Development of a Core Outcome Set for Dysphagia Interventions in Parkinson's disease (COS-DIP): study protocol

INTRODUCTION

Current clinical trials on swallowing disorders (dysphagia) in Parkinson's disease (PD) apply a high variety of outcomes and different outcome measures making comparative effectiveness research challenging. Furthermore, views of patients and dysphagia clinicians when selecting trial outcomes have not been considered in the past, thus study results may have little importance to them. This study aims to develop an agreed standardised Core Outcome Set for Dysphagia Interventions in Parkinson's disease (COS-DIP), systematically measured and reported as a minimum for all clinical trials. It will also comprise guidance on outcome definitions, outcome measures and time points of measurement.

METHODS AND ANALYSIS

The COS-DIP development will comprise five stages following established methodology: (1) a recent scoping review on all applied outcomes, their definitions, methods and time points of measurement in clinical trials in dysphagia in PD, (2) online surveys and focus groups with clinicians, patients, caregivers and family members to identify outcomes that are important to them, (3) an identified list of outcomes based on results of stage 1 and 2, (4) three round online Delphi survey with up to 200 key stakeholders to determine core outcomes and (5) two online consensus meetings with up to 40 representative key stakeholders to agree on all outcomes, definitions, methods and time points of measurement in the final COS-DIP.

ETHICS AND DISSEMINATION

Full ethical approval was obtained from the Research Ethics Committee, School of Linguistic, Speech and Communication Sciences, Trinity College Dublin, on 15 May 2023 (HT27). Dissemination of the COS-DIP will be enhanced through presentations at (inter-) national conferences and through peer-reviewed, open access publications of related manuscripts. Lay and professional information sheets and infographics will be circulated through relevant patient and professional organisations and networks.

TRIAL REGISTRATION NUMBER

The COS-DIP study was registered prospectively with the Core Outcome Measures in Effectiveness Trials (COMET) database on 24 September 2021 (www.comet-initiative.org/Studies/Details/1942).

Energy-Spread Preservation and High Efficiency in a Plasma-Wakefield Accelerator

Energy-efficient plasma-wakefield acceleration of particle bunches with low energy spread is a promising path to realizing compact free-electron lasers and particle colliders. High efficiency and low energy spread can be achieved simultaneously by strong beam loading of plasma wakefields when accelerating bunches with carefully tailored current profiles [M. Tzoufras et al., Phys. Rev. Lett. 101, 145002 (2008)PRLTAO0031-900710.1103/PhysRevLett.101.145002]. We experimentally demonstrate such optimal beam loading in a nonlinear electron-driven plasma accelerator. Bunches with an initial energy of 1 GeV were accelerated by 45 MeV with an energy-transfer efficiency of (42±4)% at a gradient of 1.3  GV/m while preserving per-mille energy spreads with full charge coupling, demonstrating wakefield flattening at the few-percent level.

FLASHForward: plasma wakefield accelerator science for high-average-power applications

The FLASHForward experimental facility is a high-performance test-bed for precision plasma wakefield research, aiming to accelerate high-quality electron beams to GeV-levels in a few centimetres of ionized gas. The plasma is created by ionizing gas in a gas cell either by a high-voltage discharge or a high-intensity laser pulse. The electrons to be accelerated will either be injected internally from the plasma background or externally from the FLASH superconducting RF front end. In both cases, the wakefield will be driven by electron beams provided by the FLASH gun and linac modules operating with a 10 Hz macro-pulse structure, generating 1.25 GeV, 1 nC electron bunches at up to 3 MHz micro-pulse repetition rates. At full capacity, this FLASH bunch-train structure corresponds to 30 kW of average power, orders of magnitude higher than drivers available to other state-of-the-art LWFA and PWFA experiments. This high-power functionality means FLASHForward is the only plasma wakefield facility in the world with the immediate capability to develop, explore and benchmark high-average-power plasma wakefield research essential for next-generation facilities. The operational parameters and technical highlights of the experiment are discussed, as well as the scientific goals and high-average-power outlook. This article is part of the Theo Murphy meeting issue 'Directions in particle beam-driven plasma wakefield acceleration'.

Erratum: Emittance Preservation in an Aberration-Free Active Plasma Lens [Phys. Rev. Lett. 121, 194801 (2018)]

This corrects the article DOI: 10.1103/PhysRevLett.121.194801.

