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Purpose: We evaluated the contribution to cancer detection of supplemental breast ultrasound screening in women with dense breasts based on a single center experience by comparing our results with similar programs elsewhere. Methods: We performed a retrospective review of handheld sonographer-performed screening ultrasound exams at our academic breast imaging center, from January 1st to December 31st, 2019. Breast density, breast cancer risk factors, BI-RADS assessment, and lesion pathology were reviewed and tallied, followed by derivation of the biopsy rate, breast cancer detection rate, PPV3 and average tumor size. These values were compared to published results of breast screening programs elsewhere. Results: 695 screening breast ultrasounds for women with dense breasts and negative mammograms were performed in 2019. The biopsy rate was 1.3%, breast cancer detection rate was 7 in 1000, PPV3 was 42%, and the average tumor size was 9.0 ± 1.4 mm. Conclusions: The first-year data of the breast screening ultrasound program at our practice are promising, demonstrating comparable cancer detection rate, higher PPV3, and similar biopsy rate in those with dense breasts compared with similar programs elsewhere. Longitudinal analysis and larger sample size are required for validation. Comparison of incidence and prevalence screening data is also warranted to elucidate the true value of this program.

Background: The role of the nurse educator is to prepare students to collaborate and practice competently and safely. One way of promoting collaboration is with the use of students as standardized patients (SPs). Method: This exercise used undergraduate nursing students in collaboration with graduate nurse practitioner (NP) students in an advanced health assessment course. Undergraduate students were assigned a specific disease process to review, then as SPs were asked to describe symptoms and answer questions regarding the disease by the NP students. At the end of a combined group debriefing, a survey was given to evaluate the process. Results: Analysis of the survey identified the following themes: Positive Learning Method, “Aha” Moments, Improvement in Critical Thinking, and Communication. Conclusion: Using undergraduate nursing students as SPs helped create real-life scenarios for both the undergraduate and graduate nursing students to learn from. [ J Nurs Educ . 2019;58(11):657–660.]

Purpose Mammographic breast density (BD) is associated with increased risk of breast cancer. This study asks which circulating metabolic and reproductive biomarkers are associated with BD, particularly dense breast area, in premenopausal women not taking exogenous hormones. Methods In a cross-sectional study, 299 premenopausal women aged 40–49 completed questionnaires, provided a fasting blood sample, had height, weight, percentage body fat, waist and hip measurements taken, and attended a screening mammogram. Multivariate linear regression was used to calculate adjusted means for percentage BD, absolute dense and non-dense area, across categories of covariates, adjusted for day of menstrual cycle, age, parity, body mass index, percentage body fat, and ethnicity. Results Fasting insulin levels were inversely associated, and insulin-like growth factor-binding protein 1 levels directly associated with percentage BD, but lost statistical significance after multivariate adjustment. Sex hormonebinding globulin levels were directly associated with percentage BD, still significant after multivariate adjustment (p = 0.03). A significant inverse dose–response association was observed between progesterone levels and dense area (p \ 0.01). Conclusions Breast density in premenopausal women seems unrelated or inversely related to insulin resistance, levels of insulin-like growth factor 1 and its binding proteins, and levels of sex steroids; therefore, the mechanism by which radiodensity on a mammogram is related to breast cancer risk remains unclear.

This prospective study was designed to evaluate the effectiveness of online pediatric education for prehospital emergency medical technicians (EMTs).Online emergency medical services (EMS) continuing education modules, on various pediatric emergency topics, were developed for dissemination statewide. Pre- and posttest scores were compared by EMT level of training, rural versus urban location, and individual module performance.A total of 539 participants completed both the pre- and posttests. Of these, more than one-third (38.0%) reported Bernalillo County, the only urban county in the state, as the county in which they worked. Pretest scores ranged from 0 to 15 (mean = 8.5; 95% confidence interval [CI] = 8.2, 8.7), with a median of 8.0 and a mode of 8.0. Posttest scores were higher, ranging from 4 to 15 (mean = 11.6; 95% CI = 11.4, 11.7). For the posttest, the median score was 12.0 and the mode was 13.0. Urban and rural EMTs improved in posttests comparably. EMT-Basic participants' scores improved (mean change in score = 3.4, 95% CI = 3.1, 3.7) more than those of EMT-Intermediates (mean = 2.9, 95% CI = 2.5, 3.2) or EMT-Paramedics (mean = 2.7, 95% CI = 2.2, 3.3).1) The New Mexico EMS for Children (EMSC) online pediatric continuing education program increased EMTs' cognitive knowledge; 2) rural EMTs accessed the training more than urban EMTs; and 3) although pre- and posttest results varied by EMT licensure level, improvements in scores also varied such that posttest scores were more similar than pretest scores.

This work reports the use of ultrasound radio frequency (RF) time series analysis as a method for ultrasound-based classification of malignant breast lesions. The RF time series method is versatile and requires only a few seconds of raw ultrasound data with no need for additional instrumentation. Using the RF time series features, and a machine learning framework, we have generated malignancy maps, from the estimated cancer likelihood, for decision support in biopsy recommendation. These maps depict the likelihood of malignancy for regions of size $1~{\hbox {mm}}^{2}$ within the suspicious lesions. We report an area under receiver operating characteristics curve of 0.86 (95% confidence interval [CI]: 0.84%–0.90%) using support vector machines and 0.81 (95% CI: 0.78–0.85) using Random Forests classification algorithms, on 22 subjects with leave-one-subject-out cross-validation. Changing the classification method yielded consistent results which indicates the robustness of this tissue typing method. The findings of this report suggest that ultrasound RF time series, along with the developed machine learning framework, can help in differentiating malignant from benign breast lesions, subsequently reducing the number of unnecessary biopsies after mammography screening.

This study investigated the effects of normal aging and Alzheimer's disease on listeners' ability to recognize gated spoken words. Groups of healthy young adults, healthy older adults, and adults with Alzheimer's disease were presented isolated gated spoken words. Theoretical predictions of the Cohort model of spoken word recognition (Marslen-Wilson, 1984) were tested, employing both between-group and within-group comparisons. The findings for the young adults supported the Cohort model's predictions. The findings for the older adult groups revealed different effects for age and disease. These results are interpreted in relation to the theoretical predictions, the findings of previous gating studies, and differentiating age from disease-related changes in spoken word recognition.

Purpose: To determine the negative predictive value of sonographically guided 14-gauge core needle biopsy of breast masses, with detailed analysis of any false-negative cases. Materials and methods: We reviewed 669 cases of sonographically guided 14-gauge core needle biopsies that had benign pathologic findings. Given a benign pathology on core biopsy, true-negatives had either benign pathology on surgical excision or at least 2 years of stable imaging and/or clinical follow-up; false-negatives had malignant histology on surgical excision. Results: Follow-up was available for 339 breast lesions; 117 were confirmed to be benign via surgical excision, and 220 were stable after 2 years or more of imaging or clinical follow-up (mean follow-up time 33.1 months, range 24–64 months). The negative predictive value was determined to be 99.4%. There were 2 false-negative cases, giving a false-negative rate of 0.1%. There was no delay in diagnosis in either case because the radiologist noted discordance between imaging and core biopsy pathology, and recommended surgical excision despite the benign core biopsy pathology. Conclusions: Sonographically guided 14-gauge core needle biopsy provides a high negative predictive value in assessing breast lesions. Radiologic/pathologic correlation should be performed to avoid delay in the diagnosis of carcinoma.

In Experiment 1, young and old adults both generated and read the same words either two, five, or eight times (with frequencies combined orthogonally) and then judged the frequency of either the generated or read words. In Experiment 2, young and old adults generated and read different words either one, two, or three times and judged the frequency of both the generated and read words. In both experiments, generation, compared to reading, increased the slope of frequency judgments comparably for the two age groups. In Experiment 1, neither age group could discriminate read from generated frequency. In Experiment 2, a 24-h retention interval reduced the slope of frequency judgments, but did not interact with either age or generation efforts. These results seem most consistent with a semantic activation explanation of the generation effect and a familiarity-based judgment about frequency of occurrence.

During the past several years, EMTs and paramedics have seen more and more children with underlying health conditions, including children with special health-care needs (CSHCN). Advances in medical knowledge, improved technology and more affordable medical equipment have allowed CSHCN to be cared for at home rather than in specialized facilities. As a result, when these children become ill or injured, EMS is called to assist the family in caring for them. The families are typically experts in providing the patient's history and assisting EMS with equipment and devices. However, some pediatric calls can keep you guessing. The patient has no known pre-existing conditions, and the family may be extremely panicked and upset by the emergency. What causes tachypnea, altered mental status (AMS) and seizures in children? How do you assess and treat those causes? The following cases involve actual patients who were seen by an urban ambulance service. Consider how each case presented to the crews, and how you would assess and treat the patients.

Considerable heterogeneity exists in the criteria used for the establishment of stages of impairment for patients with dementia. The valid distinction of stages is important both for clinical interpretation and the study of dementia. This study reports on the use of the Mattis Dementia Rating Scale (DRS) in staging dementia. Using a sample of 42 patients diagnosed with Alzheimer-type dementia, DRS performance and a rating of Instrumental Activities of Daily Living (IADL) were compared with clinical ratings of dementia severity. Total DRS score provides a clinically valid measure of stage of impairment and appeared to provide a better distinction among stages than IADL score. However, use of the IADL score in conjunction with total DRS may improve correspondence with clinical staging over use of the total DRS score alone. Normative data for the DRS are also provided. ( J Geriatr Psychiatry Neurol 1991; 4:18-25).

