Mapping the drivers of overdiagnosis to potential solutions

Thanya Pathirana and colleagues explore strategies to tackle the problem of too much medicine. Key messages: Interest is growing in tackling the problems of overdiagnosis and overtreatment. Possible drivers and potential solutions arise across five inter-related domains: culture, the health system, industry and technology, healthcare professionals, and patients and the public. More work is needed to develop and evaluate interventions aimed at preventing overdiagnosis. Raising public awareness of overdiagnosis is a priority.No Full Tex

The role of acculturation and acculturation fit in finding full employment and career satisfaction : a study of highly skilled Asian migrants to New Zealand : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

The process of cultural change and adjustment within the context of skilled migrants finding employment has been an under researched area. A further shortfall in research is that acculturation and 'acculturation fit' theory, and the concept of career satisfaction have been neglected by psychologists in the context of skilled migrants' finding employment. The present research attempted to fill this gap in research by testing a model based on the theory of acculturation and 'acculturation fit' and the concept of career satisfaction during the process of skilled Asian migrants finding full employment (i.e. proximity to full employment) in New Zealand. Proximity to full employment was hypothesised to partially mediate the relationship between psychological acculturation and career satisfaction, and the relationship between 'acculturation fit' and career satisfaction. Significant differences in mean scores of proximity to full employment and career satisfaction amongst acculturation styles were expected. Postal or electronic questionnaires were completed by 153 skilled Asian migrants and 30 experienced recruitment agents and human resource personnel in New Zealand. Measures included the 'Acculturation' measure (adapted from Mace, 2004), 'Rank Order Acculturation Style' measure (adapted from Mace), 'Guttman scale' for measuring proximity to full employment (adapted from Mace; Tharmaseelan, 2005), 'Under-Over employment' measure of employment status at present (adapted from Tharmaseelan), and the 'Overall Career Satisfaction' measure (adapted from Tharmaseelan). Regression analyses showed that employment status at present partially mediated the relationship between adapting to New Zealand culture and career satisfaction without controlling for the influence of age and duration in New Zealand. New Zealand acculturation directly predicted proximity to full employment. Significant differences in mean proximity to full employment and career satisfaction amongst acculturation styles were found before controlling for 'other' variables. No significant relationships were found when 'acculturation fit' was the independent variable. Limitations included the snowballing and networking sampling techniques utilized, which could explain the reason for obtaining a large proportion of employed Asian migrants. Despite limitations, findings indicated the importance of adapting to New Zealand culture and the major role of employment status at present in predicting career satisfaction of skilled Asian migrants in New Zealand

Quality of life of caregivers and impact on the nuclear family of children with leukaemia in the National Cancer Institute of Sri Lanka

Childhood leukaemia is the commonest cancer in children aged below 15 years. A diagnosis of childhood leukaemia is a devastating experience for any parent. This hospital-based descriptive cross sectional study aimed to assess the quality of life (QOL) of caregivers and the impact on the nuclear families of children with leukaemia. A convenient sample of 140 caregivers was surveyed using an interviewer administered questionnaire. Nearly 50% of caregivers reported low QOL in the psychological 71(50.7%), social 66(47.1%) and environmental 64(45.7%) domains while most nuclear families underwent moderate financial 88(62.9%) and psychological 100(71.4%) impacts. There was a statistically significant decline in parental employment status following the diagnosis (p<0.05).Full Tex

Lifetime risk of prostate cancer overdiagnosis in Australia: Quantifying the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach

© 2019 Author(s). Objectives To quantify the risk of overdiagnosis associated with prostate cancer screening in Australia using a novel lifetime risk approach. Design Modelling and validation of the lifetime risk method using publicly available population data. Setting Opportunistic screening for prostate cancer in the Australian population. Participants Australian male population (1982-2012). Interventions Prostate-specific antigen testing for prostate cancer screening. Primary and secondary outcome measures Primary: Lifetime risk of overdiagnosis in 2012 (excess lifetime cancer risk adjusted for changing competing mortality); Secondary: Lifetime risk of prostate cancer diagnosis (unadjusted and adjusted for competing mortality); Excess lifetime risk of prostate cancer diagnosis (for all years subsequent to 1982). Results The lifetime risk of being diagnosed with prostate cancer increased from 6.1% in 1982 (1 in 17) to 19.6% in 2012 (1 in 5). Using 2012 competing mortality rates, the lifetime risk in 1982 was 11.5% (95% CI 11.0% to 12.0%). The excess lifetime risk of prostate cancer in 2012 (adjusted for changing competing mortality) was 8.2% (95% CI 7.6% to 8.7%) (1 in 13). This corresponds to 41% of prostate cancers being overdiagnosed. Conclusions Our estimated rate of overdiagnosis is in agreement with estimates using other methods. This method may be used without the need to adjust for lead times. If annual (cross-sectional) data are used, then it may give valid estimates of overdiagnosis once screening has been established long enough for the benefits from the early detection of non-overdiagnosed cancer at a younger age to be realised in older age groups

Position estimation and tracking of an autonomous mobile sensor using received signal strength

In this paper, an algorithm for approximating the path of a moving autonomous mobile sensor with an unknown position location using Received Signal Strength (RSS) measurements is proposed. Using a Least Squares (LS) estimation method as an input, a Maximum-Likelihood (ML) approach is used to determine the location of the unknown mobile sensor. For the mobile sensor case, as the sensor changes position the characteristics of the RSS measurements also change; therefore the proposed method adapts the RSS measurement model by dynamically changing the pass loss value alpha to aid in position estimation. Secondly, a Recursive Least-Squares (RLS) algorithm is used to estimate the path of a moving mobile sensor using the Maximum-Likelihood position estimation as an input. The performance of the proposed algorithm is evaluated via simulation and it is shown that this method can accurately determine the position of the mobile sensor, and can efficiently track the position of the mobile sensor during motion.<br /

Robust video/ultrasonic fusion based estimation for automotive applications

We describe how object estimation by a stationary or a non-stationary camera can be improved using recently-developed robust estimation ideas. The robustness of vision-based systems can be improved significantly by employing a Robust Extended Kalman Filter (REKF). The system performance is also enhanced by increasing the spatial diveristy in measurements via employing additional cameras for video capture. We describe a normal-flow based image segmentation technique to identify the object for the application of our proposed state estimation technique. Our simulations demonstrate that dynamic system modelling coupled with the application of a REKF significantly improves the estimation system performance, especially when large uncertainties are present.<br /

In vitro investigation of anti-inflammatory activity and evaluation of phytochemical profile of Syzygium caryophyllatum

This study examined the anti-inflammatory potential of an aquous root extract of Syzygium caryophyllatum (Family: Myrtaceae) and reference drug Declofenac sodium, invitro using heat induced egg albumin denaturation bio assay technique. The concentrations of the root extract used were 781.25, 1562.5, 3125, 6250 and 12500 μg/mL. While diclofenac sodum were 78.12, 156.25, 312.5, 625, 1250 and 2500 μg/mL. Both the extract (r2 = 0.97; P<0.05) and Diclofenac sodium (r2 = 0.87; P<0.05) displayed marked and concentration dependent inhibition of heat-induced protein denaturation with IC50 value of 6.229 *103 μ g/ml and ~1.704*108 μg/mL respectively. Phytochemical analysis of the extract revealed the presence of the flavanoids, phenols, tanins, alkaloids, saponins and amino acids. It is concluded that the aquous root extract of Sri Lankan grown Syzygium caryophyllatum possess marked in vitro antiinflammatory activity which is mediated possibly by flavanoids, tanins and alkaloids. This is a novel finding. Further the results scientifically justify the use of roots of Syzygium caryophyllatum in Sri Lankan traditional medicine to treat inflammation