Multimodal discourse on online newspaper home pages: A social-semiotic perspective

In a short space of time, online newspapers have emerged to play an important role in the institutional construction of ‘news’ and the mass mediation of information. The home pages of online newspapers feature short verbal texts, and communicate using language, image, layout, colour, and other semiotic resources: they communicate multimodally. This thesis examines the multimodal discourse of three English-language online newspapers: the Bangkok Post (Thailand), the English-language edition (translated from Chinese) of the People’s Daily (China), and the Sydney Morning Herald (Australia). Between February, 2002 and April, 2006, three data collections were made (February-April, 2002; September-November, 2005; January-April, 2006) using a five-day ‘constructed week’ method. The main corpus was 15 home pages from each newspaper (five per collection per newspaper), but the total corpus (including other pages from each newspaper) was 603 web pages. Two senior editors (one each from the Bangkok Post and the Sydney Morning Herald) were interviewed. The multimodal discourse of the home pages was analysed using tools from Systemic Functional Multimodal Discourse Analysis (SF-MDA), and a ‘visual grammar’ of home pages building on the work of Kress & van Leeuwen (1996) was developed. In addition, a rank scale for online newspapers was proposed, and limitations of applying the tool of rank scale to this corpus were identified. An emerging genre - the headline-plus-lead-plus-hyperlink newsbite - was identified, and the design of newsbites on the home page of the Sydney Morning Herald and the evolution of their design over time was analysed. The use of images on the home pages in the corpus was analysed, and the increasing use of thumbnail images in the Sydney Morning Herald - particularly close-up thumbnails of faces - was investigated in further depth. The visual design of online newspaper home pages and the news texts appearing on them are an evolution of print news genres and their design practices. Newsbites and headline-only newsbits are verbally short, so the authors of newspaper home pages are forced to rely increasingly on visual communication in order to position stories and readers, and to communicate the values of the news institution on the home page as mediated by the screen. Thumbnail images are evolving as a new form of punctuation on some home pages, and this may be a short-lived, or an emerging historical trend in the development of punctuation, at least in online environments. Overall, online newspaper home pages are tending towards shorter texts, which communicate in novel ways. These short texts cannot communicate the values and ideology of news institutions in the way that extended verbal texts have done for centuries, yet this function of news texts remains important to the construction and maintenance of a readership, and therefore crucial to the home page of a newspaper. As a result, news institutions express values visually in their design of newspaper home pages. As readers become familiar with the meanings of online news design, they become adept at reading and understanding short stories within these multimodally-construed frames of reference. Ideology is increasingly fragmented on shorter timescales, but expressed over longer timescales in a hypermedia environment that affords and extends many of the pre-existing multimodal features of print newspaper discourse

Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle

Contains fulltext : 153582.pdf (publisher's version ) (Open Access)BACKGROUND: Many women consider mammography painful. Existing studies on pain-preventing strategies only mention pain scores reported before and after breast compression. Studying the pain dynamics during the entire compression cycle may provide new insights for effective pain-preventing strategies. METHODS: This observational study included 117 women who consented to use a custom turning knob to indicate their pain experience during standard mammographic breast compressions in the Academic Medical Center in Amsterdam, The Netherlands. The breast thickness, compression force, contact area, contact pressure and pain experience were recorded continuously. Breast volume was calculated retrospectively from the mammograms. We visualized the progression of pain in relation to breast mechanics for five groups of breast volumes and we performed multivariable regressions to identify factors that significantly predict pain experience. RESULTS: Breast compressions consisted of a deformation phase for flattening, and a clamping phase for immobilization. The clamping phase lasted 12.8 +/- 3.6 seconds (average +/- standard deviation), 1.7 times longer than the 7.5 +/- 2.6 seconds deformation phase. During the clamping phase, the average pain score increased from 4.75 to 5.88 (+24 %) on a 0 - 10 Numerical Rating Scale (NRS), and the proportion of women who reached severe pain (NRS >/= 7) increased from 23 % to 50 % (more than doubled). Moderate pain (NRS >/= 4) was reported up to four days after the mammogram. Multivariable analysis showed that pain recollection of the previous mammogram and breast pain before the compression, are significant predictors for pain. Women with smallest breasts experienced most pain: They received highest contact pressures (force divided by contact area) and the pressure increased at the highest rate. CONCLUSION: We suggest further research on two pain-preventing strategies: 1) using a personalized compression protocol by applying to all breasts the same target pressure at the same, slow rate, and 2) shortening the phase during which the breast is clamped

Experiences with a self-test for Dutch breast screening radiologists: lessons learnt

Item does not contain fulltextPURPOSE: To evaluate a self-test for Dutch breast screening radiologists introduced as part of the national quality assurance programme. METHODS AND MATERIALS: A total of 144 radiologists were invited to complete a test-set of 60 screening mammograms (20 malignancies). Participants assigned findings such as location, lesion type and BI-RADS. We determined areas under the receiver operating characteristics (ROC) curves (AUC), case and lesion sensitivity and specificity, agreement (kappa) and correlation between reader characteristics and case sensitivity (Spearman correlation coefficients). RESULTS: A total of 110 radiologists completed the test (76%). Participants read a median number of 10,000 screening mammograms/year. Median AUC value was 0.93, case and lesion sensitivity was 91% and case specificity 94%. We found substantial agreement for recall (kappa = 0.77) and laterality (kappa = 0.80), moderate agreement for lesion type (kappa = 0.57) and BI-RADS (kappa = 0.45) and no correlation between case sensitivity and reader characteristics. CONCLUSION: Areas under the ROC curve, case sensitivity and lesion sensitivity were satisfactory and recall agreement was substantial. However, agreement in lesion type and BI-RADS could be improved; further education might be aimed at reducing interobserver variation in interpretation and description of abnormalities. We offered individual feedback on interpretive performance and overall feedback at group level. Future research will determine whether performance has improved. KEY POINTS: * We introduced and evaluated a self-test for Dutch breast screening radiologists. * ROC curves, case and lesion sensitivity and recall agreement were all satisfactory. * Agreement in BI-RADS interpretation and description of abnormalities could be improved. * These are areas that should be targeted with further education and training. * We offered individual feedback on interpretative performance and overall group feedback

Towards personalized compression in mammography: a comparison study between pressure- and force-standardization

Contains fulltext : 154324.pdf (Publisher’s version ) (Open Access)OBJECTIVE: To compare a conventional 14 decanewton (daN) force-standardized compression protocol with a personalized 10kilopascal (kPa) pressure-standardized protocol. METHODS: A new add-on contact area detector, which enables pressure-standardized compression, is validated in a double-blinded intra-individual comparison study. Breast screening participants (433) received one craniocaudal (CC) and one mediolateral oblique (MLO) compression for both breasts. Three of these compressions were force-standardized, and one, blinded and randomly assigned, was pressure-standardized. Participants scored their pain experience on an 11-point numerical rating scale (NRS). Three experienced breast-screening radiologists, blinded for compression protocol, indicated which images required retakes. RESULTS: An unanticipated under-compression issue that occurred at forces below 5daN was effectively solved with minimal extra radiographer training during the study. For pressure-standardized compressions obtained at 5daN or more, the compressed breasts thickness increased on average 4.2% (MLO)-6.3% (CC), average pain scores were reduced by 10% (MLO)-17% (CC) and the proportion of women experiencing severe pain (NRS>/=7) was reduced by 27% (MLO)-32% (CC), compared with force-standardized compressions (all p-values <0.05). Average glandular dose (AGD) and proportions of retakes were similar for both protocols. CONCLUSION: Pressure-standardized compressions resulted in AGD values and a retake proportion similar to force-standardized compressions, while pain was significantly reduced

Mammographic compression after breast conserving therapy: Controlling pressure instead of force

Item does not contain fulltextPURPOSE: X-ray mammography is the primary tool for early detection of breast cancer and for follow-up after breast conserving therapy (BCT). BCT-treated breasts are smaller, less elastic, and more sensitive to pain. Instead of the current force-controlled approach of applying the same force to each breast, pressure-controlled protocols aim to improve standardization in terms of physiology by taking breast contact area and inelasticity into account. The purpose of this study is to estimate the potential for pressure protocols to reduce discomfort and pain, particularly the number of severe pain complaints for BCT-treated breasts. METHODS: A prospective observational study including 58 women having one BCT-treated breast and one untreated nonsymptomatic breast, following our hospital's 18 decanewton (daN) compression protocol was performed. Breast thickness, applied force, contact area, mean pressure, breast volume, and inelasticity (mean E-modulus) were statistically compared between the within-women breast pairs, and data were used as predictors for severe pain, i.e., scores 7 and higher on an 11-point Numerical Rating Scale. Curve-fitting models were used to estimate how pressure-controlled protocols affect breast thickness, compression force, and pain experience. RESULTS: BCT-treated breasts had on average 27% smaller contact areas, 30% lower elasticity, and 30% higher pain scores than untreated breasts (allp < 0.001). Contact area was the strongest predictor for severe pain (p < 0.01). Since BCT-treatment is associated with an average 0.36 dm(2) decrease in contact area, as well as increased pain sensitivity, BCT-breasts had on average 5.3 times higher odds for severe pain than untreated breasts. Model estimations for a pressure-controlled protocol with a 10 kPa target pressure, which is below normal arterial pressure, suggest an average 26% (range 10%-36%) reduction in pain score, and an average 77% (range 46%-95%) reduction of the odds for severe pain. The estimated increase in thickness is +6.4% for BCT breasts. CONCLUSIONS: After BCT, women have hardly any choice in avoiding an annual follow-up mammogram. Model estimations show that a 10 kPa pressure-controlled protocol has the potential to reduce pain and severe pain particularly for these women. The results highly motivate conducting further research in larger subject groups

The potential use of ultra-low radiation dose images in digital mammography--a clinical proof-of-concept study in craniocaudal views

Item does not contain fulltextOBJECTIVE: To estimate the potential of low-dose images in digital mammography by analysing the effect of substantial dose reduction in craniocaudal (CC) views on clinical performance. METHODS: At routine mammography, additional CC views were obtained with about 10% of the standard dose. Five radiologists retrospectively read the standard [mediolateral oblique (MLO) + CC] and combination low-dose mammograms (standard MLO + low-dose CC). If present, lesion type, conspicuity and suggested work-up were recorded. Final diagnoses were made by histology or follow up. A t-test or chi(2) test was used to compare results. RESULTS: 421 cases were included, presenting 5 malignancies, 66 benign lesions and multiple non-specific radiologic features. Using MLO with low-dose CC, all lesions were detected by at least one reader, but altogether less often than with standard mammography (sensitivity, 73.9% vs 81.5%). Missed lesions concerned all types. Lesions detected with both protocols were described similarly (p = 0.084) with comparable work-up recommendations (p = 0.658). CONCLUSION: Mammography with ultra-low-dose CC images particularly influences detection. While sensitivity decreased, specificity was unaffected. In this proof-of-concept study a lower limit was to be determined that is not intended nor applicable for clinical practice. This should facilitate further research in optimization of a low-dose approach, which has potential in a relatively young and largely asymptomatic population. ADVANCES IN KNOWLEDGE: Tungsten/silver-acquired mammography images might facilitate substantial dose reduction. Ultra-low-dose CC images reduce sensitivity, but not specificity. Low-dose images have potential in a largely young and asymptomatic population; a baseline is set for further research in optimization of a low-dose approach

Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer

Item does not contain fulltextSeveral reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups