Risk factors for delayed presentation and referral of symptomatic cancer: Evidence for common cancers

Background:It has been suggested that the known poorer survival from cancer in the United Kingdom, compared with other European countries, can be attributed to more advanced cancer stage at presentation. There is, therefore, a need to understand the diagnostic process, and to ascertain the risk factors for increased time to presentation.Methods:We report the results from two worldwide systematic reviews of the literature on patient-mediated and practitioner-mediated delays, identifying the factors that may influence these.Results:Across cancer sites, non-recognition of symptom seriousness is the main patient-mediated factor resulting in increased time to presentation. There is strong evidence of an association between older age and patient delay for breast cancer, between lower socio-economic status and delay for upper gastrointestinal and urological cancers and between lower education level and delay for breast and colorectal cancers. Fear of cancer is a contributor to delayed presentation, while sanctioning of help seeking by others can be a powerful mediator of reduced time to presentation. For practitioner delay, ‘misdiagnosis’ occurring either through treating patients symptomatically or relating symptoms to a health problem other than cancer, was an important theme across cancer sites. For some cancers, this could also be linked to inadequate patient examination, use of inappropriate tests or failing to follow-up negative or inconclusive test results.Conclusion:Having sought help for potential cancer symptoms, it is therefore important that practitioners recognise these symptoms, and examine, investigate and refer appropriately. © 2009 Cancer Research UK All rights reserved

The Persistent Circulation of Enterovirus 71 in People's Republic of China: Causing Emerging Nationwide Epidemics Since 2008

Emerging epidemics of hand-foot-and-mouth disease (HFMD) associated with enterovirus 71 (EV71) has become a serious concern in mainland China. It caused 126 and 353 fatalities in 2008 and 2009, respectively. The epidemiologic and pathogenic data of the outbreak collected from national laboratory network and notifiable disease surveillance system. To understand the virological evolution of this emerging outbreak, 326 VP1 gene sequences of EV71 detected in China from 1987 to 2009 were collected for genetic analyses. Evidence from both traditional and molecular epidemiology confirmed that the recent HFMD outbreak was an emerging one caused by EV71 of subgenotype C4. This emerging HFMD outbreak is associated with EV71 of subgenotype C4, circulating persistently in mainland China since 1998, but not attributed to the importation of new genotype. Originating from 1992, subgenotype C4 has been the predominant genotype since 1998 in mainland China, with an evolutionary rate of 4.6∼4.8×10−3 nucleotide substitutions/site/year. The phylogenetic analysis revealed that the majority of the virus during this epidemic was the most recent descendant of subgenotype C4 (clade C4a). It suggests that the evolution might be one of the potential reasons for this native virus to cause the emerging outbreak in China. However, strong negative selective pressure on VP1 protein of EV71 suggested that immune escape might not be the evolving strategy of EV71, predicting a light future for vaccine development. Nonetheless, long-term antigenic and genetic surveillance is still necessary for further understanding

Effect of buffer layers on p-i-n a-Si:H solar cells deposited at high rate utilising an expanding thermal plasma

\u3cp\u3eWith a cascaded arc expanding thermal plasma intrinsic amorphous silicon can be deposited at growth rates varying from 0.2 to 10 nm/s. With increasing growth rate good material is obtained at higher deposition temperatures. At higher deposition temperatures the p-layer is deteriorated when the cell is deposited in a p-i-n sequence. A buffer layer can be used as a 'soft start' for the ETP layer and as protection of the p-layer from high deposition temperatures. In this paper we will discuss the effect on p-i-n solar cells when a buffer layer is incorporated.\u3c/p\u3

Temperature dependence at various intrinsic a-Si:H growth rates of p-i-n deposited solar cells

\u3cp\u3eWith a cascaded arc expanding thermal plasma intrinsic solar grade amorphous silicon can be deposited at growth rates varying from 2 to 100 Å/s. The temperature above which good material is obtained becomes higher for higher growth rates. Higher deposition temperatures affect the p-layer within p-i-n grown solar cells, which will result in other optimum deposition temperatures of the i-layer. In this paper we will address the dependence of the p-i-n solar cell performance on the deposition rate and deposition temperature.\u3c/p\u3

Thermally deposited a-Si for solar cells

Remote plasma deposition of thin films with a thermal plasma source offers the advantages of high rates and of choice in at. compn. and structure. The radical flux can be large at low pressure, with small power flux and low substrate temp. With expanding thermal plasmas very high growth rates can be reached with good (and sometimes even with growth rate improving) properties. From measured radical densities in the plasma and at the surface detailed mechanisms are being unraveled. Dissocn. of injected radicals proceeds via charge transfer with ions and dissociative recombination or by abstraction with at. radicals. These processes can be tuned to deliver the appropriate radicals, with not too high and not too low sticking coeff. A discussion of the mechanisms and of the favorable results will be used to indicate future strategies for deposition and surface modification with thermal plasma