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The assessment (planning step 1) identifies existing services cholesterol levels in europe generic atorlip-5 5mg free shipping, as well as data and knowledge cholesterol heart disease quality atorlip-5 5mg, with regard to the burden of cancers amenable to early detection and the population at risk cholesterol levels statistics buy atorlip-5 5mg overnight delivery. The next step is to consider what could be done cholesterol food free order atorlip-5 australia, given limited resources and capacity, in order to answer the question: Where do we want to be? In early diagnosis programmes, the target population will be all patients of a certain age group and sex, prone to developing a specific cancer, and presenting with early signs and symptoms suggesting that cancer. For example, in the case of retinoblastoma, the target population would be all children presenting with a white spot in the pupil and convergent strabismus. In the case of breast cancer, it would be women over 35 years of age presenting with a lump in the breast. It is not justifiable to raise awareness in normal-risk women aged less than 35 years because breast cancer is very rare among this subgroup, and any lump in the breast will most probably be a benign tumour. For example, screening for cervical cancer is recommended for women from the age of 30 years and, when resources permit, for women aged 25 years and above. Screening is not necessary for women over 65 years, provided the last two smears were negative. However, several countries have chosen to evaluate screening for breast cancer for women using other approaches such as clinical breast examination, from the age of 35 or 40 years (see Table 7). Only for colorectal cancer, is there evidence to support screening for men, but this is recommended only for high-resource settings. Screening that concentrates solely on "high-risk groups" is rarely justified, as a high proportion of cancer patients do not have identifiable risk factors. For example, in breast cancer, it is possible to identify known risk factors only in less than 30% of cases. However, in planning the coverage of screening programmes, measures must be introduced to ensure that all those at high risk are included. The frequency of screening, that is to say, how often those who test negative should be invited to return for re-screening, is an important decision in the planning of any screening programme. Increasingly, however, it has been recognized that the frequency of re-screening should depend upon the natural history of the disease, as well as the resources available in the country. For further information on breast, cervical and oral cancer screening, see screening. It is important to assess both the impact of early detection interventions previously implemented in the target population, and the effect of interventions that have been successfully applied elsewhere, particularly in similar socioeconomic and cultural settings. For example, in a country where resources are constrained and if the majority of breast cancer patients are presenting in advanced stages, the introduction of a well-organized early diagnosis programme could, in the long-term, significantly improve survival and reduce mortality from breast cancer. For the early detection plan to be effective, all process and outcome objectives need to promote the common goal of reducing mortality from the most frequent cancers amenable to early detection. Table 6 provides examples of short-, medium- and long-term objectives of an early detection programme according to level of resources. In order for an early detection programme to be effective, it should deliver good quality services (early detection, diagnosis, treatment and follow-up) equitably and indefinitely to all members of the target population. Some resource-constrained countries with a high proportion of patients presenting with cervical cancer in advanced stages have, instead of introducing low-cost interventions, such as early diagnosis which could be offered to the whole population, opted to invest in cytology screening for cervical cancer, even though such an intervention serves only a small percentage of the population. It is particularly important to investigate the feasibility of a cancer screening programme in view of its complexity and because its introduction requires the provision of new resources. A good screening programme might eventually reduce health-care costs related to a specific cancer, but the overall cost of health care is unlikely to be reduced because screening has to be provided to large numbers of people. Could the new resources required for screening be better spent on another aspect of cancer control, or on another aspect of health care? Vulnerable and marginalized populations, who may comprise those at greatest risk, are unlikely to be included unless the programme is well organized and fully funded.

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Determine a general topic or clinical problem and then discuss your ideas with others cholesterol medication and memory loss buy discount atorlip-5, narrowing the focus to a specific research question cholesterol levels risk ratio 5mg atorlip-5 with amex. Consider the potential implications of findings related to this research: Is this question worth your time and effort to study? Determining what is known and identifying gaps in the literature are critical in the development of a research project cholesterol chart in indian food proven atorlip-5 5mg. Reviewing previous studies helps the investigator identify a suitable framework for the study cholesterol score of 209 discount atorlip-5 5 mg overnight delivery, which in turn guides the selection of relevant variables and suitable methods and measures. The process of conducting the literature review also may present an opportunity for developing a review or clinical paper for publication. Based on the literature review, the research question may need further refinement. Once this is accomplished, it is a good idea to write up a brief research concept proposal and have this reviewed and approved by the individuals whom you have identified as key to the success of your project. In some institutions, a research concept may be required as part of the formal approval process. Feedback from this process will be valuable as you develop your research proposal. In order to obtain meaningful analysis, some cancer survivorship research requires larger numbers of survivors than may be available at a single institution. The researcher could collaborate with clinicians and scientists at other centers and/or use a pre-existing database to recruit for the study. The research concept should now be used as a platform for development of the full research protocol which should include title, abstract (summary), background, aims/objectives, hypothesis, eligibility criteria, conceptual framework, study design, sampling, variables, statistical analysis, identification of study measures and instruments, ethical considerations, risks and benefits, and determination of the composition of your research team. Adding research expertise to your team is key to developing the research question(s) and methods. The type of expertise that will 51 Section 4: Survivorship Research be needed to conduct a study becomes clearer as the research topic and questions evolve. The study will develop further based on the interests and perspectives of the various experts who form the research team. The research team should include individuals from multiple disciplines who have essential and complementary skills including study design, theoretical frameworks, statistics, database design and programming, grantsmanship, and clinical expertise. Considerations for institutional support may include access to populations of interest and potential research participants, existing systems for obtaining, processing and storing research data (including tissue samples and medical record information), and availability of research office space and clinical facilities (including a private area for obtaining informed consent and conducting data collection). Once the research plan is in place, you should proceed with the process of obtaining regulatory approval to conduct the study. Perform the statistical analysis as outlined in your research plan and then interpret your findings. Prepare manuscripts for submission to scientific journals, poster abstracts, and conference presentations. If the researcher wants to answer a question from previously collected data, gaining access to the preexisting database is necessary. Building Research Partnerships Partnerships and cross-institutional collaboration are important because of the relatively small number of childhood cancer patients and survivors at most institutions. Sharing ideas with colleagues between and across institutions facilitates successful completion of research projects. The novice researcher should consider initiating a small working group with other colleagues from which pilot data can be obtained. Internal and external partnerships A group of researchers within or between institutions with a similar area of interest, but often with different areas of research expertise, who regularly schedule conference calls or meetings to brainstorm ideas for research and to share opportunities for funding, publication, leadership, and teaching. Clinical partnerships Clinical partnerships are an effective way of promoting research within institutions that have different requirements regarding time dedicated to clinical and research responsibilities. They may want to seek collaboration with another institution that has resources to assist in conducting this study. Clinical partnerships may work well for multidisciplinary research studies (studies involving multiple disciplines, such as nursing, medicine, social work, psychology, and/or neuropsychology). For example, examination of the various psychological effects of cancer requires expertise in identifying these issues, and support from physicians and nurses who follow these patients and families during treatment.

