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Patients and methods : A prospective registration of patients with colorectal cancer and a colonoscopy within the last 10 years. We tried to classify these post-colonoscopy colorectal cancers (PCCRCs) by most reasonable explanation and into subcategories suggested by the World Endoscopy Organization (WEO) and calculated the unadjusted PCCRC rate. Results : 47 PCCRCs were identified. The average age at diagnosis of PCCRC was 73 years. PCCRCs were more located in the right colon with a higher percentage of MSI-positive and B-RAF mutated tumours. The average period between index colonoscopy and diagnosis of PCCRC was 4.2 years. Sixty-eight % of all PCCRCs could be explained by procedural factors. The mean PCCRC-3y of our department was 2.46%. Conclusions : The data of our centre are in line with the data of the literature from which can be concluded that most post-colonoscopy colorectal cancers are preventable. The PCCRC-3y is an important quality measure for screening colonoscopy. Ideally all centres involved in the population screening should measure the PCCRC-3 y annually, with cooperation of the cancer registry and reimbursement data provided by the Intermutualistic Agency (IMA).

Cyclotron Radiation Emission Spectroscopy (CRES) is a technique for measuring the kinetic energy of charged particles through a precision measurement of the frequency of the cyclotron radiation generated by the particle's motion in a magnetic field. The Project 8 collaboration is developing a next-generation neutrino mass measurement experiment based on CRES. One approach is to use a phased antenna array, which surrounds a volume of tritium gas, to detect and measure the cyclotron radiation of the resulting β-decay electrons. To validate the feasibility of this method, Project 8 has designed a test stand to benchmark the performance of an antenna array at reconstructing signals that mimic those of genuine CRES events. To generate synthetic CRES events, a novel probe antenna has been developed, which emits radiation with characteristics similar to the cyclotron radiation produced by charged particles in magnetic fields. This paper outlines the design, construction, and characterization of this Synthetic Cyclotron Antenna (SYNCA). Furthermore, we perform a series of measurements that use the SYNCA to test the position reconstruction capabilities of the digital beamforming reconstruction technique. We find that the SYNCA produces radiation with characteristics closely matching those expected for cyclotron radiation and reproduces experimentally the phenomenology of digital beamforming simulations of true CRES signals.

Bayesian modeling techniques enable sensitivity analyses that incorporate detailed expectations regarding future experiments. A model-based approach also allows one to evaluate inferences and predicted outcomes, by calibrating (or measuring) the consequences incurred when certain results are reported. We present procedures for calibrating predictions of an experiment's sensitivity to both continuous and discrete parameters. Using these procedures and a new Bayesian model of the $\beta$-decay spectrum, we assess a high-precision $\beta$-decay experiment's sensitivity to the neutrino mass scale and ordering, for one assumed design scenario. We find that such an experiment could measure the electron-weighted neutrino mass within $\sim40\,$meV after 1 year (90$\%$ credibility). Neutrino masses $>500\,$meV could be measured within $\approx5\,$meV. Using only $\beta$-decay and external reactor neutrino data, we find that next-generation $\beta$-decay experiments could potentially constrain the mass ordering using a two-neutrino spectral model analysis. By calibrating mass ordering results, we identify reporting criteria that can be tuned to suppress false ordering claims. In some cases, a two-neutrino analysis can reveal that the mass ordering is inverted, an unobtainable result for the traditional one-neutrino analysis approach., Comment: 17 pages, 10 figures

The beta decay of tritium in the form of molecular TT is the basis of sensitive experiments to measure neutrino mass. The final-state electronic, vibrational, and rotational excitations modify the beta spectrum significantly, and are obtained from theory. We report measurements of the branching ratios to specific ionization states for the isotopolog HT. Two earlier, concordant measurements gave branching ratios of HT to the bound HHe$^+$ ion of 89.5% and 93.2%, in sharp disagreement with the theoretical prediction of 55-57%, raising concerns about the theory's reliability in neutrino mass experiments. Our result, 56.5(6)%, is compatible with the theoretical expectation and disagrees strongly with the previous measurements., Comment: 6 pages, 4 figures (Updated with minor typographical fixes)