Emittance Preservation in an Aberration-Free Active Plasma Lens

Active plasma lensing is a compact technology for strong focusing of charged particle beams, which has gained considerable interest for use in novel accelerator schemes. While providing kT/m focusing gradients, active plasma lenses can have aberrations caused by a radially nonuniform plasma temperature profile, leading to degradation of the beam quality. We present the first direct measurement of this aberration, consistent with theory, and show that it can be fully suppressed by changing from a light gas species (helium) to a heavier gas species (argon). Based on this result, we demonstrate emittance preservation for an electron beam focused by an argon-filled active plasma lens.

Simultaneous Liver-Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

The introduction of the Mayo End-Stage Liver Disease score into the Organ Procurement and Transplantation Network (OPTN) deceased donor liver allocation policy in 2002 has led to a significant increase in the number of simultaneous liver-kidney transplants in the United States. Despite multiple attempts, clinical science has not been able to reliably predict which liver candidates with renal insufficiency will recover renal function or need a concurrent kidney transplant. The problem facing the transplant community is that currently there are almost no medical criteria for candidacy for simultaneous liver-kidney allocation in the United States, and this lack of standardized rules and medical eligibility criteria for kidney allocation with a liver is counter to OPTN's Final Rule. Moreover, almost 50% of simultaneous liver-kidney organs come from a donor with a kidney donor profile index of ≤0.35. The kidneys from these donors could otherwise be allocated to pediatric recipients, young adults or prior organ donors. This paper presents the new OPTN and United Network of Organ Sharing simultaneous liver-kidney allocation policy, provides the supporting evidence and explains the rationale on which the policy was based.

Kidney

Kidney transplant provides significant survival, cost, and quality-of-life benefits over dialysis in patients with end-stage kidney disease, but the number of kidney transplant candidates on the waiting list continues to grow annually. By the end of 2014, nearly 100,000 adult candidates and 1500 pediatric candidates were waiting for kidney transplant. Not surprisingly, waiting times also continued to increase, along with the number of adult candidates removed from the list due to death or deteriorating medical condition. Death censored graft survival has increased after both living and deceased donor transplants over the past decade in adult recipients. The majority of the trends seen over the past 5 years continued in 2014. However, the new allocation system was implemented in late 2014, providing an opportunity to assess changes in these trends in the coming years.

OPTN/SRTR 2013 Annual Data Report: kidney

A new kidney allocation system, expected to be implemented in late 2014, will characterize donors on a percent scale (0%-100%) using the kidney donor profile index (KDPI). The 20% of deceased donor kidneys with the greatest expected posttransplant longevity will be allocated first to the 20% of candidates with the best expected posttransplant survival; kidneys that are not accepted will then be offered to remaining 80% of candidates. Waiting time will start at the time of maintenance dialysis initiation (even if before listing) or at the time of listing with an estimated glomerular filtration rate of 20 mL/min/1.73 m(2) or less. Under the current system, the number of candidates on the waiting list continues to increase, as each year more candidates are added than are removed. Median waiting times for adults increased from 3 years in 2003 to more than 4.5 years in 2009. Donation rates have not increased. Short-term outcomes continue to improve; death-censored graft survival at 90 days posttransplant was 97% or higher for deceased donor transplants and over 99% for living donor transplants. In 2013, 883 pediatric candidates were added to the waiting list; 65.8% of pediatric candidates on the list in 2013 underwent deceased donor transplant. Five-year graft survival was highest for living donor recipients aged younger than 11 years (89%) and lowest for deceased donor recipients aged 11 to 17 years (68%).

Non-contact in vivo measurement of ocular microtremor using laser speckle correlation metrology

Ocular microtremor (OMT) is a small involuntary eye movement present in all subjects. In this paper we present the results of in vivo OMT measurement using a novel non-contact laser speckle technique. OMT signals have not previously been measured from the sclera using this laser speckle correlation technique. To verify the system's ability to record eye movements, it is first tested using a large angle eye rotation. Next, the system is tested with a group of 20 subjects and OMT parameters are extracted. The results of OMT measurements gave a mean frequency of 78 ± 3.86 Hz and peak-to-peak amplitude of 21.42 ± 7.01 µrad, these values are consistent with known values from eye-contacting methods.

