies that different struggles will develop in the various regime types in response to current pressures on the welfare state. In liberal regimes, equal opportunities have been pursued through law rather than direct state intervention: the result is that gender conflicts become increasingly subsumed to the class conflicts of the market. In social democracy a substantial state sector provides both opportunities for women's advancement in employment and socialized care facilities that help to make this possible; pressure on spending leads to conflicts between public and private sector workers (who see the former as parasitic) which increasingly involve gender conflicts. Under conservative/corporatism, where women's opportunities to enter paid employment have been relatively limited, gender conflicts increasingly concern access to paid work. These predictions offer opportunities for the empirical testing of the model.
An Equal Right to Inherit? Women’s Land Rights, Customary Law and Constitutional Reform in Tanzania
Authors: Dancer Helen
Published: January 2017

This article explores contemporary contestations surrounding women’s inheritance of land in Africa. Legal activism has gained momentum, both in agendas for law reform and in test case litigation, which reached the United Nations Committee on the Elimination of Discrimination against Women in ES and SC v. United Republic of Tanzania. Comparing the approach of Tanzania to that of its neighbours, Uganda, Kenya and Rwanda, this article explores patterns of resistance and omission towards enshrining an equal right to inherit in land and succession laws. It identifies two main reasons: neoliberal drivers for land law reform of the 1990s and sociopolitical sensitivity surrounding inheritance of land. It argues that a progressive approach to constitutional and law reform on women’s land rights requires understanding of the realities of claims to family land based on kinship relations. It calls for a holistic approach to land, marriage and inheritance law reform underpinned with constitutional rights to equality and progressive interpretations of living customary law.
The Military Career of Mr (Later Sir) Rutherford Alcock (1809–97)
Authors: Kaufman M H
Published: January 2017

Rutherford Alcock obtained the MRCS diploma in 1831. During the following year he volunteered for service as a medical officer in the British Marine Brigade, which fought during the Miguelite War in Portugal from 1832 to 1834. After that campaign, he transferred to the British Auxiliary Legion of Spain in May 1835 for service in what later was called the First Carlist War (1835–37). After serving for one year as a surgeon he was promoted to the rank of Deputy Inspector General of Hospitals. He had hoped to return to King's College Hospital, London, to the Chair of Military Surgery, with an associated assistant surgeonship at the Westminster Hospital but, because of a severe bout of what is now believed to have been rheumatic fever, he lost the use of his thumbs and decided he could not continue as a surgeon. Accordingly, he decided not to take up the Chair of Military Surgery at King's on his return to Britain. In 1839 he was appointed to a lectureship in surgery at Sydenham College and, for a brief period in 1842, he was the Home Office Inspector of Anatomy. He then decided to explore other career opportunities and initially was British consul to China, at Fuchow in 1844, at Shanghai in 1846 and at Canton in 1854. In 1858 he transferred to the Diplomatic Service. He retired in 1871 after a successful and distinguished career.
John Coakley Lettsom's American Friends
Authors: James D Geraint
Published: January 2017

John Coakley Lettsom (1744–1815) regarded his West Indies birthplace and the New England states as integral parts of the colonial Empire, and described himself as Americanus. He had numerous friends in the American medical profession and was generous to them with books, plants and financial support. They travelled to Europe with letters of introduction to him and some of them became corresponding members of the Medical Society of London. This work is a brief profile of some of these academic friends.
Professor Joseph Warren Horton (1889–1967): Biological Engineer
Authors: Zeitlin Gerald L
Published: January 2017

Joseph Warren Horton graduated with a degree in electrical engineering from the Massachusetts Institute of Technology (MIT) in 1914. He became involved in the early development of electrical measurement devices, televised image transmission, and the detection of underwater sound transmission. In the mid-1930s he was appointed the first leader of the newly created Department of Biological Engineering at MIT and in this position he made major contributions to the application of physics to human physiology, in particular by increasing the safety of explosive inhalational anaesthetic agents.
Thomas Gainsborough's Doctors
Authors: Jenkins John
Published: January 2017