The Cyclotron Radiation Emission Spectroscopy (CRES) technique pioneered by Project 8 measures electromagnetic radiation from individual electrons gyrating in a background magnetic field to construct a highly precise energy spectrum for beta decay studies and other applications. The detector, magnetic trap geometry, and electron dynamics give rise to a multitude of complex electron signal structures which carry information about distinguishing physical traits. With machine learning models, we develop a scheme based on these traits to analyze and classify CRES signals. Understanding and proper use of these traits will be instrumental to improve cyclotron frequency reconstruction and help Project 8 achieve world-leading sensitivity on the tritium endpoint measurement in the future., 30 pages, 16 figures

The Locust simulation package is a new C++ software tool developed to simulate the measurement of time-varying electromagnetic fields using RF detection techniques. Modularity and flexibility allow for arbitrary input signals, while concurrently supporting tight integration with physics-based simulations as input. External signals driven by the Kassiopeia particle tracking package are discussed, demonstrating conditional feedback between Locust and Kassiopeia during software execution. An application of the simulation to the Project 8 experiment is described. Locust is publicly available at https://github.com/project8/locust_mc., 18 pages, 7 figures

We present a working concept for Phase III of the Project 8 experiment, aiming to achieve a neutrino mass sensitivity of $2~\mathrm{eV}$ ($90~\%$ C.L.) using a large volume of molecular tritium and a phased antenna array. The detection system is discussed in detail., 3 pages, 3 figures, Proceedings of Neutrino 2016, XXVII International Conference on Neutrino Physics and Astrophysics, 4-9 July 2016, London, UK

The Project 8 collaboration seeks to measure the absolute neutrino mass scale by means of precision spectroscopy of the beta decay of tritium. Our technique, cyclotron radiation emission spectroscopy, measures the frequency of the radiation emitted by electrons produced by decays in an ambient magnetic field. Because the cyclotron frequency is inversely proportional to the electron's Lorentz factor, this is also a measurement of the electron's energy. In order to demonstrate the viability of this technique, we have assembled and successfully operated a prototype system, which uses a rectangular waveguide to collect the cyclotron radiation from internal conversion electrons emitted from a gaseous $^{83m}$Kr source. Here we present the main design aspects of the first phase prototype, which was operated during parts of 2014 and 2015. We will also discuss the procedures used to analyze these data, along with the features which have been observed and the performance achieved to date., 3 pages; 2 figures; Proceedings of Neutrino 2016, XXVII International Conference on Neutrino Physics and Astrophysics, 4-9 July 2016, London, UK

The most sensitive direct method to establish the absolute neutrino mass is observation of the endpoint of the tritium beta-decay spectrum. Cyclotron Radiation Emission Spectroscopy (CRES) is a precision spectrographic technique that can probe much of the unexplored neutrino mass range with $\mathcal{O}({\rm eV})$ resolution. A lower bound of $m(\nu_e) \gtrsim 9(0.1)\, {\rm meV}$ is set by observations of neutrino oscillations, while the KATRIN Experiment - the current-generation tritium beta-decay experiment that is based on Magnetic Adiabatic Collimation with an Electrostatic (MAC-E) filter - will achieve a sensitivity of $m(\nu_e) \lesssim 0.2\,{\rm eV}$. The CRES technique aims to avoid the difficulties in scaling up a MAC-E filter-based experiment to achieve a lower mass sensitivity. In this paper we review the current status of the CRES technique and describe Project 8, a phased absolute neutrino mass experiment that has the potential to reach sensitivities down to $m(\nu_e) \lesssim 40\,{\rm meV}$ using an atomic tritium source., Comment: 19 pages, 8 figures, to be published in Journal of Physics G

Objective The aim of the study was to identify the most relevant literature on skills, attitude and behaviour of children and young people towards the use of an automated external defibrillator (AED) and then develop recommendations according to the principles of evidence-based practice. These recommendations were to serve as a basis for educational materials which would ensure that the implementation of AED-training within schools and youth organisations would be a simple process. Methods A systematic literature search was performed using a specific research question: “Are children of different ages able/willing to use an AED after a training compared to another/no training?”. A guideline development panel meeting was organised to formulate practice guidelines. The panel consisted of experts from different fields (medicine, education and psychology) and representatives of the end users (teachers and youth leaders). Results The systematic literature search identified five studies concerning AED skills by children and young people, and two studies concerning the attitudes and behaviour of children and young people towards the use of an AED. The guideline development panel carefully examined the available scientific evidence, took into consideration the skills and attitudes of children and young people, including the psychological consequences of managing a potentially life-saving situation and formulated evidence-based recommendations and good practice points. Conclusion Based on these recommendations, an education programme and new educational materials have been developed by the Belgian Red Cross-Flanders. In this way school staff and youth leaders are properly supported to teach first aid techniques to children and young people (6–18 years).

