In a randomized, controlled trial of fecal occult blood screening for colorectal cancer, the Minnesota Colon Cancer Control Study carried out 11 annual mail screens in two phases between 1976 and 1992. This long-term compliance record of 15,476 individuals is summarized and related to demographic characteristics as well as to the screening experience of the participants. There was a strong and consistent effect of age, with peak compliance among participants about 70 years old, and lower compliance among the youngest (< or = 55 years) and oldest (> or = 80 years) participants. There was a significantly higher rate of screen compliance among participants who lived with other participants, compared with households where only one individual participated in the study. Finally, participants who underwent a diagnostic colorectal examination with negative results had significantly lower odds of compliance.

There are few practical guidelines for proper adjustment of rate responsive pacemaker sensor parameters. This study describes the application of the chronotropic assessment exercise protocol (CAEP) and the Wilkoff model of chronotropic response to assess the adjustment of pacemaker sensor parameters. In 31 patients implanted 1 month previously with a dual sensor pacemaker, pacemaker sensor parameters were adjusted to yield a peak sensor rate of 100 beats/min on a simple 6-minute walk (low intensity treadmill exercise [LITE] protocol); the maximum sensor rate was set to the age predicted maximum heart rate (220-age). The rate response behavior of the pacemaker was then assessed using the slope of metabolic-chronotropic relation (MCR) during CAEP exercise. After adjustments based on the LITE protocol, CAEP exercise yielded MCR slopes of 0.92 +/- 0.25 for the entire study group, which compares well with the predicted normal slope of 1. However, 7 of the 31 patients had sensor MCR slopes during CAEP exercise that were 2 SD or more below expected. To test the sensitivity of this approach to suboptimal pacemaker programming or suboptimal exercise, simulations were performed with the maximum sensor rate programmed below age-predicted maximum heart rate or with exercise truncated before maximum exertion; with these conditions, MCR slopes were sharply lower for the entire group. The authors conclude that a simple treadmill walk (LITE) allowed for optimum programming of sensor parameters in most patients, but in a minority the chronotropic behavior was underresponsive. Failure to appropriately adjust pacemaker maximum sensor rate or failure to achieve peak exercise sharply limits the accuracy of this methodology.

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Clinical and Statistical Considerations inPersonalized Medicine, edited by Claudio Carini, Sandeep M. Menon, Mark Chang, Boca Raton, FL: Chapman and Hall/CRC, 2014, ISBN 9781466593862, 358 pp., $89.95 (hardcover)."While nothing is more uncertain than a single life, nothing is more certain than the average duration of a thousand lives"-Elizur Wright (1804-1885, sometimes described as the "father of life insurance" for his pioneering work on actuarial tables; http://en. wikipedia.org/wiki/Elizur_Wright)

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