During the 16 years Thomas Gainsborough (1727–88) lived in Bath he was especially friendly with two eminent physicians, Rice Charleton (1723–88) and Abel Moysey (1715–80). They both treated Gainsborough for a severe nervous illness. In return he painted portraits of them without charge. Gainsborough's two daughters were both mentally unstable and when the elder one became very ill he had to call for the services of a third Bath physician, Dr Ralph Schomberg (1714–92), who was also the subject of a fine portrait. In the final phase of his life Gainsborough moved to London, where he suffered his fatal illness, possibly squamous cell carcinoma. For this he was treated by William Heberden (1710–1801) and John Hunter (1728–93).
Dr John Hall (1575–1635) and Shakespeare's Medicine
Authors: Pearce J M S
Published: January 2017

The name of Dr John Hall is familiar to students of Shakespeare but less well, known to medical biographers. He was born in 1575 and studied at Queen's College, Cambridge, but had no English medical degree. He was not a member of the Royal College of Physicians (founded in 1518). Around 1600, he established himself in Stratford. In June 1607 Hall married Susanna, Shakespeare's elder daughter. He died in 1635, an eminent Stratford physician and herbalist.
A Title Acquired without Labour: Dr George Mossman, MD (1763–1824)
Authors: Alvin Christine
Published: January 2017

When George Mossman, MD arrived in Bradford in 1787, he claimed to be a graduate of Edinburgh University and thus fully qualified to practise as a Physician. But after a few years it was revealed he had little medical education and had purchased his degree from St Andrews University. His career, however, apparently was unaffected by this and other revelations, and he went on to write several acclaimed essays and journal articles, and became Bradford's most popular and revered physician.
John Wesley (1708–91)
Authors: Storey Geoffrey O
Published: January 2017

John Wesley was a competent physician, quite capable of the diagnosis and care of patients. His Primitive Physic provides a picture of therapy in the eighteenth century but he rejected the bleeding and purging which were common at that time. He was ahead of his time in his emphasis on hygiene, cleanliness and simple living. In this he has been regarded as a pioneer of preventive medicine. He was in the forefront of the philanthropic movement in his provision of Dispensaries for the poor and his care of the sick and elderly. In spite of this he does not seem to have had a direct influence on the physicians of the day. Loudon does not mention him in his Origins and Growth of the Dispensary Movement in England and Clarke only gives him a passing reference in his History of The Royal College of Physicians. He experimented with electrotherapy and it seems likely he was one of those who saw that electricity could be the ‘greatest step forward’ in medicine as a whole.
Lord Amulree (1900–83): The Indefatigable Advocate of Older Persons
Authors: Denham Michael J
Published: January 2017

Lord Amulree was an outstanding advocate of geriatric medicine in the United Kingdom. His interest in the subject started while he was working for the Ministry of Health and blossomed with his clinical appointment to the new geriatric unit at St Pancras Hospital in London. Here he established a thriving department, expounded his general and specific philosophies on the subject in numerous publications, and trained many junior members of staff who, in their turn, became advocates of the speciality. He used his position in the House of Lords to promote the cause of older persons. He is best remembered for his maxim of Adding Life to Years not Years to Life.
Effect of Breast Cancer Screening after Age 65
Authors: Chen Hsiu-Hsi , Tabar Laszlo , Fagerberg Gunnar , Duffy Stephen W
Published: January 2017

Objective

To assess the effect of mammographic screening for breast cancer in women aged 65 years or over.

Setting

The Swedish two county trial of screening for breast cancer, in which 77 080 women aged 40–74 (21 925 aged 65–74) were randomly allocated to receive regular mammographic screening for breast cancer, and 55 985 women aged 40–74 (15 344 aged 65–74) were allocated to an unscreened control group

Methods

One group was screened every 33 months on average, except for those aged 40–49 at randomisation who were screened every 24 months. The control group was screened once at the conclusion of the trial. The main statistical analysis was the comparison of cumulative mortality with 13 years of follow up between the screened and control groups, in age groups 50–64 and 65–74, using Poisson regression. This was complemented by subsidiary analyses assessing the lead time, sensitivity, and predicted mortality from the size, node status, and grade of tumours diagnosed in the screened and control groups.

Results

In the age group 65–74 at randomisation there was a significant reduction in breast cancer mortality in the screened group, with a relative mortality of 0 68 and 95% confidence interval of 0 51 to 0 89. This was backed up by the results of the analyses of lead time, sensitivity, and tumour characteristics

Conclusions

Women aged 65 or more who are regularly screened can expect a reduced risk of dying from breast cancer.
Prenatal Sonographic Detection of Isolated Fetal Choroid Plexus Cysts: Should We Screen for Trisomy 18?
Authors: Donnenfeld Alan E
Published: January 2017

It has been established that the finding of a fetal choroid plexus cyst confers an increased risk of aneuploidy, predominantly trisomy 18. In view of this association many investigators have advocated amniocentesis when a choroid plexus cyst is identified by prenatal ultrasonography. A risk/benefit and economic analysis of such a policy is presented. When the following factors are taken into account — published data on the frequency of isolated choroid plexus cysts in second trimester fetuses, the risk of trisomy 18 in these fetuses, the population frequency of trisomy 18, the natural history and prognosis for these infants, and the risks and cost of amniocentesis — it is concluded that performing amniocentesis on second trimester fetuses with choroid plexus cysts is neither cost effective nor beneficial. For the detection of one infant with trisomy 18 that will survive past five months, 25 normal fetuses would be lost owing to amniocentesis. Identification of trisomy 18 by determining the presence of choroid plexus cysts in fetuses is not a worthwhile screening policy.
Cost Comparison of Different Methods of Screening for Cystic Fibrosis
Authors: Morris Joan K , Oppenheimer Peter M
Published: January 2017

Objective

To compare the costs of several proposed methods of screening for cystic fibrosis.

Setting

England and Wales.

Methods

The costs of screening carried out at hospital antenatal clinics, general practitioner (GP) antenatal consultations, GP surgeries, and at work were estimated using data from demonstration projects. Couple screening, stepwise screening, and screening of individuals were considered.

Results

Couple screening at antenatal hospital clinics was the least expensive per carrier couple detected, amounting to £35 700 (£142 900 for each potential cystic fibrosis fetus detected). The costs of the reagents (£25 per test) accounted for over 60% of this total.

Conclusions

Antenatal screening, in addition to being the most cost effective method of screening, is also medically the screening method of choice as it provides information at the latest time when effective preventive action can be taken and at a time when all people to be screened are likely to be accessible. If the costs of the reagents could be reduced to £5 (still higher than the costs of most diagnostic reagents) the cost for each pregnant carrier couple offered screening would be reduced by 50% to about £18 000, and the cost of offering screening to 684 000 pregnant couples in England and Wales would be about 91/2 instead of £19m.
Genetic and Environmental Influences on Growth
Authors: Rona Roberto J , Chinn Susan
Published: January 2017

Objectives —

To provide an overview of the factors associated with growth in primary school children in England and Scotland and to provide information about the secular trend of growth in the last 20 years.

Setting —

Representative English and Scottish samples and an English inner city sample.

Methods —

The study had a mixed longitudinal design from 1972 to 1994. Between 8000 and 10 000 children participated in each survey. Height was measured in at least 95% of the children in most surveys, and 75% to 85% of parents provided information about family background. Main results are based on published information. Multiple regression was used for most of the analyses.

Results —

Parents' height, child's birth weight, mother's age at child's delivery, ethnic background and, in white children, family size are the only factors markedly associated with height. Variables that have traditionally been used to assess the possible effect of social conditions were generally not associated with height. The height increase was more marked in Scotland than England over the period 1972 to 1990, and the differences in height of children in the two countries is now minimal.

Conclusions —

Most factors cannot be neatly classified as purely genetic or environmental, but seem to indicate that genes are relatively more important. Social factors usually assessed in growth studies do not have an important effect on growth. The marked increase of height over time indicates that the environment and social conditions have allowed children to grow taller. Sibship size is the only factor that was shown to be related to the secular trend in growth.
Referral Criteria for Growth Screening
Authors: Hulse J A
Published: January 2017

Population height screening studies performed over the past 20 years have shown that between 17 and 21% of children with heights below the third centile have organic disease, of whom about 20% will be new diagnoses. The likelihood of organic disease increases to 50% for children with heights below −3 SDs. The age of screening will also influence the outcome as both acquired disease and disorders with progressive growth slowing, such as Turner's syndrome, are more likely to be detected by screening at an older age.

Height velocity as a screening tool has evoked interest for many years as, despite technical problems, slowly growing children are thought more likely to have disease. Inclusion of height or height/weight relations may further improve screening sensitivity. It may assist in the early detection of coeliac disease or eating disorders in older children.

A minimum of three measurements is required to define an individual's growth pattern and, preferably, five or six measurements spread over the preschool and primary school years. The value of extension of growth screening to the secondary school age group remains uncertain.

Children should be screened for both height and weight and referred when there are major discrepancies between these two measurements (more than three centile bands). A two level system of referral with a community assessment for some children and a direct referral to a growth clinic for children with more severe growth disturbance may be the best use of resources.
Second Trimester Levels of Maternal Serum Inhibi A, Total Inhibin, α Inhibin Precursor, and Activin in Down's Syndrome Pregnancy
Authors: Lambert-Messerlian G M , Canick J A , Palomaki G E , Schneyer A L , Lambert-Messerlian G M
Published: January 2017

Objective

–To determine the levels of various biochemical forms of the placental protein, inhibin (total inhibin, inhibin A, and α inhibin precursor) and activin in maternal serum samples from fetal Down's syndrome, and to determine which of these analytes most effectively identifies samples from affected pregnancies.

Methods

–Maternal serum samples were collected from 100 unaffected pregnancies and 20 cases of fetal Down's syndrome during gestational weeks 15–20 for routine triple marker screening, and were stored frozen after clinical assay. Levels of inhibin A, total inhibin, α inhibin precursor (pro-αC), and activin were compared retrospectively in the Down's syndrome cases and control samples.

Results

–There was no association of the inhibin or activin levels with gestational age or length of freezer storage, and therefore single median values were determined for the unaffected pregnancies for each analyte. Multiples of the unaffected median (MoM) values were calculated for all cases, showing that inhibin A (1.95 MoM) provided the best discrimination between cases and controls, followed by total inhibin (1.37 MoM). Mann-Whitney U analysis showed significant group differences in inhibin A (P = 0.0001) and total inhibin (P = 0.0005). In contrast, α inhibin precursor (0.81 MoM) and activin (1.16 MoM) levels in Down's syndrome cases were not significantly different from those in unaffected patients.

Conclusions

—Levels of inhibin A and total inhibin, but not α inhibin precursor or activin, are significantly raised in maternal serum from cases of fetal Down's syndrome. These data, taken together, indicate that inhibin A levels are specifically raised in Down's syndrome pregnancy. 45% of the inhibin A levels in the Down's syndrome samples were above the 90th centile of unaffected levels, indicating that inhibin A may be as good a marker as human chorionic gonadotrophin, the most informative serum marker currently in use.
Validity of Immunological Faecal Occult Blood Screening for Colorectal Cancer: A Follow up Study
Authors: Nakama Hidenori , Kamijo Noboru , Fattah A S M Abdul , Zhang Bing
Published: January 2017

Objectives

– Immunological faecal occult blood testing has been recognised as a useful method for wide scale screening of colorectal cancer in Japan during the past few years. This study was carried out to evaluate the validity of an immunological faecal occult blood test for colorectal cancer screening.

Methods

– A screening programme for colorectal cancer using an immunological faecal occult blood test was conducted on 3365 residents of regions within Nagano prefecture in 1991, and all the subjects were followed up for three years by verification from cancer registration. Based on the incidence of false negative cases among those who had been evaluated as normal by this screening, but were diagnosed as having colorectal cancer, the sensitivity and the specificity of this test were estimated.

Results

– Four false negative cases were found during the subsequent three year follow up period after screening. Among these four cases, one case was within the first follow up year, one case within the — second year, and two cases within the third year. Accordingly, the sensitivity of this test was calculated as 90.9% within one year, 83.3% within two years, and 71.4% within three years, while the specificity was found to be 95.6%, indicating a validity higher than that achieved by a chemical occult blood test.

Conclusion

– These findings suggest that the immunological faecal occult blood test has a high diagnostic accuracy and is a useful strategy for colorectal cancer screening.
Estimation of the Optimal Cut Off Point in a New Immunological Faecal Occult Blood Test in a Corporate Colorectal Cancer Screening Programme
Authors: Itoh Masato , Takahashi Ken , Nishida Hiroshi , Sakagami Kiyonobu , Okubo Toshiteru
Published: January 2017

Objective

–To estimate the optimal cut off point in a new immunological method (OC-Hemodia®) for faecal occult blood testing (FOBT).

Setting

–A corporate colorectal cancer screening programme in Japan.

Method

–The screening programme targeted colorectal cancer and adenomatous polyps ≥ 10 mm, and was conducted on 27 860 participants (age ⩾ 40) during 1991–92. The follow up consisted of diagnostic management by total colonoscopy on positive screened subjects exceeding the manufacturer recommended cut off level of 50 ng/ml faecal haemoglobin, and the identification of false negative cases by health insurance claims. The optimal cut off point was estimated by the positive predictive value, receiver operating characteristic (ROC) curve, and a cost effectiveness analysis. In this study evaluation was carried out only for cancer as the target disease.

Results

–At the current cut off level of 50 ng/ml the sensitivity and specificity were 86.5% and 94.9%. When the optimal cut off point was estimated the highest positive predictive value was obtained at 250–350 ng/ml. The ROC curve showed that the sum of sensitivity and specificity is maximised at 50 ng/ml, but evaluation of the ratio, change in sensitivity/change in false positive rate, pointed to higher optimal cut off points, showing marked changes occurring at about 200 ng/ml. The average cost per case was lowest at 250–300 ng/ml. Overall, the optimal cut off point was estimated to be about 200 ng/ml, at which the sensitivity and specificity of the test would be 77.5% and 98.9%, respectively.

Conclusion

–The optimal cut off point of the new immunological method of FOBT was estimated to be about 200 ng/ml, a value which, more than the current cut off value, favours specificity over sensitivity.
Monitoring the Performance of Breast Screening Programmes: Use of Indirect Standardisation in Evaluating the Invasive Cancer Detection Rate
Authors: Blanks R G , Day N E , Moss S M , Blanks R G , Moss S M
Published: January 2017

Close monitoring of data from individual programmes is required to evaluate the potential of the breast screening programme to reach the Health of the Nation target of 25% reduction in breast cancer mortality in the invited age group by the year 2000. This paper outlines the use of indirect age standardisation techniques to compare the performance of individual programmes in terms of their invasive cancer detection rates. Expected invasive cancer detection rates are calculated by applying data from the Swedish two county study to estimated England and Wales background incidence rates for different age strata. If the national programme overall meets these targets then the required mortality reduction should be achieved. The same method can be used by other (national) screening programmes by applying the relevant background incidence figures to produce internationally comparable data.
Monitoring the Performance of Breast Screening Programmes: Allowing for Geographical Variation in Breast Cancer Incidence
Authors: Blanks RG , Moss SM
Published: January 2017

Among the myriad of problems associated with evaluating the performance of individual screening programmes in the National Health Service breast screening programme is that of correcting for background breast cancer incidence in the catchment areas of individual programmes. The background incidence will affect not only the expected cancer detection rate at screening, but also the interval cancer rates. This paper proposes a method that can be used to correct for background incidence. The method can be used either to correct the crude cancer detection rate or the age adjusted cancer detection rate using a measure such as the standardised detection ratio. Variation in background incidence and age distribution of screened women are the two major factors affecting the expected cancer detection rate for individual screening programmes. Control of these two variables should allow more effective evaluation of individual screening programme performance.
Effect of Issuing an Invitation for Breast Cancer Screening to Women Aged 65 to 69
Authors: Hendry P J , Entwistle C
Published: January 2017

Objective

–Breast cancer screening is available to all women over 50 in the United Kingdom on the National Health Service breast screening programme. Only women aged between 50 and 64 receive a written invitation, with women over 64 being expected to self refer. Unfortunately, despite the higher incidence of breast cancer in the older age group only a very small proportion of women over 64 attend for screening. The aim of the study was to test the hypothesis that women between the ages of 65 and 69 will attend for screening if invited.

Method

–Women aged 65 to 69 were invited for screening from general practices in the Inverness area and were treated in all respects as the usual screening age group.

Results

–An uptake of 76% was achieved with a cancer detection rate of 9.3 per thousand.

Conclusion

–These results lend weight to the suggestion that women in this age group should receive a specific invitation for breast cancer screening.
Prospective Evaluation Plan for Randomised Trials of Prostate Cancer Screening
Authors: Auvinen Anssi , Rietbergen John B W , Denis Louis J , Schroder Fritz H , Prorok Philip C ,   for the International Prostate Cancer Screening Trial Evaluatio Group
Published: January 2017

To enable pooled analyses of continuing and planned randomised trials of prostate cancer screening, guidelines for minimal data required for such analyses were developed in the recent meeting of the International Prostate Screening Trial Evaluation Group (IPSTEG).

The aim of the pooled analysis with data on individual level will be:

Estimation of the effect of screening on prostate cancer mortality with greater precision than individual studies Assessment of optimal screening procedures and interval Identification of subgroups within the populations that might receive most benefit from screening Evaluation of the quality of life effects and cost effectiveness of screening.

All studies included in the combined analysis share a common core protocol with minimum data requirements. The protocol allows, however, adaptation of the procedures to local circumstances within defined options It should be noted that the process is continuing and the protocol is subject to evaluation and revision in the meetings of the IPSTEG on a regular basis.

It should be noted that the process continuing and the protocol is subject evaluation and revision in the meetings the IPSTEG on a regular basis.
Human-Figure Drawing (HFD) in the Screening of Cognitive Impairment in Old Age
Authors: Ericsson Kjerstin , Hillerås Pernilla , Holmén Karin , Winblad Bengt
Published: January 2017

Objective

–The aim of the study is to test the hypothesis that freehand human-figure drawing (HFD), can be used as a complementary screening instrument to differentiate between demented elderly people and healthy elderly controls in population based studies

Method

–HFD was examined in 668 elderly (⩾ 75 years of age) participants from an epidemiological study in Stockholm, who were asked to draw a human figure. The drawings were analysed on the content of body details and structural characteristics.

Result

–The results show quite clearly that the body details and the height decrease with decreasing cognitive function, whereas the centredness (the distance in cm from the centre of the figure to the centre of the paper) increases with decreasing cognitive functioning. Demented people place their figures in the upper left: corner of the sheet, compared with the mostly well centred figures of non-demented people. Age, on the other hand, has an influence on the HFD as after 90 years of age most of the variable show regressive changes.

Conclusion

–The HFD can help to differentiate between demented and non-demented subjects as well as between dementia of different severity. The HFD does not help us, however, to discriminate between Alzheimer's disease and vascular dementia. Age has an influence on the HFD in the sense that after 90 years most of the variables regress to a smaller or more primitive form.