We used data and leftover samples collected through the SurvUDI network to describe the epidemiology of hepatitis C virus (HCV) infection among injection drug users (IDUs) in Eastern Central Canada. Among the 1380 selected IDUs, having participated twice or more between 1997 and 2003, the overall HCV prevalence rate was 60.4% (95% confidence interval [CI]: 57.7–63.0%). Among the 543 initially uninfected participants, the HCV incidence rate was 27.1 per 100 person-years (95% CI: 23.4–30.9 per 100 person-years). Independent predictors of seroconversion, identified among 359 participants, were age, injecting for a year or less, injecting with a syringe previously used by someone else, injecting most often cocaine, engaging in prostitution, and being recruited in a major urban centre. The HCV epidemic severely affects IDUs in this area. Actions to prevent HCV transmission, such as distribution of sterile injection equipment, have to be reinforced. Special efforts have to be targeted towards starting IDUs.

Background: Proton pump inhibitors (PPI) demonstrate high healing rates of 85‐98% in clinical trials. Due to the limited knowledge regarding response and non‐response to lansoprazole in daily practice and for the reason that resistance to PPIs is scarce, we investigated factors possibly associated with non‐response. Methods: Data were used from a prospective, open label, observational follow‐up study in which 10,008 lansoprazole users were followed over time. The study was designed according to the SAMM guidelines. A matched nested case‐control design was used to compare non‐responding (cases) and responding (controls) lansoprazole users. Non‐response was defined as worsening or non‐improvement of symptoms at the first evaluation after at least 8 weeks of use, response as disappearance or improvement of symptoms within 8 weeks of use. Controls were matched for the evaluating physician.Results: A total of 186 non‐responders and 372 responders to PPI treatment were identified as cases and controls. Age of over 60 years, heavy smoking and previous use of PPIs were significantly more common in non‐responding patients compared with responding patients. There were no differences found between the reported diagnosis regarding response. Conclusion: In daily clinical practice, previous use of PPIs, heavy smoking and an age > 60 years were significantly associated with non‐response to treatment with lansoprazole. Previous use of PPIs in non‐responding patients might suggest resistance to PPIs. The knowledge that non‐response drives non‐response may encourage physicians to follow PPI users with previous PPI use more closely.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

Purpose—Soon after the introduction of the proton pump inhibitor, lansoprazole, a 4-year observational follow-up study was started to evaluate the safety of this drug in naturally-occurring groups of patients in The Netherlands. Results of this study were compared with clinical trial data and the limited published data from observational studies. Methods— prospective, observational study in which patients with a new episode of lansoprazole use were followed during the medication period for a maximum of 2 years. All (adverse) events during use were documented by the prescriber, irrespective of possible association with lansoprazole therapy. Results— total of 805 general practitioners (GPs) and 266 specialists provided a total of 10,008 lansoprazole users with a broad range of diagnoses. Of all patients, 17.4% reported one or more adverse events. The profile and frequency of reported adverse events was consistent with results from clinical trials and other observational studies. The most frequently reported adverse events were diarrhoea, headache, nausea, skin disorders, dizziness and generalized abdominal pain/cramps. There was no new evidence of rare adverse events. Furthermore, no lansoprazole-related unlabelled adverse events of clinical significance were recorded. Conclusions— Although the patterns of use of lansoprazole in daily practice deviated to some extent from the diagnoses in the information leaflet, lansoprazole was found to have a highly acceptable safety profile in this large naturally-occurring group of users. Reporting rates were higher soon after introduction of lansoprazole before falling to a lower stable level. Copyright © 2000 John Wiley & Sons, Ltd.