Objectives The objective of this study was to compare breast cancer outcomes among women subject to different policies on mammography screening frequency. Setting Data were obtained for women participating in the Screening Mammography Programme of British Columbia (SMPBC) for 1988–2005. The SMPBC changed its policy for women aged 50–79 years from annual to biennial mammography in 1997, but retained an annual recommendation for women aged 40–49 years. Methods Breast cancer outcomes were compared for women participating in the programme before and after 1997 for two groups: ages 40–49 and 50–79 years. Results There were data on 658,151 women. Comparing pre-1997 and post-1997, the median interscreen interval increased by 11.1 months in women 50–79 but by only 0.3 months in women aged 40–49. Excluding those detected at initial screen, 6291 breast cancers were identified. Comparing pre-1997 and post-1997: the relative rates (RR) of screen detected cancer increased in women aged 40–49 (RR = 1.32) and the rate of invasive cancers ≥20 mm at diagnosis decreased (RR = 0.83); the rate of cancers with axillary node involvement increased in women aged 50–79 (RR = 1.23). Cancer survival improved after 1997 for women diagnosed at ages 40–49 (hazard ratio = 0.62), but was unchanged for women aged 50–79. Breast cancer mortality rates did not change between the periods in either age group. Conclusion The proximal cancer outcomes considered (staging and survival) improved in women aged 40–49 but this was offset in women aged 50–79 associated with the change in screen frequency. These changes did not result in alterations in breast cancer mortality rates in either age group.

Mammographic screening is a proven method for the early detection of breast cancer. The authors analyzed the impact of service mammographic screening on breast cancer mortality among British Columbia women who volunteered to be screened by the Screening Mammography Program of British Columbia. A cohort of women having at least one mammographic screen by Screening Mammography Program of British Columbia between the ages of 40 and 79 in the period 1988-2003 was identified. All cases and deaths from breast cancer occurring in British Columbia were identified from the British Columbia Cancer Registry and linked to the screening cohort. Expected deaths from breast cancer in the cohort were calculated using incidence and survival rates for British Columbia women not in the cohort. Adjustment was made for age and socioeconomic status of their area of residence at time of diagnosis. The breast cancer mortality ratio was calculated by dividing observed by expected breast cancer deaths. The mortality ratio (95% confidence interval) was 0.60 (0.55, 0.65) for all ages combined (p < 0.0001). The mortality ratio in women aged 40-49 at first screening was 0.61 (0.52, 0.71), similar to that in women over 50 (p = 0.90). Exclusion of mortality associated with breast cancers diagnosed after age 50 in women starting screening in their 40s increased the mortality ratio to 0.63 (0.52, 0.77), but it remained statistically significant. Correction for self-selection bias using estimates from the literature increased the mortality ratio for all ages to 0.76. Mammographic screening at all ages between 40 and 79 reduced subsequent mortality rates from breast cancer.

Although the wider scientifi c community has long embraced the benefi ts of population-based breast screening, there seems to be an active anti-screening campaign orchestrated in part by members of the Nordic Cochrane Centre. These contrary views are based on erroneous interpretation of data from cancer registries and peerreviewed articles. Their specifi c aim seems to be to support a pre-existing opposition to all forms of screening. These individuals, making claims of poor methods, selectively discount overwhelming scientifi c evidence from numerous randomised trials in diff erent countries that organised screening reduces breast cancer mortality. They claim that the signifi cant decrease in breast cancer mortality achieved by screening is due to improvements in treatment alone, discounting the benefi ts of early detection. If true, this would imply that breast cancer is an exception among adenocarcinomas in that early detection does not improve prog nosis—a claim contrary to the evidence. For women with breast cancer, early detection also results in improved quality of life from less extensive surgical treatment. Women with screen-detected breast cancer in the UK have half the mastectomy rate of women with symptomatic cancers— ie, 27% versus 53%. Organised, high-quality breast screening is an important public health initiative by numerous governments worldwide. These policies are based on robust and extensive analysis of individualised patient data from scientifi c trials, with particular attention paid to the balance of potential benefi ts and harms. To imply that such an international action is mass misrepresentation, or that screening is done for the benefi t of self-interested professionals, is as perverse as it is unjustifi ed. Comprehensive guidelines deal with the entire screening process. Organisations responsible for screening programmes regularly review published evidence on the eff ects of mammographic screening, and also contradictory interpretations. We consider the interpretation by Jorgensen, Keen, and Gotzsche, of the balance of benefi ts and harms to be scientifi cally unsound. Women would be better served by focusing eff orts on how best, and not whether, to provide breast screening. The signatories below, charged with provision and implementation of breast screening in many diff erent countries, remain convinced that the scientifi c foundation for populationbased, quality-assured, organised breast screening is one of the major accomplishments of the translation of clinical cancer research into public health practice. Early detection, in combination with appropriate treatment, signifi cantly lowers breast cancer mortality and improves the life quality of patients with the disease.

Renal sizes in a group of 68 patients suffering from various nephropathies were compared to expected normal values.Kidneys with lipoid nephrosis and lobular glomerulonephritis were shown to be statistically increased in size, whereas no statistical difference was noted in cases of membranous, membranoproliferative and latent glomerulonephritis. These 2 relatively new entities should be included in the differential diagnosis of enlarged kidneys with no other apparent abnormality on excretory urography.