Introduction The 2015 National Institute for Health and Care Excellence guidelines widened the referral criteria for the two-week-wait pathway for suspected lower gastrointestinal cancer. We implemented a straight-to-test protocol to accommodate the anticipated increase in referrals. We evaluated the impact of these changes for relevant pathway metrics and clinical outcomes using a retrospective cohort study with historic controls. Materials and methods We analysed data from all patients referred to a teaching hospital via the two-week-wait pathway for suspected lower gastrointestinal cancer under the previous guidelines between 1 March and 31 August 2015 compared with the same period in 2016, when the updated guidelines and straight-to-test protocol had been implemented. Results In the 2015 cohort, there were 64 cancer diagnoses from 664 referrals (9.6% pick-up) compared with 58 cancer diagnoses from 954 referrals in the 2016 cohort (6.1% pick-up). Our straight-to-test protocol reduced the median time to cancer diagnosis by 12.5 days (P < 0.001) and reduced the median time to cancer treatment by 7.5 days (P < 0.05) An increased proportion of non-colorectal cancers were diagnosed in 2016 compared with 2015, (37.9% vs 17.2%, P < 0.05) and more adenomas were removed in 2016 compared with 2015 (377 vs 193). Discussion and conclusion Our straight-to-test protocol has resulted in a reduction in times to cancer diagnosis and cancer treatment, despite an increase in the number of referrals. The new referral criteria have considerable resource implications, but their implementation did not result in an increase in the total number of cancers diagnosed.

Here, we report further analysis of data drawn from a Randomized Controlled Trial (RCT) run in the United Kingdom designed to evaluate the efficacy of an adaptive software game to aid the learning of English phonics, GraphoGame Rime. We evaluate the efficacy of GraphoGame Rime for the "top half" of players in the RCT, children aged 6 to 7 years who played above the group mean play progress point (95 children). We also analyze three sub-groupings of this cohort. The GraphoGame family of games in different languages was originally designed to support children at family risk of dyslexia, hence we analyzed data for the subgroup of the GraphoGame Rime children who were struggling in school and had Individual Education Plans (IEPs). Secondly, we analyzed data from the younger children in the RCT, born in the Spring and Summer months, as international studies of GraphoGame have found the strongest effects during the first year of reading tuition and our participants were in their second year of reading tuition. Finally, we analyzed GraphoGame Rime data from players in schools rated as "requiring improvement." Schools that are found to be "requiring improvement" in the United Kingdom are encouraged to use additional teaching strategies to achieve better outcomes. GraphoGame Rime is relatively cheap to acquire and easy to implement, hence if it offers significant gains over "business-as-usual" this would be a valulable additional strategy for such schools. We find that GraphoGame Rime is more effective than "business-as-usual" in developing knowledge of English phonics for all of the groupings analyzed. We conclude that the supplementary use of GraphoGame Rime in addition to ongoing classroom literacy instruction can benefit children in learning phonic decoding and spelling skills.

This study explores the neurocognitive predictors of response to intervention with GraphoGame Rime (GG Rime), an adaptive software game designed to aid the learning of English phonics. A cohort of 398 children (aged 6–7 years) who had participated in a recent randomised controlled trial (RCT) of GG Rime in the United Kingdom were studied. Half were randomly assigned to play GG Rime and the other half were assigned to Business As Usual (BAU). A series of pretests were given prior to the intervention to all participants, designed to measure phonological awareness skills, executive function (EF) skills and the ability to synchronise finger tapping to a rhythmic beat. Rhythmic synchronisation has been linked to reading readiness and early reading attainment, and is related to phonological awareness. Individual differences prior to the intervention in all three types of measure were significantly associated with progression through the game. Gender was also important for progression through the game, with boys progressing significantly further than girls. Vocabulary was not a predictor of progression through the game. Playing time, rhythmic synchronisation, phonological skills and EF skills did not differ by gender. Once playing time and non-verbal cognitive ability were controlled, phonological awareness, EF, rhythmic synchronisation and gender all remained significant predictors of progression through the game. In further analyses comparing these predictors, their interactions and controlling for the autoregressor of prior responsiveness to phonics instruction, phoneme awareness and EF skills were the strongest unique predictors. Analyses with the whole cohort (analysing BAU and GG children independently) showed that all neurocognitive measures contributed to progress in reading and spelling over the school year. We conclude that individual differences in phonological skills and EF skills predict which children will benefit most from computer assisted reading interventions like GG Rime. Further, boys respond better to this computerised intervention than girls. Accordingly, to be maximally beneficial to poor readers, the supplementary use of GG Rime in addition to ongoing classroom literacy instruction could be especially targeted to boys, but should be accompanied by a focus on developing both oral phonological awareness and EF skills.

Highlights EEG was recorded while 8-week old infants listened to rhythmic speech and non-speech. Both A CNN and SVM reliably classified infant brain responses. The CNN was more robust to noisy EEG data. Simple rhythmic EEG measures may enable prediction of language outcomes.

Objective To evaluate the role of transvaginal ultrasound triage in women with a history of tamoxifen treatment who present with post-menopausal bleeding. Study design A retrospective review was undertaken of patients who presented with symptoms of post-menopausal bleeding and underwent ultrasound triage. Endometrial thickness and ultrasonographic features were then correlated with hysteroscopic and histopathological outcome data. The findings and outcomes for women with a history of tamoxifen use (tamoxifen group) were compared to those who had not taken tamoxifen (non-tamoxifen group). Results A total of 614 women with post-menopausal bleeding underwent transvaginal ultrasound triage, of whom 53 had a history of current or previous tamoxifen treatment. An endometrial thickness of ≥5 mm or the presence of other abnormal features was used to triage women to further investigation by hysteroscopy and biopsy. Endometrial thickness was significantly greater in the tamoxifen group (11 mm vs. 6 mm). Nearly all of the tamoxifen group were triaged to further investigation (98.1%), compared with significantly fewer in the non-tamoxifen group (68.3%) Overall, the incidence of endometrial pathology was also significantly higher in tamoxifen patients (43.4% vs. 31.7%). Conclusion For women presenting with post-menopausal bleeding, the use of transvaginal ultrasound as a triage tool is rarely helpful in evaluating women who have a history as tamoxifen use, as most will require further investigation with hysteroscopy and biopsy. A post-menopausal bleeding protocol that omits transvaginal ultrasound for women with a history of tamoxifen use may be an appropriate and effective pathway for managing these patients.