SUMMARY Purpose Diarrhoea is one of the most frequently reported adverse events during proton pump inhibitor use in any setting. Because of the limited available information, this study was set up with the aim of assessing the incidence and characteristics of diarrhoea and to investigate possible associated co-factors in proton pump inhibitor users in daily practice. Methods Data were used from a prospective, observational study in which 10 008 lansprazole users were followed over time (1994–1998). The study was designed according to the SAMM guidelines. A nested case–control design was used to compare proton pump inhibitor users reporting diarrhoea with those reporting no diarrhoea. Results The frequency of diarrhoea was 3.7% and the incidence density 10.7 per 1000 patient months of proton pump inhibitor use. The diarrhoea was most commonly loose and occurred on average 4.4 times per day. The analysis of co-factors revealed that patients with concomitant use of oral antibiotics and patients reporting neurological and/or dermatological adverse events, were at risk of developing diarrhoea during proton pomp inhibitor use. Conclusions In conclusion, diarrhoea was as frequently reported in our study as in clinical trials and observational data of lansoprazole users. We found the concomitant use of oral antibiotics and the reporting of certain other adverse events to be associated with the reporting of diarrhoea during lansoprazole use. Although a relationship with the proton pump inhibitor intake seemed very plausible, we recommend that use of concomitant medicines as a cause of diarrhoea must be taken into consideration in lansoprazole users. Copyright # 2002 John Wiley & Sons, Ltd.

During proton pump inhibitor (PPI) use, in clinical trials, headache is one of the most frequently reported adverse events (frequency 1.3 to 8.8%), while results of one observational study indicate that headache is the fifth most frequently reported adverse event (incidence densities 2.5 to 4.6 per 1000 patient-months of exposure). However, there are no observational studies performed regarding the occurrence and features of headache during use of PPIs in daily practice. For this reason this study was set up with the aim to assess the incidence and characteristics of headache and to investigate possible associated co-factors in PPI users in daily practice.Data were used from a prospective, observational study in which 10 008 lansoprazole users were followed over time. The study was designed according to the Safety Assessment of Marketed Medicines guidelines. A nested case-control design was used to compare PPI users reporting headache or not.The frequency of headache was 2.5% in users of lansoprazole and the incidence density was 7.2 per 1000 patient-months of PPI lansoprazole use. Two-thirds of patients with headache had tension headache and one-third had migraine. The analysis of co-factors revealed that women, patients with previous use of analgesics and patients reporting several adverse events, were at risk to develop headache during PPI use. Patients with headache also, significantly more often, reported diarrhoea, nausea and dizziness. A discontinuation of PPI therapy resulted in a cessation or reduction of the headache in 80.0% (20 of 25).As can be expected, headache was reported less frequently in this study compared with clinical trials with lansoprazole. The incidence density was comparable with other observational data of lansoprazole and omeprazole users. Besides several commonly accepted co-factors such as female gender and a history of analgesic use, we also found the reporting of other adverse events to be associated with the reporting of headache during lansoprazole use. The cessation of headache after a discontinuation of use of the PPI and the observed dose relationship suggested that headache was indeed an adverse effect of lansoprazole use.

Background With the increase in global prevalence of syphilis, synthesis of evidence of point-of-care (POC) assays is warranted. While a clear methodology exists to meta-analyse diagnostic performance, a clear rubric that incorporates implementation research outcomes (IRO) relevant for policy making is lacking. Recently, Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift to emphasis on patient-centred outcomes for making policy recommendations. However, a lack of clarity in defining, elucidating, and reporting of these outcomes prevents their utilisation in practice. Within this context, we reviewed global evidence on IROs for syphilis POC tests. Method We systematically searched nine electronic databases for the period of January 1980 to September 2010. Articles that addressed IRO regarding POC syphilis tests were reviewed and data extracted. A second reviewer independently reviewed a subset of the articles. Outcomes were synthesised into a narrative review. Results 31 (48%) from 64 full text articles assessed were included in the narrative review. Twenty-four studies were cross-sectional, six were case-control, while one was a clustered randomised control trial (RCT). IROs were categorised into: Acceptability, Preference, Feasibility, Prevalence, Barriers and Challenges, and Economic Evaluations of POC tests. Three papers reported outcomes on acceptability, four on preference, ten on feasibility, seven on impact, six on prevalence, seven on barriers and challenges, and seven on economic evaluations. Overall, studies were concordant on findings of high acceptability and feasibility of POC tests as well as the testing strategy used. Preference was not well demonstrated in studies. Impact was particularly well demonstrated in antenatal clinic attendees by a clustered RCT. Barriers and challenges ranged from biotechnological limitations of the tests to lack of political will. Heterogeneous methodologies employed across studies to conduct economic evaluations made it difficult to draw conclusive statements. Conclusions Results were generally in agreement across studies, yet unsystematic methods of collecting and recording outcomes made it difficult to statistically combine outcomes. Weaknesses in the reporting of IROs limit our ability to form comprehensive context-specific policies. Further efforts in establishing a framework for conducting implementation research is required.

