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Introduction Iron oxide nanoparticles have been used in preclinical and clinical research as imaging agents for decades because of their magnetic properties and their known safety profile. We have been developing the MagSense® HER2 Test Reagent (MSH2TR), a formulation of anti-human epidermal growth factor receptor 2 (HER2) conjugated iron oxide nanoparticles, for the noninvasive detection of metastatic lymph nodes to aid in staging of HER2 positive (HER2+) breast cancer patients. Currently, nodal staging requires a patient’s lymph nodes to be surgically removed or biopsied for histopathological examination. MSH2TR is currently being investigated in a first-in-human phase I study in subjects with HER2+ primary breast cancer who, in the judgment of the investigator, have a likelihood of lymph node metastasis. Methods This phase I study is designed to be a preliminary proof-of-principle study with the primary objective of achieving an initial assessment of the safety and tolerability of the MSH2TR injectable imaging agent. A secondary objective of the study is the confirmation that the route of administration is effective in allowing the imaging agent to reach the patient’s lymph nodes. The exploratory objectives of the study include a comparison of the two imaging modalities: magnetic resonance imaging (MRI) and a novel proprietary technology called magnetic relaxometry (MRX), to standard clinical tissue histopathology. The exploratory objectives are expected to provide a preliminary assessment as to whether the MagSense® HER2 imaging agent, when used with one or both imaging modalities, might be able to provide a non-invasive alternative to nodal biopsy. All eligible subjects receive a 30mg injection of MSH2TR into the subareolar interstitial tissue or area near and around the primary tumor. MRI of the axilla are performed before and 24 to 72 hours after MSH2TR injection followed by core biopsy or dissection of the suspected lymph node tissue as per standard of care (SOC) procedures for histopathology assessments and also for ex vivo MRX measurements using the MagSense® Relaxometry Instrument. Review of the MRI scans and histopathology are performed in respective central laboratories. The study is currently enrolling in 4 clinical sites in Australia. Results From an interim evaluation of the first five patients that have completed the study, MSH2TR appears to be safe and well tolerated and no safety issues reported related to the imaging agent. The imaging agent, as administered, is reaching the lymph nodes. The study intends to enroll approximately 15 patients for the preliminary efficacy assessment. Safety and efficacy results from available patients’ data will be presented. Conclusion Available data to date from the ongoing phase I study show that the MagSense® HER2 imaging agent, as administered, appear to be safe and drains to the axillary lymph nodes within the timeframe of interest. Further data collection is ongoing for the preliminary evaluation of efficacy. Citation Format: Yalia Jayalakshmi, Jane Fox, Natalie Yang, Marie Zhang, Robert Proulx, Steven Reich. Noninvasive Detection of Lymph Node Involvement in Subjects with Human Epidermal Growth Factor Receptor 2 Positive (HER2+) Breast Cancer using the MagSense® HER2 Test Reagent – A First-In-Human Phase 1 Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-09-02.

The reality is that transport and mobility matters to us all, it literally sustains our lives being an enabler of our economic and social life. ‘We’ take it for granted and perhaps none more so than the motorcar. Yet road transport also comes at a price – it takes lives. From a United Nations perspective, it is identified that road crashes risk jeopardizing the whole sustainable development agenda. This research commences by reflecting on the history and strategic direction being advocated at an international level. It considers the global divide, before attention and emphasis is turned to the EU’s approach to saving lives on the road. This is also compared with the US. The method applied is from a legal/policy measures approach – which puts the driver at the heart of intervention strategies. Focus in particular is accorded to the success of the EU driver/education law and policy. Comparisons are also drawn within, between the pandemic of Covid-19 and this global epidemic (in terms of lives lost). It concludes by declaring road deaths as a global emergency, one that needs to be approached in the same way and with the same vigour and haste, in order to stop numbers rising.