The Kuwait-Scotland eHealth Innovation Network (KSeHIN): a sustainable approach to quality improvement in healthcare

BACKGROUND

The rising prevalence of obesity and diabetes in Kuwait represents a significant challenge for the country's healthcare system. Diabetes care in Scotland has improved by adopting a system of managed clinical networks supported by a national informatics platform. In 2010, a Kuwait-Dundee collaboration was established with a view to transforming diabetes care in Kuwait. This paper describes the significant progress that has been made to date.

METHODS

The Kuwait-Scotland eHealth Innovation Network (KSeHIN) is a partnership among health, education, industry and government. KSeHIN aims to deliver a package of clinical service development, education (including a formal postgraduate programme and continuing professional development) and research underpinned by a comprehensive informatics system.

RESULTS

The informatics system includes a disease registry for children and adults with diabetes. At the patient level, the system provides an overview of clinical and operational data. At the population level, users view key performance indicators based on national standards of diabetes care established by KSeHIN. The national childhood registry (CODeR) accumulates approximately 300 children a year. The adult registry (KHN), implemented in four primary healthcare centres in 2013, has approximately 4000 registered patients, most of whom are not yet meeting national clinical targets. A credit-bearing postgraduate educational programme provides module-based teaching and workplace-based projects. In addition, a new clinical skills centre provides simulator-based training. Over 150 masters students from throughout Kuwait are enrolled and over 400 work-based projects have been completed to date.

CONCLUSION

KSeHIN represents a successful collaboration between multiple stakeholders working across traditional boundaries. It is targeting patient outcomes, system performance and professional development to provide a sustainable transformation in the quality of diabetes healthcare for the growing population of Kuwaitis with diabetes in Kuwait.

An automated ocular microtremor feature extraction using the Gabor thresholding technique

Ocular Microtremor (OMT) is a very fine continuous eye movement which has potential in monitoring and identifying a number of clinical conditions. There is a need for improved analysis and processing techniques to extract useful, quantifiable parameters from the OMT signal. A number of papers have shown the clinical significance of looking at the 'bursts' and 'baseling' patterns of the OMT signal. Analysis to date relies on visual inspection alone. This paper introduces an automated approach to burst/baseline identification based on a time-varying filter using the Gabor transform.

Development and application of a quality control procedure for short-wave diathermy units

Short-wave diathermy (SWD) is a form of radiofrequency (RF) radiation, operating at 27.12 MHz, that is used therapeutically by physiotherapists. Although this form of therapy is widely available, the management of the equipment is not often addressed by either physiotherapists or by medical physics/clinical engineering. A quality control protocol for SWD units, examining power output and electrical and mechanical condition, was developed and applied to 20 units used in clinical practice. In addition, an environmental assessment of where the units were used was also included. Results showed that the power output was generally stable (coefficient of variation range 0-8.8%) and reproducible (coefficient of variation range 0-6.8%). When the outputs from 12 similar units were compared, it was found that the relationship between the units' intensity settings and power output measurements was non-linear. Two units with mechanical timers were found to have inaccuracies that could contribute, under a 'worst-case' scenario, to a dosage error of up to 45%. Environmental analysis found that all treatment plinths in use contained metal parts, which could constitute a fire hazard, and no department examined was equipped with an RF screened room, a facility that would ensure that other persons in the vicinity were not exposed to excessive stray radiation.

The effect of cytokine gene polymorphisms on pediatric heart allograft outcome

BACKGROUND

Cytokines play a major role in the inflammatory and immune responses that mediate allograft outcome. Several studies have shown that the production of cytokines varies among individuals and these variations are determined by genetic polymorphisms, most commonly within the regulatory region of the cytokine gene. The aim of this study was to assess the effect of these allelic variations on acute rejection after pediatric heart transplantation.

METHODS

We performed cytokine genotyping using polymerase chain reaction-sequence specific primers in 93 pediatric heart transplant recipients and 29 heart donors for the following functional polymorphisms: tumor necrosis factor-alpha (TNF-alpha) (-308), interleukin (IL)-10 (-1082, -819, and -592), TGF-beta1 (codon 10 and 25), IL-6 (-174), and interferon-gamma (INF-gamma) (+874). The distribution of polymorphisms in this population did not differ from published controls. The patients were classified as either non-rejecters (0 or 1 episode) or rejecters (> 1 episode) based on the number of biopsy proven rejection episodes in the first year after transplantation.

