bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Empirical Validation of Risk Screening for Down's Syndrome
Authors: Wald N J , Hackshaw A K , Huttly W , Kennard A 
Published: January 2017

Objective— To validate individual risk estimates in antenatal serum screening for Down's syndrome. Methods— Women screened for Down's syndrome using maternal serum a fetoprotein (AFP), unconjugated oestriol (uE3), and human chorionic gonadotrophs (hCG) with maternal age (the triple test) or AFP, uE3, free β subunit and free a subunit of hCG with maternal age (the quadruple test) were grouped according to their predicted risk of having an affected pregnancy. The mean predicted risk in each category was then compared with the observed prevalence based on the number of affected and unaffected pregnancies in each category. Subjects— About 100 000 pregnant women screened for Down's syndrome from 1989 to 1995. Results— There was close agreement between the predicted term risk and the prevalence at birth for both the triple test and the quadruple test. For example, with the quadruple test the predicted risk in the highest risk group was 1 in 3.3 and the prevalence was 1 in 2.6; in the lowest risk group these were 1 in 3000 and 1 in 2300 respectively. Conclusion— Risk estimates based on multiple marker screening for Down's syndrome are accurate. The technique used to demonstrate this is simple and offers a useful empirical check on screening performance.
Reasons for Cervical Cancer despite Extensive Screening
Authors: Stenkvist B , Söderström J 
Published: January 2017

Objective— To explain an age adjusted incidence rate of cervical cancer of 10.1 and 10.5 per 100 000 women, despite extensive screening. Setting— The Swedish county of Gävleborg in 1986 and 1987. Methods— Thirty eight patients with “cervical cancer” reported to the central cancer registry in Sweden were investigated. The patients and their diagnoses were scrutinised in a double blind manner. Results— Eighteen per cent (7/38) of cases were shown to be mistakes in data transfer; 11% (4/38) of cases were endocervical adenocarcinomas; 13% (5/38) were histopathological misinterpretations and should have been reported as carcinoma in situ. Of the remaining 22 patients with invasive squamous cancer, 12 (55%) had not participated in the gynaecological health control programme. Of the 10 participants with invasive squamous cancer despite this participation, eight (80%) had repeatedly had abnormal Papanicolaou smears without further gynaecological/histopathological examination and treatment. There was no evidence of cases of carcinoma in situ or endometrial cancer diagnosed in 1986–87 being squamous cervix cancer. The true incidence of squamous cervical cancer among participants was 3.0 per 100 000 for the two years scrutinised. If all the patients with Papanicolaou smear abnormalities had been properly managed at the right time, and the treatment had been successful, the incidence of invasive squamous cancer would have been 0.8 per 100 000 women among participants as opposed to 38.2 per 100 000 among non-participants. Conclusion— The evidence strongly suggests overascertainment of cervical cancer, which conceals the success of screening, and also suggests that much attention must be given to clinical management of detected lesions in cervical screening. Care is needed in applying accurate histopathological criteria when making a diagnosis of invasive squamous cancer, to separate squamous cancer from other malignant tumours of the cervix, and in data transfer to cancer registries.
Co-Morbidity in Patients with Abdominal Aortic Aneurysm
Authors: Kanagasabay Robin , Gajraj Haroun , Pointon Linda , Scott R Alan P 
Published: January 2017

Objectives— Selection for surgery of patients with abdominal aortic aneurysm (AAA) depends on an assessment of risk from operation compared with risk from aneurysm rupture. A study was performed to assess the levels of co-morbidity and to see whether co-morbidity was different in people with a normal aorta after ultrasonographic examination than in those with an aneurysmal aorta. Setting and methods— Over a two year period 5392 people (2341 men, 3051 women) aged 65–80 were screened using B-mode linear ultrasound, with maximum measurements taken of transverse, anteroposterior diameters, or both. All subjects were given a questionnaire seeking a history of angina, stroke, claudication, myocardial infarct, respiratory problems, and diabetes. Results— 218 men and women were found to have an AAA of 3 cm or greater. The results of the questionnaire were analysed using logistic regression whereby all the co-morbid conditions were adjusted for each other and for smoking, sex, and age. The only conditions which were significantly associated with AAA in both sexes were myocardial infarction with an odds ratio(OR) of 1.66 (95% confidence interval (CI) 1.06 to 2.60) and claudication with an OR of 1.68 (95% CI 1.17 to 2.42). The association between angina and AAA was of borderline significance (OR = 1.52, 95% CI 1.00 to 2.30). Stroke was significantly associated only in women, with an OR of 3.71 (95% CI 1.42 to 9.69). Rates of diabetes and respiratory disease were not significantly different between people with AAA and normal aortas.
Screening for Cutaneous Malignant Melanoma: A Feasibility Study
Authors: Törnberg Sven , Månsson-Brahme Eva , Linden Diana , Ringborg Ulrik , Krakau Ingvar , Karnell Ruth , Landegren Johan , Brandberg Yvonne , Hakulinen Timo 
Published: January 2017

Objectives— To study two different procedures for inviting subjects to screening for malignant melanoma, and to study the role of specially trained nurses as primary examiners. Methods— The study was carried out in Stockholm county and comprised 5000 randomly selected men and women aged 40 to 60, of whom 2500 were invited with a personal invitation letter and with a set time of appointment and 2500 were sent a questionnaire and instructions for self examination of the skin. To test the nurses' competence, a survey was made, comparing the judgments of skin examination between nurses and doctors. Results— 1654 (66%) of those invited for a skin examination took part. 1507 (60%) replied in the questionnaire group, of whom 1024 (41%) requested and attended a subsequent skin examination. Of the subjects attending from both groups, the nurses judged 9% v 11% as having skin lesions suggesting malignant melanoma, whereas the two doctors referred 4% v 3% of the subjects for surgical biopsy. Two malignant melanomas were detected, both of them in the questionnaire group. In the study of nurses' screening competence, both nurses and doctors equally judged one case out of 19 as having a lesion suspicious for malignant melanoma. Conclusions— When the questionnaire method was used the results were achieved with one third fewer skin examinations, but it is difficult to conclude whether one of the procedures is better than the other. The results also indicate that nurses can be trained to be the primary examiners in a melanoma screening programme.
The diagnostic accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool: a systematic review
Authors: Dyer Suzanne M , Laver Kate , Friel Margeret , Whitehead Craig , Crotty Maria 
Published: January 2017

Objectives: The objective of this study was to conduct a systematic review of evidence for the accuracy of the Kimberley Indigenous Cognitive Assessment (KICA) tool in supporting the diagnosis of dementia in Indigenous Australian populations. Methods: Cross-sectional diagnostic accuracy studies of the KICA with an appropriate reference standard published to November 2015 were included. Comparison to an alternative cognitive assessment tool was required in non-remote populations. Case control analyses were excluded. Results: Four studies were included: one of the KICA-Cog and KICA-Carer, one of the KICA Screen, and two of the modified-KICA. All tools developed for remote populations had a sensitivity of ≥76% and a specificity of ≥71% for the diagnosis of dementia. The KICA-Cog and KICA-Carer conducted in series had the highest sensitivity and specificity (91% and 94% respectively). In an urban and regional population, the mKICA had similar accuracy to the Mini-Mental State Examination (MMSE) (AUC 0.93, 95% CI 0.88–0.99 vs 0.94, 95% CI 0.89–0.99). Key risk of bias limitations related to lack of pre-determined cut-points and population selection methods. Conclusion: The use of the KICA in remote Indigenous Australians may assist in timely diagnosis of dementia in this population. Using the KICA-Cog and KICA-Carer in series may maximise specificity, decreasing false positive results without compromising sensitivity.
Work–life balance and welfare
Authors: Evans Lois , Young Greg 
Published: January 2017

Objectives: An online survey and focus groups were conducted, providing qualitative information on the work–life balance of psychiatrists and trainees in Australasia. Methods: An invitation to participate in an anonymous online welfare survey was emailed to all the Royal Australian and New Zealand College of Psychiatrists trainees, Fellows, and Affiliates. Following this, nine focus groups were held across Australia and New Zealand. Results: Responses received were thematically analysed. The emergent patterns are presented in this report. Conclusions: Our research suggests that work–life balance can be subjectively and objectively measured. There are phases of good and bad work–life balance, depending on stage of career and other commitments. Work–life balance may be an indicator of the health of individuals and organisations. Due to its complexity, with intrinsic and extrinsic factors involved, solutions are unlikely to be simple. Further studies are needed to substantiate our findings.
Dose-Ranging Pharmacokinetic Study of Ciprofloxacin after 200-, 300-, and 400-mg Intravenous Doses
Authors: Nix David E. , Spivey J. Michael , Norman Allyn , Schentag Jerome J. 
Published: January 2017

OBJECTIVE: To assess the pharmacokinetics and tolerance of ciprofloxacin after the administration of single intravenous doses of 200, 300, and 400 mg. DESIGN: Double-blind, three-period, randomized, crossover trial. SETTING: Private, university-affiliated, hospital-based, clinical research center. PATIENTS: Normal healthy male volunteers, 18–40 years of age. INTERVENTIONS: Subjects received 200-, 300-, and 400-mg single intravenous doses of ciprofloxacin via 30-minute infusions in random sequence. MAIN OUTCOME MEASURES: Serum ciprofloxacin concentrations were determined by HPLC after each dose and the results were used to derive pharmacokinetic parameters. Tolerance was assessed by reported and observed adverse events, urine microscopic examinations for crystals, and examination of intravenous infusion sites. RESULTS: The mean area under the time curve (AUC) values displayed linearity with respect to the administered dose. No statistical differences were observed in total body clearance, steady-state volume of distribution, or elimination half-life with respect to dose administered. The mean total body clearance, steady-state volume of distribution, or elimination half-life ranged from 36 to 41 L/h, 146 to 169 L, and 3.5 to 3.7 h for the 200-, 300-, and 400-mg doses, respectively. Adverse effects, including venous irritation (four subjects) and crystalluria (two subjects), were mild and did not require withdrawal of any subject from the study. CONCLUSIONS: Intravenous ciprofloxacin in doses ranging from 200 to 400 mg demonstrated linear pharmacokinetics. These single doses were well tolerated, although cases of transient venous irritation and crystalluria were observed.
Effect of the Mode of Lipid Administration on Parenteral Nutrition-Related Infections
Authors: D'Angio Richard G. , Riechers Karen C. , Gilsdorf Robert B. , Constantino John M. 
Published: January 2017

OBJECTIVE: To determine if total nutrient admixtures (TNAs) influence the rate of infection in clinical practice. DESIGN: Prospective, randomized trial. SETTING: Department of Veterans Affairs Medical Center. PATIENTS: All patients were administered parenteral nutrition (PN) via a central venous catheter and received daily lipids. INTERVENTION: Patients were randomized as to the mode of administration of lipids. Lipids were either administered with other PN components in a TNA or were piggybacked (PB) into the PN solution. MAIN OUTCOME MEASURES: Treatment groups were compared for the rate of occurrence of PN-related infections. Infections were classified as catheter infections or catheter sepsis. RESULTS: Ninety-eight patients were entered into the trial. Data from % patients (44 TNA, 52 PB) were available for analysis. Treatment groups were well matched for age, baseline albumin, days of PN, predicted basal metabolic rate, and calorie and protein requirements. TNA patients received a significantly greater percentage of nonprotein calories as lipid. The incidence of infection was 12.6 and 10.3 per 1000 days of PN in the TNA and PB groups, respectively (p=0.89). The microorganisms responsible for infection and the type of infections that developed were similar in both groups. CONCLUSIONS: Use of TNAs does not influence the rate of infection in patients receiving PN.