Objective To quantify the difference in the exposure category breakdowns of national HIV surveillance figures if exposure data from the Institut nationale de Sante Publique du Quebec (INSPQ) were included in national datasets. Background National HIV/AIDS surveillance is coordinated by the Public Health Agency of Canada9s (PHAC) Surveillance and Risk Assessment Division9s (SRAD). HIV is reportable in all provinces and territories, although the degree of epidemiologic information collected and submitted varies. Quebec9s case reports to PHAC come from their laboratory-based surveillance system, which contains positive test reports, by age and sex. All Quebec cases are classified in SRAD9s dataset as Not Reported, which contributes to the large proportion of cases at the national level with no known exposure category. Methods Quebec9s provincial HIV surveillance system “Programme de surveillance de l9infection par le VIH au Quebec” collects further epidemiological information, including exposure category and risk factor information, although recorded separately from the HIV laboratory test results file. This provincial system9s exposure category data was added to existing national surveillance data, and the exposure category breakdowns recalculated, in order to assess change in the proportion of unknown/not reported cases and to quantify the resulting difference in exposure category breakdowns at the national level. Results With inclusion of Quebec data for 2009, there is a 50% decrease (from 45.5% to 23.1%) in the proportion of national HIV cases with unknown exposure category. There are also differences in the overall national exposure category breakdowns. For 2009, proportional increases were observed in the men who have sex with men (MSM) and heterosexual-endemic categories (5.4% and 2.8% respectively), while proportional decreases were observed in the exposure categories of injection drug use (−4.1%), heterosexual-risk (−2.0%), and no-identified-risk heterosexual (−2.2%). Conclusions Inclusion of Quebec9s risk exposure data in the national HIV dataset is significant; the national dataset becomes more complete and the proportion of cases with unknown exposure category is reduced. This analysis demonstrates that inclusion of exposure category data, from the provincial HIV surveillance system of Quebec9s INSPQ can alter the exposure category breakdowns at the national level, thereby offering a more accurate picture of HIV diagnoses in Canada.

Background The WHO estimates that 170 million people worldwide are infected with Hepatitis C. In the context of HIV co-infection, rapid point-of-care tests gain importance in both the developing and developed countries. Moreover, in the light of the Food and Drug Administration9s approval of the Oraquick point-of-care test for Hepatitis C for use in the USA, the accuracy of these tests is relevant. Objective We conducted a systematic review and meta-analysis of the literature examining the sensitivity and specificity of all rapid point-of-care tests used to diagnose incident or prevalent Hepatitis C, with an attention to involvement of industry in reporting of results. Methods Two reviewers conducted independent searches of five databases between the years of 1995 and 2010. Bayesian meta-analysis was conducted accounting for the use of imperfect reference standards (sensitivity and specificity ranges of 90%–100% were assumed) in the assessment of index tests. The quality of all included full-text studies was assessed using the QUADAS and STARD checklists, with a focus on reporting of conflict of interest with industry. Results A total of seven studies were identified from the database searches, of which five were conducted in developing settings. Eight index tests were examined including Oraquick, HCV Tri-Dot, HCV Bidot, Therma Ricerca, SM-HCV, Onecheck, Goldspot and Accurate. Sensitivity of all index tests ranged from 45% to 100%, while specificity ranged from 93% to 100%. Oraquick reportedly had the highest accuracy, with sensitivity ranging from 99% to 100% and a specificity of 100%. However, the authors of the study reported a financial relationship with Orasure Technologies Inc., the makers of Oraquick. Although pooled sensitivity of all tests was high at 92.72% (95% CI 72.11% to 99.93%), when the Oraquick study was removed from analysis, the pooled sensitivity of all other tests dropped to 77.11% (95% CI 45.49% to 99.61%) see Abstract P3-S5.03 table 1. Pooled specificity remained high at almost 100% regardless of whether the Oraquick study was included or not. Conclusion Although Oraquick appears to be the most promising test, authors9 ties with industry make these results less credible. More independent testing is required to be able to make policy recommendations for the most accurate index test to detect Hepatitis C infection.

