Mammography: EUSOBI recommendations for women’s information

This paper summarises the basic information to be offered to women who undergo mammography. After a delineation of the general aim of early diagnosis of breast cancer, the main difference between screening mammography and diagnostic mammography is explained. The best time for scheduling mammography in fertile women is defined. The need to bring images and reports from the previous mammogram (and from other recent breast imaging examinations) is highlighted. The technique and procedure of mammography are briefly described with particular attention to discomfort and pain experienced by a fraction of women who undergo the test. Information is given on the recall during a screening program and on the request for further work-up after a diagnostic mammography. The logic of the diagnostic mammography report and of classification systems such as BI-RADS and R1-R5 is illustrated, and brief but clear information is given about the diagnostic performance of the test, with particular reference to interval cancers. Moreover, the breast cancer risk due to radiation exposure from mammography is compared to the reduction in mortality obtained with the test, and the concept of overdiagnosis is presented. Finally, five frequently asked questions are answered

Gaseous Galaxy Halos

Galactic halo gas traces inflowing star formation fuel and feedback from a galaxy's disk and is therefore crucial to our understanding of galaxy evolution. In this review, we summarize the multi-wavelength observational properties and origin models of Galactic and low redshift spiral galaxy halo gas. Galactic halos contain multiphase gas flows that are dominated in mass by the ionized component and extend to large radii. The densest, coldest halo gas observed in neutral hydrogen (HI) is generally closest to the disk (< 20 kpc), and absorption line results indicate warm and warm-hot diffuse halo gas is present throughout a galaxy's halo. The hot halo gas detected is not a significant fraction of a galaxy's baryons. The disk-halo interface is where the multiphase flows are integrated into the star forming disk, and there is evidence for both feedback and fueling at this interface from the temperature and kinematic gradient of the gas and HI structures. The origin and fate of halo gas is considered in the context of cosmological and idealized local simulations. Accretion along cosmic filaments occurs in both a hot (> 10^5.5 K) and cold mode in simulations, with the compressed material close to the disk the coldest and densest, in agreement with observations. There is evidence in halo gas observations for radiative and mechanical feedback mechanisms, including escaping photons from the disk, supernova-driven winds, and a galactic fountain. Satellite accretion also leaves behind abundant halo gas. This satellite gas interacts with the existing halo medium, and much of this gas will become part of the diffuse halo before it can reach the disk. The accretion rate from cold and warm halo gas is generally below a galaxy disk's star formation rate, but gas at the disk-halo interface and stellar feedback may be important additional fuel sources.Comment: 50 pages, 9 figures (1 in 3D, view with a current version of Adobe), to appear in ARA&A, 50, 49

Examining Patient Conceptions: A Case of Metastatic Breast Cancer in an African American Male to Female Transgender Patient

An African American male to female transgender patient treated with estrogen detected a breast lump that was confirmed by her primary care provider. The patient refused mammography and 14 months later she was diagnosed with metastatic breast cancer with spinal cord compression. We used ethnographic interviews and observations to elicit the patient’s conceptions of her illness and actions. The patient identified herself as biologically male and socially female; she thought that the former protected her against breast cancer; she had fears that excision would make a breast tumor spread; and she believed injectable estrogens were less likely than oral estrogens to cause cancer. Analysis suggests dissociation between the patient’s social and biological identities, fear and fatalism around cancer screening, and legitimization of injectable hormones. This case emphasizes the importance of eliciting and interpreting a patient’s conceptions of health and illness when discordant understandings develop between patient and physician

Calibration of ultraviolet, mid-infrared and radio star formation rate indicators

We present calibrations for star formation rate indicators in the ultraviolet, mid-infrared and radio continuum bands, including one of the first direct calibrations of 150 MHz as a star formation rate indicator. Our calibrations utilize 66 nearby star forming galaxies with Balmer decrement corrected H-alpha luminosities, which span 5 orders of magnitude in star formation rate and have absolute magnitudes of -24<M_r<-12. Most of our photometry and spectrophotometry is measured from the same region of each galaxy, and our spectrophotometry has been validated with SDSS photometry, so our random and systematic errors are small relative to the intrinsic scatter seen in star formation rate indicator calibrations. We find WISE W4 (22.8 micron), Spitzer 24 micron and 1.4 GHz have tight correlations with Balmer decrement corrected H-alpha luminosity, with scatter of only 0.2 dex. Our calibrations are comparable to those from the prior literature for L* galaxies, but for dwarf galaxies our calibrations can give star formation rates that are far greater than those derived from much of the prior literature.M.J.I.B. acknowledges financial support from The Australian Research Council (FT100100280), the Monash Research Accelerator Program (MRA), the Monash Outside Studies Programme (OSP), and the University of Cambridge. Part of this work was undertaken while M.J.I.B. was on OSP (sabbatical) leave at the University of Cambridge, Swinburne University, and the University of Melbourne. M.B. was supported by the MINEDUC-UA project, code ANT 1655. Funding for SDSS-III has been provided by the Alfred P. Sloan Foundation, the Participating Institutions, the National Science Foundation, and the U.S. Department of Energy Office of Science. The SDSS-III Web site is http://www.sdss3.org/. SDSS-III is managed by the Astrophysical Research Consortium for the Participating Institutions of the SDSS-III Collaboration including the University of Arizona, the Brazilian Participation Group, Brookhaven National Laboratory, University of Cambridge, University of Florida, the French Participation Group, the German Participation Group, the Instituto de Astrofisica de Canarias, the Michigan State/Notre Dame/JINA Participation Group, Johns Hopkins University, Lawrence Berkeley National Laboratory, Max Planck Institute for Astrophysics, New Mexico State University, New York University, Ohio State University, Pennsylvania State University, University of Portsmouth, Princeton University, the Spanish Participation Group, University of Tokyo, University of Utah, Vanderbilt University, University of Virginia, University of Washington, and Yale University. The NASA-Sloan Atlas was created by Michael Blanton, with extensive help and testing from Eyal Kazin, Guangtun Zhu, Adrian Price-Whelan, John Moustakas, Demitri Muna, Renbin Yan, and Benjamin Weaver. Funding for the NASA-Sloan Atlas has been provided by the NASA Astrophysics Data Analysis Program (08-ADP08-0072) and the NSF (AST-1211644)

Peer navigation improves diagnostic follow-up after breast cancer screening among Korean American women: results of a randomized trial

To test an intervention to increase adherence to diagnostic follow-up tests among Asian American women. Korean American women who were referred for a diagnostic follow-up test (mainly diagnostic mammograms) and who had missed their follow-up appointment were eligible to participate in the study. Women from two clinics (n&nbsp;=&nbsp;176) were randomly allocated to a usual care control arm or a peer navigator intervention arm. A 20-min telephone survey was administered to women in both study arms six&nbsp;months after they were identified to assess demographic and socio-economic characteristics and the primary outcome, self-reported completion of the recommended follow-up exam. Among women who completed the survey at six-month follow-up, self-reported completion of follow-up procedures was 97% in the intervention arm and 67% in the control arm (p&nbsp;&lt;&nbsp;0.001). Based on an intent-to-treat analysis of all women who were randomized and an assumption of no completion of follow-up exam for women with missing outcome data, self-reported completion of follow-up was 61% in the intervention arm and 46% in the usual care control arm (p&nbsp;&lt;&nbsp;0.069). Our results suggest that a peer navigator intervention to assist Korean American women to obtain follow-up diagnostic tests after an abnormal breast cancer screening test is efficacious

Fall Classification by Machine Learning Using Mobile Phones

Fall prevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls–left and right lateral, forward trips, and backward slips–while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls

Improving breast cancer services for African-American women living in St. Louis

A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality