Inter country analysis of breast density classification using visual grading. Analysis of mammographic breast density using visual grading

Purpose: Disagreement in mammographic breast density (MBD) assessment can impact breast cancer risk stratification, choices of further breast cancer screening intervals and pathways. This study examines whether inter-country MBD expectations and assessment approaches are associated with differences in MBD assessment. Methods: Twenty American Board of Radiology (ABR) examiners and 24 United Kingdom (UK) practitioners using the 4th edition BI-RADS® lexicon assessed 40 mammogram cases of 20 women. Twenty-six Royal Australian and New Zealand College of Radiologists (RANZCR) registered radiologists also assessed the same cases. Inter-observer correlation and agreement were assessed using a Spearman’s correlation (ρ) and weighted Kappa (Kw) respectively. Results: Strong positive correlation was observed between the study cohorts on a binary scale (1–2 vs. 3–4) [ABR examiners and RANZCR radiologists (ρ = 0.950); ABR examiners and UK practitioners (ρ = 0.940); RANZCR radiologists and UK practitioners (ρ = 0.958)]. ABR and RANZCR radiologists demonstrated slight agreement [Kw = 0.10; 95% CI = -1.13 - 0.43] while ABR and UK practitioners showed a fair agreement [Kw = 0.25; 95% CI = -0.42 - 0.61], and an almost perfect agreement was observed between RANZCR radiologists and UK practitioners [Kw = 0.95; 95% CI = 0.91 - 0.97]. Conclusion: Findings demonstrate wide international and inter-observer variability in MBD assessment. This level of variability underscores the need for automation and standardisation of MBD assessment. Keywords: Breast density, inter-observer agreement, visual assessment methods

Preliminary observations on the avifauna of Ikokoto Forest, Udzungwa Mountains, Tanzania

A study was conducted at c. 110 ha of Ikokoto forest using mist-netting and general field observations. Sixty-four species were recorded of which 61% were of conservation importance in terms of forest dependence. All species were found to belong to the familiar assembly of the large Udzungwa forests. Six species, the Green-throated Greenbul Andropadus fusciceps, Spot-throat Modulatrix stictigula, African Tailorbird Artisornis metopias, Black-lored Cisticola Cisticola nigriloris, Uhehe Fiscal Laniarius marwitzi and Fülleborn’s Black Boubou Laniarius fuelleborni detected are restricted range and one species Moreau’s Sunbird Nectarinia moreaui is nearthreatened according to IUCN threat status. The presence of many species which are forest dependent in this tiny forest indicates that this site, though small in size and highly fragmented, retains significant conservation value for birds

John De Sequeyra\u27s Notes on diseases

A thesis submitted in partial fulfillment of the requirements for the degree of Bachelor of Arts with Honors in History from The College of William and Mary

Effective lifetime radiation risk for a number of national mammography screening programmes

Background and purpose: The performance of mammography screening programmes is focussed mainly on breast cancer detection rates. However, when the benefits and risks of mammography are considered, the risk of radiation-induced cancer is calculated for only the examined breast using Mean Glandular Dose (MGD). The risk from radiation during mammography is often described as low or minimal. This study aims to evaluate the effective lifetime risk from full field digital mammography (FFDM) for a number of national screening programmes. Material and Methods: Using an ATOM phantom, radiation doses to multiple organs were measured during standard screening mammography. Sixteen FFDM machines were used and the effective lifetime risk was calculated across the female lifespan for each machine. Once the risks were calculated using the phantom, the total effective lifetime risk across 48 national screening programmes was then calculated; this assumed that all these programmes use FFDM for screening. Results: Large differences exist in effective lifetime risk, varying from 42.21 [39.12 - 45.30] cases/106 (mean [95% CI]) in the Maltese screening programme to 1099.67 [1019.25 - 1180.09] cases/106 for high breast cancer risk women in the United States of America. These differences are mainly attributed to the commencement age of screening mammography and the time interval between successive screens. Conclusions: Effective risk should be considered as an additional parameter for the assessment of screening mammography programme performance, especially for those programmes which recommend an early onset and more frequent screening mammography

Lunar hand tools

Tools useful for operations and maintenance tasks on the lunar surface were determined and designed. Primary constraints are the lunar environment, the astronaut's space suit and the strength limits of the astronaut on the moon. A multipurpose rotary motion tool and a collapsible tool carrier were designed. For the rotary tool, a brushless motor and controls were specified, a material for the housing was chosen, bearings and lubrication were recommended and a planetary reduction gear attachment was designed. The tool carrier was designed primarily for ease of access to the tools and fasteners. A material was selected and structural analysis was performed on the carrier. Recommendations were made about the limitations of human performance and about possible attachments to the torque driver

The role of metaphor in shaping the identity and agenda of the United Nations: the imagining of an international community and international threat

This article examines the representation of the United Nations in speeches delivered by its Secretary General. It focuses on the role of metaphor in constructing a common ‘imagining’ of international diplomacy and legitimising an international organisational identity. The SG legitimises the organisation, in part, through the delegitimisation of agents/actions/events constructed as threatening to the international community and to the well-being of mankind. It is a desire to combat the forces of menace or evil which are argued to motivate and determine the organisational agenda. This is predicated upon an international ideology of humanity in which difference is silenced and ‘working towards the common good’ is emphasised. This is exploited to rouse emotions and legitimise institutional power. Polarisation and antithesis are achieved through the employment of metaphors designed to enhance positive and negative evaluations. The article further points to the constitutive, persuasive and edifying power of topic and situationally-motivated metaphors in speech-making

Breast screening attendance of Aboriginal and Torres Strait Islander women in the Northern Territory of Australia

Objective: To compare breast screening attendances of Indigenous and non-Indigenous women. Methods: A total of 4,093 BreastScreen cases were used including 857 self-identified Indigenous women. Chi-squared analysis compared data between Indigenous and non-Indigenous women. Logistic regression was used for groupings based on visits-to-screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. Results: Indigenous women were younger and had fewer visits to screening compared with non-Indigenous women. Non-English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3-2.9). Living remotely was associated with fewer visits for non-Indigenous women only (OR 1.3, 95%CI 1.1-1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1-18.8; and OR 11.5, 95%CI 9.6-13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3-3.3; and OR 1.8, 95%CI 1.5-2.1, respectively). Conclusions: Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non-Indigenous women. Implications for public health: Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote-living non-Indigenous women should also be addressed