RESULTS

Forty-two of the 69 TNF-alpha patients (61%) in the low producer group were non-rejecters, while 9 of the 24 (37.5%) with high TNF-alpha were non-rejecters (p = 0.047). In contrast, IL-10 genotype showed the opposite finding. Forty-two of the 66 patients (64%) in the high and intermediate IL-10 group were non-rejecters, while 9 of the 26 (35%) in the low IL-10 group were non-rejecters (p = 0.011). The combination of low TNF-alpha with a high or intermediate IL-10 genotype was associated with the lowest risk of rejection (34/49 or 69% non-rejecters). Neither the distribution of the IL-6, INF-gamma, and TGF-beta1 genotype in recipients nor the donor genotype showed any association with acute rejection.

CONCLUSION

Genetic polymorphisms that have been associated with low TNF-alpha and high IL-10 production are associated with a lower number of acute rejection episodes after pediatric heart transplantation.

Interferometry for ocular microtremor measurement

The eyes of all normal subjects undergo a continuous, low-amplitude, high-frequency tremor called ocular microtremor (OMT). A number of potential clinical applications of OMT have been identified, including the prediction of outcome in coma. To date, OMT has been investigated primarily with an eye-contacting piezoelectric probe. We describe a laser-based, noncontacting, interferometric technique for the measurement of OMT. The technique employs an in-plane-sensitive, phase-modulating speckle interferometer to detect the movement of the sclera, or white of the eye.

Mergers. Question of attitude

Research with staff in two organisations involved in a merger revealed some convergence of cultures one year after the merger. But staff from the smaller organisation perceived some losses. Staff from both organisations felt poorly rewarded for their work. Staff from the smaller organisation perceived relationships in the organisation more positively than those in the larger one, before and after the merger. Staff saw their employers as very concerned with safety before and after the merger.

A novel fluorescent marker for assembled mitochondria ATP synthase of yeast. OSCP subunit fused to green fluorescent protein is assembled into the complex in vivo

We have shown that OSCP, a subunit of yeast mitochondrial ATP synthase, can be incorporated into the intact enzyme as a fusion protein representing OSCP fused at its C-terminus to the green fluorescent protein (GFP) of Aequorea victoria. The relevant fusion OSCP-GFP-h6 additionally contains a hexahistidine tag at the C-terminus. Expression of OSCP-GFP-h6 in yeast cells lacking endogenous OSCP led to the efficient restoration of growth of cells on the non-fermentable substrate, ethanol. Confocal laser scanning microscopy revealed fluorescence due to GFP in mitochondria of cells expressing OSCP-GFP-h6. Use of immobilised metal ion affinity chromatography enabled the recovery of assembled ATP synthase complexes which contained OSCP-GFP-h6 identified by its mobility on SDS-PAGE and immunoreactivity to anti-OSCP and anti-GFP antibodies. The successful isolation of the assembled multisubunit ATP synthase containing GFP fused to one of the essential subunits of the complex widely expands the potential applications of GFP. In principle, these include the spatial and temporal monitoring of ATP synthase complexes in vivo, and the exploration of interactions involving ATP synthase subunits by fluorescence resonance energy transfer (FRET).

Outcome of cardiac transplantation in children. Survival in a contemporary multi-institutional experience. Pediatric Heart Transplant Study

BACKGROUND

Meaningful analysis of survival and risk factors for death in children who undergo heart transplantation is problematic because of the small number of heart transplantations performed at individual institutions.

METHODS AND RESULTS

To more accurately examine survival and risk factors for death in children undergoing heart transplantation, we analyzed 191 patients between 1 and 18 years old who received transplants at 22 centers in the Pediatric Heart Transplant Study between January 1, 1993, and December 31, 1994. Cardiac diagnosis was congenital heart disease in 74 patients (39%), dilated cardiomyopathy in 73 (38%), and other in 44 (23%). Actuarial survival was 93% at 1 month, 82% at 1 year, and 81% at 2 years after transplantation. The major causes of death (n = 31) were rejection (29% of deaths), early graft failure (19%), infection (16%), sudden death (13%), and other causes (23%). By multivariate analysis, risk factors for death were assist devices (P = .02), nonidentical ABO blood types (P = .05), and younger age (P = .10).

CONCLUSIONS

Contemporary survival for pediatric heart transplant recipients > or = 1 year old is comparable to survival after adult heart transplantation. Risk factors for death are the need for assist devices, nonidentical ABO blood types, and younger age. Rejection is the most common cause of death after pediatric heart transplantation.