The Victorian Tumour Summits are an initiative of the Victorian Integrated Cancer Services to engage clinicians and consumers in identifying unwarranted variations in cancer care across the state. From the analysis presented at the Victorian Breast Tumour Summit in 2021, this study provides a state-wide overview of epidemiology and surgical care of breast cancer in Victoria to outline any variations in care across the state, and limitations in data reporting, which impacts the understanding of breast cancer burden and service planning.A retrospective analysis of Victorian breast cancer patients diagnosed between 2016 and 2018 was performed using a linked data set provided by the Department of Health. The linked data sources include Victorian Cancer Registry, Victorian Admitted Episodes Dataset and Victorian Radiotherapy Minimum Data Set, from which patient demographic details, tumor characteristics and treatment records were extracted. Pearson's chi-squared test was used to determine the statistical significance of relationships between various categorical parameters. Variables including demographics, types of surgery (breast-conserving vs. mastectomy), rates of neoadjuvant chemotherapy, and time to surgery were examined.One thousand nine hundred thirty-seven patients with ductal carcinoma in situ and 13,375 patients with invasive breast cancer (IBC) were included. Of 11,351 patients with stages I-III IBC (85%, N = 13,375) 66% underwent breast-conserving surgery (BCS), and 31% underwent mastectomy. The ratio of mastectomy to BCS increased with increasing disease stage. Neoadjuvant chemotherapy was utilized in 11% of early IBC patients who were surgically treated. Eighty-three percent of patients undergoing upfront breast surgery were treated within 5 weeks of diagnosis, with a significant difference in the median time to surgery between public and private sectors. Breast reconstruction was performed in 37% of mastectomy patients, of whom 83% underwent immediate breast reconstruction, and 17% underwent delayed breast reconstruction.Victorian breast cancer data show a high quality of surgical care coordination. Significant gaps in our data warrant future improvements in the Victorian breast cancer notification system and access to pharmaceutical data for an enhanced understanding of the breast cancer treatment pathways and care delivery.

Cooperation is key to policing and keeping mankind safe and secure; this includes protecting citizens from various crimes, including terrorist attacks. However, it is not an easy feat to always achieve – as is explained within this paper. The related research considers the complexities and challenges of sharing and coordinating across divides – or, in other words, cooperating across borders (be they open or closed). Specifically, it discusses the advancements made between one bloc of countries – the European Union; and, how the evolutionary process has aided to expand cooperative community practices via various means between the police and other lea’s. As part of this, transport and movement are viewed as an essential element to be discussed and factored in. Finally, the paper considers the, arguably, devolutionary position of the UK and the implications – post 2020, in terms of marking a ‘potentially’ regressive position, one that stands to compromise safety and security.

Rationale and Objectives Propagation-based phase-contrast CT (PB-CT) is an advanced X-ray imaging technology that exploits both refraction and absorption of the transmitted X-ray beam. This study was aimed at optimizing the experimental conditions of PB-CT for breast cancer imaging and examined its performance relative to conventional absorption-based CT (AB-CT) in terms of image quality and radiation dose. Materials and Methods Surgically excised breast mastectomy specimens (n = 12) were scanned using both PB-CT and AB-CT techniques under varying imaging conditions. To evaluate the radiological image quality, visual grading characteristics (VGC) analysis was used in which 11 breast specialist radiologists compared the overall image quality of PB-CT images with respect to the corresponding AB-CT images. The area under the VGC curve was calculated to measure the differences between PB-CT and AB-CT images. Results The highest radiological quality was obtained for PB-CT images using a 32 keV energy X-ray beam and by applying the Homogeneous Transport of Intensity Equation phase retrieval with the value of its parameter γ set to one-half of the theoretically optimal value for the given materials. Using these optimized conditions, the image quality of PB-CT images obtained at 4 mGy and 2 mGy mean glandular dose was significantly higher than AB-CT images at 4 mGy (AUCVGC = 0.901, p = 0.001 and AUCVGC = 0.819, p = 0.011, respectively). Conclusion PB-CT achieves a higher radiological image quality compared to AB-CT even at a considerably lower mean glandular dose. Successful translation of the PB-CT technique for breast cancer imaging can potentially result in improved breast cancer diagnosis.