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In all cases cholesterol medication before blood test atorlip-5 5mg amex, the two groups were significantly different from one another (p < 0 does cholesterol medication make you drowsy cheap atorlip-5 5 mg line. They attempted to classify patients into two groups: those whose cancer recurred within five years of diagnosis and tumor resection (poor prognosis group) cholesterol levels for 50 year old male order genuine atorlip-5 on line, and those who remained disease-free beyond five years (good prognosis group) cholesterol ratio american heart association buy atorlip-5 5mg with amex. They used a three-step supervised classification method to develop a 70-gene predictive signature, which they applied to an independent test set of 19 patients. This 21-gene signature was applied to two independent breast cancer datasets and successfully separated patients into good and poor outcome groups (p < 0. Bair and Tibshirani (2004) proposed a semi-supervised version of principal components analysis that is capable of generating a continuous predictor of patient survival. Their algorithm consistently selected fewer than 20 genes and successfully divided patients into high- and low-risk groups in four different datasets: lymphoma (p-value=0. Since different clinical data and survival information were made available from these two publications, the 61 overlapping samples will make up the training set in this project and the remaining 234 samples will comprise the test set. The training and test sets used in this paper are available at the supplemental website for this project: expression. The samples in both breast cancer datasets were hybridized to two-color microarrays containing approximately 25,000 genes. Of the 295 total samples in the training and validation datasets, the survival times ranged from 0. These traditional methods tend to overestimate the goodness-of-fit between model and data, and the model is subsequently unable to retain its predictive power when applied to independent datasets (Derksen & Keselman, 1992; Volinsky et al. If there are G candidate explanatory genes in the expression set, then there are 2G possible models to consider. When working with tens of thousands of genes, such an undertaking is computationally intractable. In order to discard the noncontributory models and obtain a subset that approximates an average over 15 all 2 possibilities, Raftery (1995) proposed to use the regression by leaps and G bounds algorithm from Furnival and Wilson (1974). This algorithm takes a userspecified input "nbest" and efficiently returns the top nbest models of each size (maximum 30 variables). After identifying the strongest model returned by the leaps and bounds algorithm, the procedure can eliminate any model whose posterior probability is below the cutoff point in relation to the best model. The cutoff point can be varied, but the default is 20; that is, a model must be at least 1/20 as likely as the strongest model in order to be retained. Once this step is complete, the remaining group of models constitutes the set S to be used in Equation (1). The Laplace method approximation is generally far more accurate than this final term suggests; see Kass and Wasserman (1995) and Raftery (1996) for discussion. This information is helpful in facilitating biological discussion as it reveals which of the genes are relevant predictors. Let the expression (bi 0) indicate that the regression parameter for gene xi exists in the vector of regression parameters i for at least one model M. The posterior probability of gene xi is a summation of the posterior probabilities of all models in Ms. This computation ensures that all statistically relevant predictor genes will be a part of at least one model in the subset. The data was made available by the Cardiovascular Health Study and included 23 variables. Patient risk scores were calculated by taking the weighted average of the risk scores for each of the top five contending models. The patients were then assigned to either the high-risk, medium-risk, or low-risk group based on the empirical 33rd and 66th percentile cutoff points in the risk scores of the training set. This is because the typical microarray dataset contains thousands or even tens of thousands of genes, but the leaps and bounds algorithm from Furnival and Wilson (1974) can only consider a maximum of 30 variables when selecting the top nbest models to return to the user. The usual practice of employing stepwise backward elimination to reduce the number of genes down to 30 is not applicable in a situation where the number of predictive variables is greater than the number of samples. As the algorithm iterates, genes with a high posterior probability (equation (7)) are retained while genes with a low posterior probability are eliminated.

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