When should we stop mammography screening for breast cancer in elderly women?

There is insufficient evidence to recommend for or against routine screening mammography beyond the age of 69 years. The best candidates to stop screening are elderly women who have significant comorbidities, poor functional status, low bone mineral density (BMD), little interest in preventive care, or an unwillingness to accept the potential harm of screening. (Grade of Recommendation: C, based on retrospective cohort studies.

Low weight congestion control for multi sender applications

This paper presents a prototype for single-rate reliable multicast congestion control, which has been built into an existing commercial whiteboard. The prototype was developed using a novel scheme that was engineered around conflicting industry provided requirements for collaborative workspaces. This required the scheme to be both low-weight when used with many senders and compatible with NAT, firewalls and reflectors. The key to overcome this conflict was to combine congestion control and recovery feedback. This differs from many current solutions in that they are often designed for use with a wide variety of protocols and thus operate independent of the recovery mechanism. This paper does not go into the detail required to specify a protocol but instead discusses a few important design requirements for multi-sender applications, which are generally not considered by current research, and describes an approach towards meeting these requirements. Document type: Part of book or chapter of boo

Real-time control and management of distributed applications using ip-multicast

Abstract A central issue within any distributed computer environment is how to control and manage running applications. This paper presents an implementation of a framework for control and management of distributed applications and components using IPmulticast. The framework allows for easy and scalable control of single applications, groups of applications or parts of applications using a new agent based architecture. Messaging is done using the Control Bus and the Scalable Reliable Real-time Transfer Protocol for reliable distribution of data. The paper presents how this framework is integrated into Java based applications and how developers specify access points. The paper also presents an application called multicast Manager -mManager, a Java implementation that provides a user interface to the framework. The mManager allows administrators to get an overview of currently running applications and if necessary control these applications. The paper presents example usage scenarios where the framework is used to create bandwidth adaptive applications and better group awareness

Problems and Solutions in Researching Computer Game Assisted Dialogues for Persons with Aphasia

In this paper, we describe technological advances for supporting persons with aphasia in philosophical dialogues about personally relevant and contestable questions. A computer game-based application for iPads is developed and researched through Living Lab inspired workshops in order to promote the target group’s communicative participation during group argumentation. We outline some central parts of the background theory of the application and some of its main features, which are related to needs of the target group. Methodological issues connected to the design and use of Living Labs with persons with aphasia are discussed. We describe a few problems with researching development of communicative participation during group argumentation using an app assisted intervention for the target group and suggest some possible solutions

Game Technologies to Assist Learning of Communication Skills in Dialogic Settings for Persons with Aphasia

Persons with aphasia suffer from a loss of communication ability as a consequence of a brain injury. A small strand of research indicates effec- tiveness of dialogic interventions for communication development for persons with aphasia, but a vast amount of research studies shows its effectiveness for other target groups. In this paper, we describe the main parts of the hitherto technological development of an application named Dialogica that is (i) aimed at facilitating increased communicative participation in dialogic settings for persons with aphasia and other communication disorders, (ii) based on comput- er game technology as well as on theory in dialogic education and argumenta- tion theory, and (iii) designed for mobile devices with larger screens

Prevention and early detection of prostate cancer

This Review was sponsored and funded by the International Society of Cancer Prevention (ISCaP), the European Association of Urology (EAU), the National Cancer Institute, USA (NCI) (grant number 1R13CA171707-01), Prostate Cancer UK, Cancer Research UK (CRUK) (grant number C569/A16477), and the Association for International Cancer Research (AICR

Comparison of MR/Ultrasound Fusion-Guided Biopsy With Ultrasound-Guided Biopsy for the Diagnosis of Prostate Cancer

IMPORTANCE Targeted magnetic resonance (MR)/ultrasound fusion prostate biopsy has been shown to detect prostate cancer. The implications of targeted biopsy alone vs standard extended-sextant biopsy or the 2 modalities combined are not well understood. OBJECTIVE To assess targeted vs standard biopsy and the 2 approaches combined for the diagnosis of intermediate-to high-risk prostate cancer. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 1003 men undergoing both targeted and standard biopsy concurrently from 2007 through 2014 at the National Cancer Institute in the United States. Patients were referred for elevated level of prostate-specific antigen (PSA) or abnormal digital rectal examination results, often with prior negative biopsy results. Risk categorization was compared among targeted and standard biopsy and, when available, whole-gland pathology after prostatectomy as the "gold standard." INTERVENTIONS Patients underwent multiparametric prostate magnetic resonance imaging to identify regions of prostate cancer suspicion followed by targeted MR/ultrasound fusion biopsy and concurrent standard biopsy. MAIN OUTCOMES AND MEASURES The primary objective was to compare targeted and standard biopsy approaches for detection of high-risk prostate cancer (Gleason score Ն4 + 3); secondary end points focused on detection of low-risk prostate cancer (Gleason score 3 + 3 or low-volume 3 + 4) and the biopsy ability to predict whole-gland pathology at prostatectomy. RESULTS Targeted MR/ultrasound fusion biopsy diagnosed 461 prostate cancer cases, and standard biopsy diagnosed 469 cases. There was exact agreement between targeted and standard biopsy in 690 men (69%) undergoing biopsy. Targeted biopsy diagnosed 30% more high-risk cancers vs standard biopsy (173 vs 122 cases, P < .001) and 17% fewer low-risk cancers (213 vs 258 cases, P < .001). When standard biopsy cores were combined with the targeted approach, an additional 103 cases (22%) of mostly low-risk prostate cancer were diagnosed (83% low risk, 12% intermediate risk, and 5% high risk). The predictive ability of targeted biopsy for differentiating low-risk from intermediate-and high-risk disease in 170 men with whole-gland pathology after prostatectomy was greater than that of standard biopsy or the 2 approaches combined (area under the curve, 0.73, 0.59, and 0.67, respectively; P < .05 for all comparisons). CONCLUSIONS AND RELEVANCE Among men undergoing biopsy for suspected prostate cancer, targeted MR/ultrasound fusion biopsy, compared with standard extended-sextant ultrasound-guided biopsy, was associated with increased detection of high-risk prostate cancer and decreased detection of low-risk prostate cancer. Future studies will be needed to assess the ultimate clinical implications of targeted biopsy

Addressing overdiagnosis and overtreatment in cancer: a prescription for change

A vast range of disorders—from indolent to fast-growing lesions—are labelled as cancer. Therefore, we believe that several changes should be made to the approach to cancer screening and care, such as use of new terminology for indolent and precancerous disorders. We propose the term indolent lesion of epithelial origin, or IDLE, for those lesions (currently labelled as cancers) and their precursors that are unlikely to cause harm if they are left untreated. Furthermore, precursors of cancer or high-risk disorders should not have the term cancer in them. The rationale for this change in approach is that indolent lesions with low malignant potential are common, and screening brings indolent lesions and their precursors to clinical attention, which leads to overdiagnosis and, if unrecognised, possible overtreatment. To minimise that potential, new strategies should be adopted to better define and manage IDLEs. Screening guidelines should be revised to lower the chance of detection of minimal-risk IDLEs and inconsequential cancers with the same energy traditionally used to increase the sensitivity of screening tests. Changing the terminology for some of the lesions currently referred to as cancer will allow physicians to shift medicolegal notions and perceived risk to reflect the evolving understanding of biology, be more judicious about when a biopsy should be done, and organise studies and registries that offer observation or less invasive approaches for indolent disease. Emphasis on avoidance of harm while assuring benefit will improve screening and treatment of patients and will be equally effective in the prevention of death from cancer