Double reading in breast cancer screening : cohort evaluation in the CO-OPS trial

Purpose: To investigate the effect of double readings by a second radiologist on recall rates, cancer detection and characteristics of cancers detected in the National Health Service Breast Screening Program in England. Materials and Methods: In this retrospective analysis we evaluated 805,206 women through screening and diagnostic test results by extracting one year of routine data from 33 English breast screening centers. Centers used double reading of digital mammograms, with arbitration if there were discrepant reads. Information on reader decisions, with results of follow-up tests, were used to explore the effect of the second reader. The statistical tests used were the test for equality of proportions, the χ2 test for independence and the t-test. Results: The first reader recalled 4·76%, (38295/805206, 95% CI 4·71%-4·80%) of women. Two readers recalled 6·19% in total, (49857/805206, 95% CI 6·14%- 6·24%), but arbitration of discordant reads reduced recall rate to 4·08%, (32863/805206, 95% CI 4·04%-4·12%, p<0.001). 7055 cancers were detected of which 627 (8·89%, 95% CI 8·22%-9·55%, p<0.001) were detected by the second reader only. These additional cancers were more likely to be ductal carcinoma in situ, (30·5% (183/600) vs 22.0% (1344/6114), p<0.001); and additional invasive cancers were smaller (mean 14·2mm vs 16·7mm, p<0.001), had fewer involved nodes, and were likely to be lower grade. Conclusion: Double reading with arbitration reduces recall and increases cancer detection compared to single reading. Cancers detected only by the second reader were smaller, lower grade, and had less nodal involvement

The Structure of Eu-III

Previous x-ray diffraction studies have reported Eu to transform from the hcp structure to a new phase, Eu-III, at 18 GPa. Using x-ray powder diffraction we have determined that Eu remains hcp up to 33 GPa, and that the extra peaks that appear at 18 GPa are from an impurity phase with space group R-3c . Above 33 GPa the diffraction pattern becomes very much more complex, signalling a transition to a phase with a distorted hcp structure.Comment: 4 pages, 4 figures, AIRAPT-23 Conference, Mumbai, 201

Optimising breast cancer screening reading: blinding the second reader to the first reader's decisions.

OBJECTIVES: In breast cancer screening, two readers separately examine each woman's mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other's decisions (blinding) affects behaviour and outcomes. METHODS: This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson's chi-squared test. RESULTS: When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other's decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001). CONCLUSIONS: Our results suggest that when not blinded, reader 2 is influenced by reader 1's decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics. KEY POINTS: • In Europe, it is recommended that breast screening mammograms are analysed by two readers but there is little evidence on the effect of 'blinding' the readers so they cannot see each other's decisions. • We found evidence that when the second reader is not blinded, they are more likely to agree with a recall decision from the first reader and less likely to make an independent judgement (alliterative error). This may reduce overall accuracy through bypassing arbitration. • This observational study suggests an association between blinding the second reader and higher positive predictive value of screening, but this may be confounded by centre characteristics

Inhomogeneous nucleation in quark hadron phase transition

The effect of subcritical hadron bubbles on a first-order quark-hadron phase transition is studied. These subcritical hadron bubbles are created due to thermal fluctuations, and can introduce a finite amount of phase mixing (quark phase mixed with hadron phase) even at and above the critical temperature. For reasonable choices of surface tension and correlation length, as obtained from the lattice QCD calculations, we show that the amount of phase mixing at the critical temperature remains below the percolation threshold. Thus, as the system cools below the critical temperature, the transition proceeds through the nucleation of critical-size hadron bubbles from a metastable quark-gluon phase (QGP), within an inhomogeneous background populated by an equilibrium distribution of subcritical hadron bubbles. The inhomogeneity of the medium results in a substantial reduction of the nucleation barrier for critical bubbles. Using the corrected nucleation barrier, we estimate the amount of supercooling for different parameters controlling the phase transition, and briefly discuss its implications to cosmology and heavy-ion collisions.Comment: LaTeX, 14 pages with 8 Postscript figures. Discussion added in introduction and conclusion, Fig. 8 added, few more references added, Typographical errors corrected. Version to appear in Phys. Rev.

PR3-ANCA:a promising biomarker in primary sclerosing cholangitis (PSC)

BACKGROUND AND AIMS:The only recognized biomarker for primary sclerosing cholangitis (PSC) is atypical anti-neutrophil cytoplasmic antibodies (aANCA), which, in addition to having low sensitivity and specificity, is an indirect immunofluorescence (IIF) test lacking the advantages of high throughput and objectivity. Recent reports have shown that antibodies to proteinase-3 (PR3-ANCA) might add diagnostic value in inflammatory bowel disease (IBD), specifically in ulcerative colitis (UC). As PSC is associated with IBD, the objective of this study was to evaluate the frequency and clinical significance of PR3-ANCA in a large cohort of patients. METHODS:A total of 244 PSC and 254 control [autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), hepatitis C viral infection (HCV), hepatitis B viral infection (HBV), and healthy controls] sera and their clinical correlations were retrospectively analyzed for PR3-ANCA determined by ELISA and a new chemiluminescence immunoassay (CIA). Testing was also performed for aANCA by IIF. RESULTS:When measured by CIA, PR3-ANCA was detected in 38.5% (94/244) of PSC patients compared to 10.6% (27/254) controls (p<0.0001). By ELISA, PR3-ANCA was detected in 23.4% (57/244) of PSC patients compared to 2.7% (6/254) controls (p<0.0001). PR3-ANCA in PSC patients was not associated with the presence or type of underlying IBD, and, in fact, it was more frequent in Crohn's disease (CD) patients with PSC than previously reported in CD alone. PR3-ANCA in PSC measured by CIA correlated with higher liver enzymes. CONCLUSION:PR3-ANCA is detected in a significant proportion of PSC patients compared to other liver diseases including PBC and AIH. PR3-ANCA is associated with higher liver enzyme levels in PSC, and is not solely related to underlying IBD

Neutron diffraction of hydrogen inclusion compounds under pressure

When ice is compressed alongside a gas, crystalline 'host - guest' inclusion compounds known as gas clathrate hydrates form. These compounds are of interest not only for their environmental and possible technological impact as gas storage and separation materials, but also for their ability to probe networks not readily adopted by the pure `host' water molecules, and to study the interactions between water and gas molecules. Despite the pressure dependent crystal structures being fully determined for a large variety of `guest' gas species there is still relatively little known about the crystal structures in small guest gas systems such as H2 hydrate. The majority of structural studies have been done with x-ray diffraction and report a number of conflicting structures or hydrogen contents for the four known stable phases (sII, C0, C1 and C2). As this is a very hydrogen rich system the most ideal method to study the structure is neutron diffraction, which is able to fully determine the location of the hydrogen atoms within the structure and would allow a direct measurement of any hydrogen ordering within the host structure and the H2 content. In this work the phase diagram of the deuterated analogue of the H2-H2O system is explored at low pressures (below 0.3 GPa) with neutron diffraction. In the pressure/temperature region where the sII phase is known to be stable, two metastable phases were observed between the formation of sII from ice Ih and that this transition sequence occurred in line with Ostwald's Rule of Stages. One of these metastable phases was the C0 phase known to be stable in the H2-H2O system above 0.5 GPa, and the other is a new structure not previously observed in this system and is dubbed in this work as C-1 . Prior to this work the C0 phase has been reported with various structures that were determined with x-ray diffraction, and here the crystal structure and H2 content at low pressure are determined with neutron diffraction. The C0 phase was found to form a similar host structure to those of the previous studies with spiral guest sites but is best described with highly mobile H2 guests and a higher symmetry space group which make it the same structure as the spiral hydrate structure (s-Sp) recently observed in the CO2 hydrate system. In addition to this structure being determined at pressure a sample of C0 was also recovered to ambient pressure at low temperature and its structure/H2 content is presented as it was warmed to decomposition. The crystal structure of the C-1 phase was determined to be similar to ice Ih and a sample was recovered to ambient pressure to study its decomposition behaviour. Evidence for a similar structure in the helium hydrate system at low pressure is also reported here. This work was then extended to higher pressures with the recent developments of a hydrogen-compatible gas loader and large-volume diamond anvil cells. Several test experiments on gas-loaded Paris-Edinburgh presses are described on systems that are similar to hydrogen-water like urea-hydrogen and neon-water. And a further preliminary high pressure study on the deuterated analogue of the H2- H2O system in a diamond anvil cell between 3.6 and 28 GPa shows decomposition behaviour as pressure was increased

From External Evaluation, to School Self-evaluation, to Peer Review

Most modern systems of school education around the world now have highly developed evaluation processes. Following quickly in the wake of external evaluation policies have followed calls for schools to develop their own capacities for self-review. An OECD report (2013) describes a number of ways in which developing school evaluation capacity should be a priority for school improvement. Among the report’s suggestions are promoting peer learning among schools (pp. 469–470). This chapter describes the research on external evaluation, internal evaluation and the relationship between these two. It then moves on to define and describes peer review and chart its growth. The accountability dimension of peer review is also explored. Finally the existing evidence on peer review is presented from the vocational and schools sectors to show key findings so far, and key conditions for effective peer review are described