We studied the structural and functional heart adaptations of 52 male triathletes compared with those of 22 active, nonathletic men, by 2-dimensional Doppler echocardiography. Left ventricular diastolic function was evaluated by recording transmitral flow velocities. To exclude the influences of preload, left atrial pressure, and aortic pressure, left ventricular diastolic function was also evaluated by pulsed Doppler tissue imaging. Significant differences in cardiac structure and function were observed between the 2 groups. In the triathletes, the left ventricular diastolic function was completely normal, despite signs of mixed eccentric and concentric left ventricular hypertrophy, and this function was better than that in the control group. We measured 2 aspects of the late passive diastolic filling period in the triathletes: ASEAC value (the amplitude of excursion of the interventricular septal endocardium at the end of left ventricular diastole just after atrial contraction); and the time between onset of the P wave on the electrocardiographic tracing and onset of systolic septal movement on M-mode echocardiography. Pulsed Doppler tissue imaging confirmed these results. The E/A ratios (peak early left ventricular diastolic motion velocity divided by the peak atrial systolic motion velocity), measured by pulsed Doppler tissue imaging, yielded even more evidence for supernormal left ventricular diastolic function in the triathletes. Left ventricular relaxation and filling properties were measured along the longitudinal and transverse axes by pulsed Doppler tissue imaging, which was useful for evaluating left ventricular diastolic function. We determined that triathletes may develop supernormal left ventricular diastolic function with increased diastolic reserves.

A triathlete has to complete a hard endurance effort in aerobic circumstances. This requires important cardiovascular, haemodynamic and metabolic adaptations which alter the percentage body fat. This study included 52 triathletes and 22 control persons. The anthropometric data of the two groups were similar. All the subjects underwent the same extensive non-invasive cardiac exploration with two-dimensional cardiac echo-doppler examination. Maximal incremental exercise tests with determination of lactate and the ventilatory threshold were done on bicycle and on treadmill. Three different methods determined the percentage of body fat: 4 and 12 skin fold method, bioelectrical impedance analysis and dual energy X-ray absorptionmetry. The results showed important structural and functional heart changes in the triathletes. These changes caused distinct heamodynamic adaptations so that the maximal performing capacity and the aerobic capacity could be forced up largely. The haemodynamic adaptations were connected with changes in the percentage body fat in triathletes. The determination of the 12 skin fold measurements enabled us to distinguish the triathletes with better competition results from the inferior triathletes. It is concluded that the method of 12 skin fold measurements gives the most reliable results and requires only a limited instrumentarium. Moreover, this examination can be performed correctly and easily in all circumstances.

In this study (n = 200), the characteristics of IDUs participating in a provincial needle exchange program (NEP) for more than 2 years (2 years) were compared with those of IDUs having participated for less than 2 years (or = 2 years). Compared to theor = 2 years, the2 years were more often recipients of welfare (RC: 4.7), especially among the HIV-positive (RC: 62.0); tried quitting drugs more frequently (RC: 3.8); more often recommended the NEP to other IDUs (RC: 3.1); and more often requested being given shelter and longer opening hours (RC: 3.6). These results highlight the urgent need to improve and develop transitional and support services for the2 years. Preventive interventions that would reach out to theor = 2 years where they live should also be implemented in close collaboration with organizations involved in mental health and drug use prevention.

To perform a triathlon in aerobic conditions, a variety of cardiovascular, haemodynamic and metabolic adaptations are required. The heart is the central concern and also the most important limiting factor. In this study we investigate the structural and functional heart adaptations of a group of triathletes.A group of 52 male triathletes was divided into 4 subgroups in function of their athletic results and compared with a control group of 22 healthy, very active but no athletic men. The groups had comparable anthropometric and general physical characteristics. Very significant differences in cardiac structure and cardiac function were observed between the groups. In the triathletes, we registered distinct signs of significantly mixed eccentric and concentric hypertrophy. Unlike the findings in a pathological left ventricular hypertrophy, the diastolic left ventricular function in triathletes was completely normal and even better than in the control group. The late passive diastolic filling period of the triathlete, in particular, seemed to have specific characteristics. The comparison between the subgroups of triathletes shows us that genetic factors probably play an important role in the cardiac adaptations in triathletes.In our opinion the "athletic heart" in triathletes is not a specific "physiological entity" but is a transitional phase to a dilated hypertrophic cardiomyopathy. Our study yields some arguments for the following proposition: "People are born as elite athletes, with specific characteristics of the left ventricle and with a specifically supernormal diastolic left ventricular function."

Background: Immediately after the introduction of the proton pump inhibitor lansoprazole, a 2-year follow-up study was started to evaluate patterns of use, safety and effectiveness of this drug in naturally occurring groups of patients in the Netherlands. Medical data were recorded by participating physicians while medication listings were provided by pharmacists. Methods: The study was designed according to the Safety Assessment of Marketed Medicines guidelines. The only inclusion criterion was the use of lansoprazole prior to entry into the study. Results: A total of 5669 lansoprazole users was included by 374 general practitioners and 117 specialists. Lansoprazole was mostly prescribed in patients with reflux oesophagitis (55.1%), `gastritis' (26.8%) and duodenal ulcers (11.4%), sometimes as part of a Helicobacter pylori eradication therapy (8.5%). For their complaints most patients (91.1%) had previously used acid-related drugs. Improvement or disappearance of complaints was achieved in 88.9% and 90.5% of patients after 4 and 8 weeks of treatment, respectively. Diarrhoea (4.1%), headache (2.9%) and nausea (2.6%) were the most frequently reported adverse events. Conclusion: The patterns of use of lansoprazole in daily practice deviated from the recommendations in the information leaflet. Nevertheless, lansoprazole was found to be safe in this naturally occurring group of users. Effectiveness appeared to be comparable to results found in clinical trials of the registered indications for lansoprazole.

Background More than 350 million people are infected with the Hepatitis B virus worldwide, with four million new cases every year. The prevalence of the Hepatitis B virus is highest in developing settings where laboratory equipment and diagnostic resources are limited. This creates a need for rapid point-of-care testing in order to screen blood donors and ensure timely diagnosis and treatment of infected individuals. Although studies have been conducted examining the accuracy of different tests, there has not been a synthesis of the available global evidence, or an assessment of the quality of evidence to date. Objective We conducted a systematic review of the global literature examining the sensitivity and specificity of rapid point-of-care tests used to diagnose Hepatitis B, and meta-analysed the data. Additionally, we conducted a critical appraisal of the quality of included studies. Methods Two reviewers conducted independent searches of five databases between the years of 1990 and 2010 for global evidence. Meta-analysis was performed grouping studies based on whether the index test identified HBsAg, both HBs and eAg, or antibody to HbsAg. We used Bayesian meta-analysis, accounting for the fact that all of the studies used imperfect reference standards (sensitivity and specificity assumed to range between 90% and 100%). The quality of all included full-text studies was assessed using the QUADAS and STARD checklists. Results A total of 17 studies were identified, of which 13 were from developing countries and which investigated 22 different index tests. When studies were pooled, the Determine HBsAg test showed a combined sensitivity of 98.76% and a specificity of 99.94%. Other HBsAg tests showed a lower combined sensitivity (96.77%) but comparable specificity (99.89%). The Amrad HBs+eAg test showed a combined sensitivity of 98.04% and a specificity of 99.04%, while the tests detecting antibody to HBsAg showed a combined sensitivity of 99.77% and a specificity of 96.08%. Studies were of poor-moderate quality with QUADAS scores ranging from 3 to 10/14 and STARD scores ranging from 7 to 14/25 see Abstract P3-S5.04 table 1. Conclusion The Amrad and Determine tests show the highest pooled accuracy. However, this could be explained by the fact that the other subgroups included studies examining different index tests with a wide range of accuracies. There is a need for more consistently designed studies, using ideal reference standards recommended by the CDC or Health Canada.

Background Few studies have examined the association between HIV status knowledge and sexual behaviours among injection drug users (IDUs). We tested the hypothesis that IDUs who know their HIV positive status will have safer sexual practices than IDUs aware of their HIV negative status or never tested for HIV. Methods IDUs who had injected in the past 6 months were recruited in harm reduction programs across the Province of Quebec and Ottawa, Canada. Participants completed a questionnaire including questions on sexual behaviours and provided saliva for HIV antibody testing. For IDUs with multiple participations, the last interview was selected. Data from 2003 to 2009 were analysed. Three groups were compared—IDUs aware of their positive HIV status (n=510), IDUs aware of their HIV negative status (n=2928) and IDUs never tested for HIV (n=427). Proportions were compared using χ 2 tests. Results Male IDUs aware of their positive HIV status were less likely to have had sex in the last month (HIV positive—32.4%, HIV negative—47.2% and never tested—55.0%; p Conclusions IDUs aware of their positive HIV serostatus reported more consistent condom use with their various types of sex partners than those aware of their HIV negative status or never tested.

From a population survey of 2865 subjects, test characteristics of a number of clinical findings relating to knee osteoarthritis were calculated against the standard of radiographic diagnosis. The clinical findings included from the history were age, gender, current pain in the knee, swollen knee, pain in both hands, morning stiffness, osteoarthritis in any joint, pain or stiffness, or both, in knees or hips when rising from seated position, and pain in knees or hips while climbing stairs; and from the physical examination: Quetelet's index, Heberden's nodes, bony enlargement, palpable effusion, soft tissue swelling, limitation of knee function, pain with knee flexion, bony tenderness and, finally, the latex fixation test. Of 18 clinical variables, all but Heberden's nodes, palpable knee effusion, pain in both hands, and latex fixation test showed a significant association after adjustment for age. Neither one single variable nor a combination could predict radiographic osteoarthritis of the knee with reasonable accuracy and thus be applicable in clinical practice. The x ray film, therefore, keeps its place in the diagnosis of knee osteoarthritis in general practice as well as in epidemiological research.

Background Recently Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift from diagnostic accuracy to emphasis on patient-centred outcomes for making policy recommendations. While meta-analyses have evaluated diagnostic accuracy of POC HIV tests, a systematic appraisal of other implementation research outcomes, such as cost, is lacking. Within this context, we reviewed global evidence on cost outcomes of OraQuick Advance HIV—1/2 Antibody Test. Method We systematically searched six electronic databases for the period of January 1999 to January 2011. Cost outcomes with OraQuick tests were reviewed and data extracted. For economic evaluation we accepted both partial and full study designs. Outcomes were synthesised into a narrative review. Results We identified nine studies offering economic evaluations of oral and blood based OraQuick, of which six were full economic evaluations and remaining were partial evaluations. The full economic evaluations included five Cost Effectiveness Analysis (CEA) and one Cost Utility Analysis (CUA) design; one partial evaluation was a cost comparison study and two were cost analysis studies. All studies were in the USA except one, which was from Mexico. All studies performed sensitivity analyses to explore the impact of uncertainty in their model parameters and findings. Methodological approaches applied by the authors were not standardised and program cost varied by location, but overall there was uniformity in the study conclusions. The studies concluded that OraQuick was cost effective in low prevalence settings and resulted in low rates of false positives which have favourable economic implications. The tests were found to be cost saving to the medical system, and offer the advantage of convenience in administration when compared to current standards of care. Since it was recognised that pre- and post-test counselling cost and personnel costs accounted for most of the overall costs for these rapid tests, one approach that was proposed to reduce this cost was to limit the time spent on counselling or by using lower-paid personnel for counselling activities. Conclusion The economic evaluation results presented here can guide program managers and health policy decision makers in the research for efficient HIV testing options, for the proper allocation of healthcare resources and for adoption of models of healthcare delivery that represent the best value for money.