Haemophilus influenzae type b (Hib) vaccination and uptake predictors in Northern Ireland

In order to study selected factors affecting the uptake of Haemophilus influenzae type b (Hib) vaccine a case control study was undertaken in residents of the Southern Health and Social Services Board in Northern Ireland. Standard data from the child health computer system were used. Residents in the catchment area of the health board born between 1 January and 30 June 1993 were defined as cases (unvaccinated) and controls (vaccinated). The uptake of Hib vaccination and odds ratios for factors associated with non-completion of vaccination were calculated. Overall uptake of Hib vaccination exceeded 97%. Children of mothers who smoked or children who had two or more younger siblings were less likely to have been vaccinated.

The factor structure of "schizotypal' traits: a large replication study

The heterogeneity of schizotypal traits, suggested in previous research, was further investigated in a sample of subjects (N = 1095) administered a composite questionnaire consisting of a large number of published scales the majority of which were designed to measure psychotic characteristics. Factor analysis confirmed the four components previously indicated in our work with the same instrument; namely, "aberrant perceptions and beliefs', "cognitive disorganization', "introvertive anhedonia' and "asocial behaviour'. This structure was maintained regardless of whether or not the analysis included scales from the Eysenck Personality Questionnaire, which might otherwise have been held to explain the variance. "Aberrant perceptions and beliefs'-reminiscent of the positive symptoms of schizophrenia-was the strongest component; but, given the multidimensional nature of the data, together with the pattern of factor loadings and intercorrelations for the scales involved, it was concluded that the broader term "psychosis-proneness' or "psychoticism' (in a non-Eysenckian sense) might be a better descriptor of the clinical and personality domain sampled.

What makes general practitioners do child health surveillance?

The contribution of different general practitioner characteristics, views, and experiences to the likelihood of their providing child health surveillance (CHS) was determined and their perceived training needs discovered. Family health service authority administrative data on the study population was combined with a postal questionnaire survey. Subjects were all general practitioners in three district health authorities in the North West Thames region. There were striking differences between districts in the proportion of practitioners undertaking CHS. General practitioners with paediatric training were three times more likely to do CHS. Women doctors were twice as likely to do CHS as men. The personal views of general practitioners were significantly associated with whether or not they undertook CHS. The CHS fee did not appear to be the major motivating factor. There was considerable demand for further training. The proportion of general practitioners undertaking CHS is likely to increase with the proportion of women and vocationally trained doctors. More local training is wanted, both by general practitioners already doing CHS and by those who would like to do it. Health authorities need to ensure that such training is convenient and continuing.

Cooperation or conflict over child health surveillance? Views of key actors

OBJECTIVE

To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit.

DESIGN

Postal questionnaire survey.

SETTING

Three health districts in North West Thames health region.

SUBJECTS

All 602 general practitioners, 272 health visitors, and 42 clinical medical officers in these districts.

MAIN MEASURES

Attitudes to and perceptions of child health surveillance and audit. Questionnaires were completed by 440 general practitioners (response rate 73%), 164 health visitors (60%), and 39 clinical medical officers (93%).

RESULTS

Attitudes to child health surveillance were less positive among general practitioners than health visitors or clinical medical officers. Few respondents agreed that child health surveillance was a cost effective use of general practitioners' time (general practitioners 28%, 113/407; health visitors 28%, 40/145; clinical medical officers 39%, 15/39) and most thought that health visitors should carry out more of the doctors' examinations (68%, 262/387; 65%, 89/136; 66%, 25/38). General practitioners thought that clinical medical officers were less supportive than other relevant groups of their doing more child health surveillance. Most (72%, 105/146) health visitors thought that the 1990 contract had reduced parental choice of where to attend for child health surveillance. General practitioners were less enthusiastic than health visitors about most forms of clinical audit.

CONCLUSIONS

Despite reservations about the impact of recent changes all groups were willing to explore innovative ways of delivering child health surveillance.

IMPLICATIONS

There is scope for health visitors to increase their responsibilities and for more varied relationships between general practitioners and community child health doctors.

Hemodynamic response to treadmill exercise in normal volunteers: an assessment by Doppler ultrasonic measurement of ascending aortic blood velocity and acceleration

Accurate assessment of ascending aortic blood velocity indices and reproducibility of a Doppler ultrasonic system during exercise were determined; the Doppler technique was then used to assess the effects of age, sex, and beta blockade on exercise hemodynamics. Doppler-determined velocity correlated well with an invasive electromagnetic system. Reproducibility of Doppler variables during three exercise tests was high (coefficient of variation less than 10%) and did not deteriorate appreciably with exercise. Peak velocity (PV) and maximum acceleration (MA) were inversely related to age, the relationship being more significant during exercise, whereas the systolic velocity integral showed no such relationship either at rest or during exercise. Doppler variables showed no difference between sexes, except at high levels of exercise. Beta blockade markedly attenuated the exercise response as shown by significant decreases in both MA and PV during exercise. The Doppler velocity data presented in this study provide a reference against which previously documented changes in exercising ischemic patients can be better related.

An unusual presentation of an infected urachal cyst. Review of urachal anomalies

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckel's diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.

Characteristics of a specific radioimmunoassay for measurement of ferritin on the surface of peripheral mononuclear white blood cells in cancer patients

Using 125I-labeled rabbit anti-Hodgkin's spleen ferritin antibody (RHF), a simple radioimmunoassay has been developed for quantitation of ferritin on the surface of peripheral blood mononuclear white blood cells (PBM). This method makes use of a % specific binding determination (%SP) by measuring the amount of 125I-labeled RHF bound to 1 X 10(6) PBM in the presence and absence of soluble ferritin. To standardize this procedure, artificial ferritin positive control cells were prepared by covalently coupling ferritin to cultured acute lymphoblastic leukemia cells. These cells were tested on a daily basis in parallel with patient PBM's to ensure inter and intra-assay precision and remained stable for over two years. Characteristics of 125I-labeled RHF binding to control and patient PBM's were evaluated to determine the specificity of interaction and optimum binding parameters. %SP was linear in the range of 1 X 10(5) - 1 X 10(6) PBM's and was progressively inhibited by graded concentrations of soluble ferritin. F(ab')2 preparations of RHF were equally as effective as intact RHF in blocking 125I-labeled RHF binding confirming that 125I-labeled RHF was not binding non-specifically to PBM Fc receptors. Additional experiments describing kinetics and methods of standardization of new lots of 125I-labeled RHF are also described.

Measurement of ferritin-bearing peripheral mononuclear blood cells in cancer patients by radioimmunoassay

A radioimmunoassay has been developed to measure ferritin bound to the surface of isolated human peripheral blood mononuclear white blood cells (PBMs) in order to investigate the possible relationship of this phenomenon to breast and other forms of cancer. The assay measures the specific binding (%SP) of affinity-purified 125I-labeled rabbit anti-Hodgkin's spleen ferritin antibody to isolated patient PBMs. A preliminary prospective, preclinical trial on 300 patients was run which included: (a) normals, benign breast disease, and medical/surgical patients as non-cancer controls; (b) postoperative primary cancer and advanced cancer in clinical remission as post cancer controls; and (c) both early preoperative breast cancer patients and cancer patients with localized recurrences or active disseminated disease as test groups. The mean %SP for the non-cancer control groups was in the range of 4.3 to 5.1 (n = 187), which was identical to that for inactive cancer or postoperative cancer, which was no evidence of recurrence. Using a %SP normal cutoff level of 6.5, which resulted in a false-positive rate of approximately 10% for both non-cancer and post-cancer control groups, only 27% of early preoperative cancers (n = 22) gave elevated %SP values. These results suggest that measurement of ferritin-PBM is inappropriate for early disease diagnosis. In contrast, 91% of patients with advanced active breast cancer and 73% of those patients with other types of advanced cancers, including tumors of ovarian, lung, colon or esophageal origin, showed elevated %SP values more than double those of post-cancer controls. The mean %SP value in active advanced cancer was 10.8 for breast (n = 12) and 10.6 for all other solid tumors investigated (n = 34). Paired patient comparisons of ferritin-PBM and plasma carcinoembryonic antigen in breast cancer showed elevations in 91% of the patients for ferritin-PBM and 67% for carcinoembryonic antigen. Overall, these results suggest that patients with advanced cancer display elevated levels of ferritin on the surface of their PBMs and that this measurement may be a useful adjunct in monitoring and evaluating the clinical status of cancer patients.