Zephyr: The Twelfth Issue

This is the twelfth issue of Zephyr, the University of New England\u27s journal of creative expression. Since 2000, Zephyr has published original drawings, paintings, photography, prose, and verse created by current and former members of the University community. Zephyr\u27s Editorial Board is made up exclusively of matriculating students.https://dune.une.edu/zephyr/1011/thumbnail.jp

Accuracy and Interpretation Time of Computer-Aided Detection Among Novice and Experienced Breast MRI Readers

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy and interpretation times of breast MRI with and without use of a computer-aided detection (CAD) system by novice and experienced readers. SUBJECTS AND METHODS: A reader study was undertaken with 20 radiologists, nine experienced and 11 novice. Each radiologist participated in two reading sessions spaced 6 months apart that consisted of 70 cases (27 benign, 43 malignant), read with and without CAD assistance. Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy as measured by the area under the receiver operating characteristic curve (AUC) were reported for each radiologist. Accuracy comparisons across use of CAD and experience level were examined. Time to interpret and report on each case was recorded. RESULTS: CAD improved sensitivity for both experienced (AUC, 0.91 vs 0.84; 95% CI on the difference, 0.04, 0.11) and novice readers (AUC, 0.83 vs 0.77; 95% CI on the difference, 0.01, 0.10). The increase in sensitivity was statistically higher for experienced readers (p = 0.01). Diagnostic accuracy, measured by AUC, for novices without CAD was 0.77, for novices with CAD was 0.79, for experienced readers without CAD was 0.80, and for experienced readers with CAD was 0.83. An upward trend was noticed, but the differences were not statistically significant. There were no significant differences in interpretation times. COCLUSIONS: MRI sensitivity improved with CAD for both experienced readers and novices with no overall increase in time to evaluate cases. However, overall accuracy was not significantly improved. As the use of breast MRI with CAD increases, more attention to the potential contributions of CAD to the diagnostic accuracy of MRI is needed

Long-term weight loss with metformin or lifestyle intervention in the Diabetes prevention Program outcomes study

© 2019 American College of Physicians Background: Identifying reliable predictors of long-term weight loss (LTWL) could lead to improved weight management. Objective: To identify some predictors of LTWL. Design: The DPP (Diabetes Prevention Program) was a randomized controlled trial that compared weight loss with metformin, intensive lifestyle intervention (ILS), or placebo. Its Outcomes Study (DPPOS) observed patients after the masked treatment phase ended. (ClinicalTrials.gov: NCT00004992 and NCT00038727) Setting: 27 DPP and DPPOS clinics. Participants: Of the 3234 randomly assigned participants, 1066 lost at least 5% of baseline weight in the first year and were followed for 15 years. Measurements: Treatment assignment, personal characteristics, and weight. Results: After 1 year, 289 (28.5%) participants in the metformin group, 640 (62.6%) in the ILS group, and 137 (13.4%) in the placebo group had lost at least 5% of their weight. After the masked treatment phase ended, the mean weight loss relative to baseline that was maintained between years 6 and 15 was 6.2% (95% CI, 5.2% to 7.2%) in the metformin group, 3.7% (CI, 3.1% to 4.4%) in the ILS group, and 2.8% (CI, 1.3% to 4.4%) in the placebo group. Independent predictors of LTWL included greater weight loss in the first year in all groups, older age and continued metformin use in the metformin group, older age and absence of either diabetes or a family history of diabetes in the ILS group, and higher fasting plasma glucose levels at baseline in the placebo group. Limitation: Post hoc analysis; examination of nonrandomized subsets of randomized groups after year 1. Conclusion: Among persons with weight loss of at least 5% after 1 year, those originally randomly assigned to metformin had the greatest loss during years 6 to 15. Older age and the amount of weight initially lost were the most consistent predictors of LTWL maintenance

Establishing a constitutional 'right of asylum' in early nineteenth-century Britain

For several generations before the First World War, the idea that the British constitution contained a ‘right of asylum' for foreign nationals was commonplace. Though this belief had profound consequences for Britain's treatment of political and religious exiles, its relations with foreign states, and the drafting of its extradition and immigration laws, there has been little enquiry into its origins. This article delineates the emergence of the idea of a constitutional ‘right of asylum', locating it in a series of political clashes over the ‘Alien Act' that took place during the decade after the Napoleonic Wars. This legislation, which established controls over foreigners during the French Revolution and the quarter-century of war that followed, was increasingly challenged by the Whig and radical oppositions after Waterloo, both for its specific arbitrary provisions and as a more fundamental violation of the rights of aliens guaranteed by key constitutional documents like Magna Carta and the Habeas Corpus Act. By the mid-1820s these objections cohered into a conviction that asylum itself could be claimed as a right. This conviction and the arguments that spawned it were repeated for many subsequent decades, forming the basis of the widespread Victorian belief in the ‘right of asylum’

Effect of Metformin and Lifestyle Interventions on Mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study

ObjectiveTo determine whether metformin or lifestyle modification can lower rates of all-cause and cause-specific mortality in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study.Research design and methodsFrom 1996 to 1999, 3,234 adults at high risk for type 2 diabetes were randomized to an intensive lifestyle intervention, masked metformin, or placebo. Placebo and lifestyle interventions stopped in 2001, and a modified lifestyle program was offered to everyone, but unmasked study metformin continued in those originally randomized. Causes of deaths through 31 December 2018 were adjudicated by blinded reviews. All-cause and cause-specific mortality hazard ratios (HRs) were estimated from Cox proportional hazards regression models and Fine-Gray models, respectively.ResultsOver a median of 21 years (interquartile range 20-21), 453 participants died. Cancer was the leading cause of death (n = 170), followed by cardiovascular disease (n = 131). Compared with placebo, metformin did not influence mortality from all causes (HR 0.99 [95% CI 0.79, 1.25]), cancer (HR 1.04 [95% CI 0.72, 1.52]), or cardiovascular disease (HR 1.08 [95% CI 0.70, 1.66]). Similarly, lifestyle modification did not impact all-cause (HR 1.02 [95% CI 0.81, 1.28]), cancer (HR 1.07 [95% CI 0.74, 1.55]), or cardiovascular disease (HR 1.18 [95% CI 0.77, 1.81]) mortality. Analyses adjusted for diabetes status and duration, BMI, cumulative glycemic exposure, and cardiovascular risks yielded results similar to those for all-cause mortality.ConclusionsCancer was the leading cause of mortality among adults at high risk for type 2 diabetes. Although metformin and lifestyle modification prevented diabetes, neither strategy reduced all-cause, cancer, or cardiovascular mortality rates