Very preterm infants are at increased risk of adverse outcomes in early childhood. We assessed whether delayed clamping of the umbilical cord reduces mortality or major disability at 2 years in the APTS Childhood Follow Up Study.In this long-term follow-up analysis of the multicentre, randomised APTS trial in 25 centres in seven countries, infants (30 weeks gestation) were randomly assigned before birth (1:1) to have clinicians aim to delay clamping for 60 s or more or clamp within 10 s of birth, both without cord milking. The primary outcome was death or major disability (cerebral palsy, severe visual loss, deafness requiring a hearing aid or cochlear implants, major language or speech problems, or cognitive delay) at 2 years corrected age, analysed in the intention-to-treat population. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12610000633088).Between Oct 21, 2009, and Jan 6, 2017, consent was obtained for follow-up for 1531 infants, of whom 767 were randomly assigned to delayed clamping and 764 to immediate clamping. 384 (25%) of 1531 infants were multiple births, 862 (56%) infants were male, and 505 (33%) were born before 27 weeks gestation. 564 (74%) of 767 infants assigned to delayed clamping and 726 (96%) of 764 infants assigned to immediate clamping received treatment that fully adhered to the protocol. Death or major disability was determined in 1419 (93%) infants and occurred in 204 (29%) of 709 infants who were assigned to delayed clamping versus 240 (34%) of 710 assigned to immediate clamping, (relative risk [RR]) 0·83, 95% CI 0·72-0·95; p=0·010). 60 (8%) of 725 infants in the delayed clamping group and 81 (11%) of 720 infants in the immediate clamping group died by 2 years of age (RR 0·70, 95% CI 0·52-0·95); among those who survived, major disability at 2 years occurred in 23% (144/627) versus 26% (159/603) of infants, respectively (RR 0·88, 0·74-1·04).Clamping the umbilical cord at least 60 s after birth reduced the risk of death or major disability at 2 years by 17%, reflecting a 30% reduction in relative mortality with no difference in major disability.Australian National Health and Medical Research Council.

BACKGROUND: One of the sequalae of breast cancer treatments may be pelvic floor (PF) dysfunction such as urinary incontinence (UI), faecal incontinence (FI), and pelvic organ prolapse (POP). OBJECTIVE: The aim of this study was to compare the occurrence and related distress and impact of PF dysfunction between women with and without breast cancer. METHODS: Women with and without breast cancer participated in this cross-sectional study. The Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire were used to quantify the prevalence and related distress, and impact of PF dysfunction. Factors associated with PF outcomes were examined using logistic and linear regressions while controlling for known risk factors for PF dysfunction (age, body mass index, and parity). RESULTS: 120 women with breast cancer, and 170 women without breast cancer responded. The occurrence of any type of UI was higher in women with breast cancer than women without breast cancer (percentage difference=17%; 95% CI: 7, 29). Women with breast cancer experienced higher impact of urinary symptoms (mean difference=18.2; 95% CI: 8.9, 27.7) compared to those without. Multivariable analysis indicated that having breast cancer (β 0.33; 95%CI: 0.08, 0.51) was the strongest predictor of greater impact of urinary symptoms. CONCLUSION: Women with breast cancer reported a higher occurrence and impact of urinary symptoms than women without breast cancer. While further studies are required to confirm our findings, routine screening and offering treatment for urinary symptoms may be indicated for women with breast cancer.

Patients diagnosed with triple negative breast cancer (TNBC) have an increased risk of rapid metastasis compared to other subtypes. Predicting long-term survival post-chemotherapy in patients with TNBC is difficult, yet enhanced infiltration of tumor infiltrating lymphocytes (TILs) has been associated with therapeutic response and reduced risk of metastatic relapse. Immune biomarkers that predict the immune state of a tumor and risk of metastatic relapse pre- or mid-neoadjuvant chemotherapy are urgently needed to allow earlier implementation of alternate therapies that may reduce TNBC patient mortality. Utilizing a neoadjuvant chemotherapy trial where TNBC patients had sequential biopsies taken, we demonstrate that measurement of T-cell subsets and effector function, specifically CD45RO expression, throughout chemotherapy predicts risk of metastatic relapse. Furthermore, we identified the tumor inherent interferon regulatory factor IRF9 as a marker of active intratumoral type I and II interferon (IFN) signaling and reduced risk of distant relapse. Functional implications of tumor intrinsic IFN signaling were demonstrated using an immunocompetent mouse model of TNBC, where enhanced type I IFN signaling increased anti-tumor immunity and metastasis-free survival post-chemotherapy. Using two independent adjuvant cohorts we were able to validate loss of IRF9 as a poor prognostic biomarker pre-chemotherapy. Thus, IRF9 expression may offer early insight into TNBC patient prognosis and tumor heat, allowing for identification of patients that are unlikely to respond to chemotherapy alone and could benefit from further immune-based therapeutic intervention.

An upsurge of fascist and anti-fascist activity in Australia in the early part of the twentieth century has received sustained historical attention. Yet scholarly historical coverage of the latter ...

The policing role is constantly changing and becoming more challenging, with the uk seeing reduced numbers and financial cuts. Going forward, it is likely that the police will become more involved in the policing of drones. This research looks at the governance of drones from a top down approach – international-regional-national. The legislative complexity is first reviewed before investigating the blurring of roles between Aviation Administration-Authorities and the police. Focus is given regionally to the eu and nationally to the uk with a comparison study of the usa. The research considers the developing remit of the police and who should police drones at a national level. The research finds that currently, the police are under-trained in this subject area and there is insufficient coordination with the national Aviation Authorities.

Rationale: Postconditioning at the time of primary percutaneous coronary intervention (PCI) for ST-segment–elevation myocardial infarction may reduce infarct size and improve myocardial salvage. However, clinical trials have shown inconsistent benefit. Objective: We performed the first National Heart, Lung, and Blood Institute–sponsored trial of postconditioning in the United States using strict enrollment criteria to optimize the early benefits of postconditioning and assess its long-term effects on left ventricular (LV) function. Methods and Results: We randomized 122 ST-segment–elevation myocardial infarction patients to postconditioning (4, 30 seconds PTCA [percutaneous transluminal coronary angioplasty] inflations/deflations)+PCI (n=65) versus routine PCI (n=57). All subjects had an occluded major epicardial artery (thrombolysis in myocardial infarction=0) with ischemic times between 1 and 6 hours with no evidence of preinfarction angina or collateral blood flow. Cardiac magnetic resonance imaging measured at 2 days post-PCI showed no difference between the postconditioning group and control in regards to infarct size (22.5±14.5 versus 24.0±18.5 g), myocardial salvage index (30.3±15.6% versus 31.5±23.6%), or mean LV ejection fraction. Magnetic resonance imaging at 12 months showed a significant recovery of LV ejection fraction in both groups (61.0±11.4% and 61.4±9.1%; P P P =0.05) on baseline magnetic resonance imaging and significantly less adverse LV remodeling compared with control subjects with microvascular obstruction ( P Conclusions: We found no early benefit of postconditioning on infarct size, myocardial salvage index, and LV function compared with routine PCI. However, postconditioning was associated with improved LV remodeling at 1 year of follow-up, especially in subjects with microvascular obstruction. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01324453.

Purpose: Breast cancer is the most common cancer in women in developing and developed countries and is responsible for 15% of women’s cancer deaths worldwide. Conventional absorption-based breast imaging techniques lack sufficient contrast for comprehensive diagnosis. Propagation-based phase-contrast computed tomography (PB-CT) is a developing technique that exploits a more contrast-sensitive property of x-rays: x-ray refraction. X-ray absorption, refraction, and contrast-to-noise in the corresponding images depend on the x-ray energy used, for the same/fixed radiation dose. The aim of this paper is to explore the relationship between x-ray energy and radiological image quality in PB-CT imaging. Approach: Thirty-nine mastectomy samples were scanned at the imaging and medical beamline at the Australian Synchrotron. Samples were scanned at various x-ray energies of 26, 28, 30, 32, 34, and 60 keV using a Hamamatsu Flat Panel detector at the same object-to-detector distance of 6 m and mean glandular dose of 4 mGy. A total of 132 image sets were produced for analysis. Seven observers rated PB-CT images against absorption-based CT (AB-CT) images of the same samples on a five-point scale. A visual grading characteristics (VGC) study was used to determine the difference in image quality. Results: PB-CT images produced at 28, 30, 32, and 34 keV x-ray energies demonstrated statistically significant higher image quality than reference AB-CT images. The optimum x-ray energy, 30 keV, displayed the largest area under the curve [Formula: see text] of 0.754 ([Formula: see text]). This was followed by 32 keV ([Formula: see text] , [Formula: see text]), 34 keV ([Formula: see text] , [Formula: see text]), and 28 keV ([Formula: see text] , [Formula: see text]). Conclusions: An optimum energy range (around 30 keV) in the PB-CT technique allows for higher image quality at a dose comparable to conventional mammographic techniques. This results in improved radiological image quality compared with conventional techniques, which may ultimately lead to higher diagnostic efficacy and a reduction in breast cancer mortalities.

Whilst some of the diversity in management of women with ductal carcinoma in situ (DCIS) may be explained by tumour characteristics, the role of patient preference and the factors underlying those preferences have been less frequently examined. We have used a descriptive qualitative study to explore treatment decisions for a group of Australian women diagnosed with DCIS through mammographic screening. Semi-structured telephone interviews were performed with 16 women diagnosed with DCIS between January 2012 and December 2018, recruited through the LifePool dataset (a subset of BreastScreen participants who have agreed to participate in research). Content analysis using deductive coding identified three themes: participants did not have a clear understanding of their diagnosis or prognosis; reported involvement in decision making about management varied; specific factors including the psychosexual impact of mastectomy and perceptions of radiotherapy, could act as barriers or facilitators to specific decisions about treatment. The treatment the women received was not simply determined by the characteristics of their disease. Interaction with the managing clinician was pivotal, however many other factors played a part in individual decisions. Recognising that decisions are not purely a function of disease characteristics is important for both women with DCIS and the clinicians who care for them., Highlights • Factors other than the characteristics of the DCIS were involved in decisions about management. • There was a lack of understanding about diagnosis and prognosis. •There was inconsistent involvement by women in decision making about management. • Factors such as perception of mastectomy and radiotherapy could act as barriers or facilitators in decision making.

Summary Background Although metformin is increasingly being used in women with type 2 diabetes during pregnancy, little data exist on the benefits and harms of metformin use on pregnancy outcomes in these women. We aimed to investigate the effects of the addition of metformin to a standard regimen of insulin on neonatal morbidity and mortality in pregnant women with type 2 diabetes. Methods In this prospective, multicentre, international, randomised, parallel, double-masked, placebo-controlled trial, women with type 2 diabetes during pregnancy were randomly assigned from 25 centres in Canada and four in Australia to receive either metformin 1000 mg twice daily or placebo, added to insulin. Randomisation was done via a web-based computerised randomisation service and stratified by centre and pre-pregnancy BMI ( ClinicalTrials.gov , NCT01353391 . Findings Between May 25, 2011, and Oct 11, 2018, we randomly assigned 502 women, 253 (50%) to metformin and 249 (50%) to placebo. Complete data were available for 233 (92%) participants in the metformin group and 240 (96%) in the placebo group for the primary outcome. We found no significant difference in the primary composite neonatal outcome between the two groups (40% vs 40%; p=0·86; relative risk [RR] 1·02 [0·83 to 1·26]). Compared with women in the placebo group, metformin-treated women achieved better glycaemic control (HbA1c at 34 weeks' gestation 41·0 mmol/mol [SD 8·5] vs 43·2 mmol/mol [–10]; 5·90% vs 6·10%; p=0·015; mean glucose 6·05 [0·93] vs 6·27 [0·90]; difference −0·2 [–0·4 to 0·0]), required less insulin (1·1 units per kg per day vs 1·5 units per kg per day; difference −0·4 [95% CI −0·5 to −0·2]; p Interpretation We found several maternal glycaemic and neonatal adiposity benefits in the metformin group. Along with reduced maternal weight gain and insulin dosage and improved glycaemic control, the lower adiposity and infant size measurements resulted in fewer large infants but a higher proportion of small-for-gestational-age infants. Understanding the implications of these effects on infants will be important to properly advise patients who are contemplating the use of metformin during pregnancy. Funding Canadian Institutes of Health Research, Lunenfeld-Tanenbaum Research Institute, University of Toronto.

While there is clear evidence that severe maternal morbidity (SMM) contributes significantly to poor maternal health outcomes, limited data exist on its impact on perinatal outcomes. We undertook a systematic review and meta-analysis to ascertain the association between SMM and adverse perinatal outcomes in high-income countries (HICs). We searched for full-text publications in PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Scopus databases. Studies that reported data on the association of SMM and adverse perinatal outcomes, either as a composite or individual outcome, were included. Two authors independently assessed study eligibility, extracted data, and performed quality assessment using the Newcastle&ndash, Ottawa Scale. We used random-effects modelling to calculate odds ratios (ORs) with 95% confidence intervals. We also assessed the risk of publication bias and statistical heterogeneity using funnel plots and Higgins I2, respectively. We defined sub-groups of SMM as hemorrhagic disorders, hypertensive disorders, cardiovascular disorders, hepatic disorders, renal disorders, and thromboembolic disorders. Adverse perinatal outcome was defined as preterm birth (before 37 weeks gestation), small for gestational age (SGA) (birth weight (BW) &lt, 10th centile for gestation), low birthweight (LBW) (BW &lt, 2.5 kg), Apgar score &lt, 7 at 5 min, neonatal intensive care unit (NICU) admission, stillbirth and perinatal death (stillbirth and neonatal deaths up to 28 days). A total of 35 studies consisting of 38,909,426 women were included in the final analysis. SMMs associated with obstetric hemorrhage (OR 3.42, 95% CI: 2.55&ndash, 4.58), severe hypertensive disorders (OR 6.79, 95% CI: 6.06&ndash, 7.60), hepatic (OR 3.19, 95% CI: 2.46&ndash, 4.13) and thromboembolic disorders (OR 2.40, 95% CI: 1.67&ndash, 3.46) were significantly associated with preterm birth. SMMs from hypertensive disorders (OR 2.86, 95% CI: 2.51&ndash, 3.25) or thromboembolic disorders (OR 1.48, 95% CI: 1.09&ndash, 1.99) were associated with greater odds of having SGA infant. Women with severe hemorrhage had increased odds of LBW infant (OR 2.31, 95% CI: 1.57&ndash, 3.40). SMMs from obstetric hemorrhage (OR 4.16, 95% CI: 2.54&ndash, 6.81) or hypertensive disorders (OR 4.61, 95% CI: 1.17&ndash, 18.20) were associated with an increased odds of low 5-min Apgar score and NICU admission (Severe obstetric hemorrhage: OR 3.34, 95% CI: 2.26&ndash, 4.94 and hypertensive disorders: OR 3.63, 95% CI: 2.63&ndash, 5.02, respectively). Overall, women with SMM were 4 times more likely to experience stillbirth (OR 3.98, 95%C 3.12&ndash, 7.60) compared to those without SMM with cardiovascular disease (OR 15.2, 95% CI: 1.29&ndash, 180.60) and thromboembolic disorders (OR 9.43, 95% CI: 4.38&ndash, 20.29) conferring greatest risk of this complication. The odds of neonatal death were significantly higher in women with SMM (OR 3.98, 95% CI: 2.44&ndash, 6.47), with those experiencing hemorrhagic (OR 7.33, 95% CI: 3.06&ndash, 17.53) and hypertensive complications (OR 3.0, 95% CI: 1.78&ndash, 5.07) at highest risk. Overall, SMM was also associated with higher odds of perinatal death (OR 4.74, 95% CI: 2.47&ndash, 9.12) mainly driven by the increased risk in women experiencing severe obstetric hemorrhage (OR 6.18, 95% CI: 2.55&ndash, 14.96). Our results highlight the importance of mitigating the impact of SMM not only to improve maternal health but also to ameliorate its consequences on perinatal outcomes.

Propagation-based phase-contrast CT (PB-CT) is a novel imaging technique that visualises variations in both X-ray attenuation and refraction. This study aimed to compare the clinical image quality of breast PB-CT using synchrotron radiation with conventional absorption-based CT (AB-CT), at the same radiation dose. Seven breast mastectomy specimens were scanned and evaluated by a group of 14 radiologists and medical imaging experts who assessed the images based on seven radiological image quality criteria. Visual grading characteristics (VGC) were used to analyse the results and the area under the VGC curve was obtained to measure the differences between the two techniques. For six image quality criteria (overall quality, perceptible contrast, lesion sharpness, normal tissue interfaces, calcification visibility and image noise), PB-CT images were superior to AB-CT images of the same dose (AUCVGC: 0.704 to 0.914, P≤.05). For the seventh criteria (artefacts), PB-CT images were also rated better than AB-CT images (AUCVGC: 0.647) but the difference was not significant. The results of this study provide a solid basis for future experimental and clinical protocols of breast PB-CT.

INTRODUCTION The aim of this study was to investigate mammographic density in a sample of Victorian women and explore a possible association between mammographic density and ethnicity. METHODS Categories of mammographic density, using Volpara Density Grade, were reported using two editions of Volpara automated software in a data set of women attending two Victorian sites for mammographic screening. The variables available for analysis were age, self-reported exposure to menopausal hormone therapy (MHT) and ethnicity based on country of birth. RESULTS Data from 16,943 women were available for analysis. Using the VDG 4th edition, 40% of women were classified in the higher two categories (42% for the 5th edition) and 76.9% of women were in the same VDG category using both systems. In the sample, 87.7% of women were in the age range currently invited for screening in Victoria (50-74 years). Of the total group, 82.5% could be classified on the basis of country of birth. In multivariable logistic regression analyses examining factors associated with higher VDG, age (protective), use of MHT (risk factor) and being born in a country with predominantly Asian ancestry (risk factor) were all statistically significant at P

Background In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake. Methods A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter. Results Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR. Conclusions Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi-linguistic population.

Histopathological analysis is the current gold standard in breast cancer diagnosis and management, however, as imaging technology improves, the amount of potential diagnostic information that may be demonstrable radiologically should also increase. We aimed to evaluate the potential clinical usefulness of 3-D phase-contrast micro-computed tomography (micro-CT) imaging at high spatial resolutions as an adjunct to conventional histological microscopy. Ten breast tissue specimens, 2 mm in diameter, were scanned at the SYRMEP beamline of the Elettra Synchrotron using the propagation-based phase-contrast micro-tomography method. We obtained $1.2~\mu \text{m}$ pixel size images, which were analyzed and compared with corresponding histological sections examined under light microscopy. To evaluate the effect of spatial resolution on breast cancer diagnosis, scans with four different pixel sizes were also performed. Our comparative analysis revealed that high-resolution images can enable, at a near-histological level, detailed architectural assessment of tissue that may permit increased breast cancer diagnostic sensitivity and specificity when compared with current imaging practices. The potential clinical applications of this method are also discussed.

Research into dust deposition rates on the wall paintings in the State Apartments at the Palace of Westminster, London, UK, began during the restoration of the encaustic floor tiles. The study has ...

Small-for-gestational-age infants are at a substantially increased risk of perinatal complications, but the risk of recurrent small-for-gestational-age is not well known, particularly because there are many demographic and obstetrical factors that interact and modify this risk. We investigated the relationship between previous small-for-gestational-age births and the risk of recurrence at term in a large Australian cohort.We aimed to identify key demographic and obstetrical variables that influence the risk of recurrence of a small-for-gestational-age infant at term. The primary outcome measure was the odds of recurrence of small-for-gestational-age in subsequent pregnancies up to a maximum of 4 consecutive term births.This was a retrospective analysis of women who had more than 1 consecutive nonanomalous, singleton, term live births between July 1997 and September 2018 at the Mater Mother's Hospital in Brisbane, Australia. Women with multiple pregnancy, preterm birth, or major congenital malformations were excluded. Small-for-gestational-age was defined as birthweight at the10th centile. We calculated the odds of recurrence depending on the number of previous small-for-gestational-age infants and if only the preceding infant was small-for-gestational-age. The study population was dichotomized into small-for-gestational-age and non-small-for-gestational-age for each consecutive pregnancy. Univariate analyses compared baseline demographic and obstetrical characteristics followed by logistic regression modeling to determine the odds of recurrence in the second, third, and fourth pregnancies.The final study comprised 24,819 women. The proportion of women who had a small-for-gestational-age infant in their first pregnancy was 9.4%, whereas the proportion of women who had a small-for-gestational-age infant in their second, third, and fourth pregnancies after the birth of a previous small-for-gestational-age infant were 20.5% (479 of 2338), 24.6% (63 of 256), and 30.4% (14 of 46), respectively. Regardless of parity, the odds of recurrence increased if the preceding infant was small-for-gestational-age. The odds of recurrence increased markedly if there was more than 1 previous small-for-gestational-age infant. In women with 3 previous small-for-gestational-age infants, the adjusted odds of another small-for-gestational-age infant were 66.00 (95% confidence interval, 11.35-383.76). Maternal age, body mass index, ethnicity, and smoking were significant risk factors for recurrent small-for-gestational-age. However, maternal diabetes mellitus or hypertension, either in a previous or current pregnancy, did not influence the risk of recurrence.The risk of recurrence in a subsequent pregnancy increased if there was a previous small-for-gestational-age birth. Women with consecutive small-for-gestational-age infants were at the highest risk of recurrence. Our results highlight that women with a previous small-for-gestational-age infant are at a substantial risk of another small infant and need to be counseled and monitored appropriately.

How can we understand the pivotal value of touch and collaborative processes within two artists’ drawing practice and how do we articulate the generative nature of such practice-based research? Bullen’s drawing explores the relationship between hand, breath and surface, Fox’s, the semi-resisted action of wind between paper and pencil. Both artists have a shared concern with non-representational drawing processes, an expanded notion of ‘material’ and a focus on the experience of reciprocity between the individual practitioner and the world in which they practice. These concerns are discussed in terms of ‘being present’ and ‘making present’, which this article attempts to conceptualise at an interim stage in the research with reference to theory about drawing, anthropology and meditation practice. The understanding of drawing mobilized here is one in which, as Grisewood argues, ‘seeing’ is not a prerequisite. It is a practice of drawing that is about receiving (Berger 2005) and being (Viola 1995). Lyon, Bullen and Fox are developing a collaborative methodology for this research in which their respective embodied, manual practices of drawing and writing are in dialogue.

•A unique look at the challenges of drones-UAV’s by an expert in this field.•Primary research – considers societies acceptance of technology.•And, the fears that society has of drones and of flying.•Lessons from civil aviation – in terms of being prepared are considered for the drone age.•Trust – safety and security and analysed alongside greed and advancements.

PURPOSE Propagation-based phase-contrast computed tomography (PB-CT) is a method for three-dimensional x-ray imaging that utilizes refraction, as well as absorption, of x rays in the tissues to increase the signal-to-noise ratio (SNR) in the resultant images, in comparison with equivalent conventional absorption-only x-ray tomography (CT). Importantly, the higher SNR is achieved without sacrificing spatial resolution or increasing the radiation dose delivered to the imaged tissues. The present work has been carried out in the context of the current development of a breast CT imaging facility at the Australian Synchrotron. METHODS Seven unfixed complete mastectomy samples with and without breast cancer lesions have been imaged using absorption-only CT and PB-CT techniques under controlled experimental conditions. The radiation doses delivered to the mastectomy samples during the scans were comparable to those approved for mammographic screening. Physical characteristics of the reconstructed images, such as spatial resolution and SNR, have been measured and compared with the results of the radiological quality assessment of the complete absorption CT and PB-CT image stacks. RESULTS Despite the presence of some image artefacts, the PB-CT images have outperformed comparable absorption CT images collected at the same radiation dose, in terms of both the measured objective image characteristics and the radiological image scores. The outcomes of these experiments are shown to be consistent with predictions of the theory of PB-CT imaging and previous reported experimental studies of this imaging modality. CONCLUSIONS The results presented in this paper demonstrate that PB-CT holds a high potential for improving on the quality and diagnostic value of images obtained using existing medical x-ray technologies, such as mammography and digital breast tomosynthesis (DBT). If implemented at suitable synchrotron imaging facilities, PB-CT can be used to complement existing imaging modalities, leading to more accurate breast cancer diagnosis.

Although the risk of neonatal mortality is generally low for late preterm and early term infants, they are still significantly predisposed to severe neonatal morbidity (SNM) despite being born at relatively advanced gestations. In this study, we investigated maternal and intrapartum risk factors for early SNM in late preterm and early term infants. This was a retrospective cohort study of non-anomalous, singleton infants (34+0–38+6 gestational weeks) born at the Mater Mother’s Hospital in Brisbane, Australia from January 2015 to May 2020. Early SNM was defined as a composite of any of the following severe neonatal outcome indicators: admission to neonatal intensive care unit (NICU) in conjunction with an Apgar score &lt, 4 at 5 min, severe respiratory distress, severe neonatal acidosis (cord pH &lt, 7.0 or base excess &lt, −12 mmol/L). Multivariable binomial logistic regression analyses using generalized estimating equations (GEE) were used to identify risk factors. Of the total infants born at 34+0–38+6 gestational weeks, 5.7% had at least one component of the composite outcome. For late preterm infants, pre-existing diabetes mellitus, instrumental birth and emergency caesarean birth for non-reassuring fetal status were associated with increased odds for early SNM, whilst for early term infants, pre-existing and gestational diabetes mellitus, antepartum hemorrhage, instrumental, emergency caesarean and elective caesarean birth were significant risk factors. In conclusion, we identified several risk factors contributing to early SNM in late preterm and early term cohort. Our results suggest that predicted probability of early SNM decreased as gestation increased.

Although legal practitioners recognise the terminology ‘open skies’ there is no one accepted definition. The principle aim maybe the same, namely ‘to democratise aviation’ but interpretation and practice translates through into variances and divisions as to how liberal nations are willing to be. This paper explores the concept and development of ‘open-skies’ with the intention of questioning whether this hypothesis is a realistic and an accomplishable objective. This paper commences with a relevant-contextualised, historical exploration of open-skies agreements. The development of the us and eu are analysed before the research discusses the on-going developments in terms of the ‘potential’ of, and ‘difficulties’ in, realising asean-eu and asean-us open skies agreement. The findings show the challenges and successes within the global aviation sector as viewed from this triangulated approach, and the conclusion drawn is that there remains impediments which will be difficult to overcome.

Highlights • IgG4-RM is exceedingly rare with only ten reported cases in the literatreu. • Diagnosis of IgG4-RM is based exclusively on histological analysis. • It is a benign chronic inflammatory process that can be treated sufficiently with excision or steroid. • Extensive whole body imaging is generally not recommended unless the patient is symptomatic., Introduction IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis. Presentation of case This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD. Discussion IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision. Conclusion IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clinical examination and imaging studies. Increasing awareness of this condition among clinicians will assist them in managing patients better. Extensive whole body imaging is not recommended unless symptomatic.

Transport has always been, and will continue to be, a means to serve to eradicate world inequalities bringing relief and salvation across the globe and no transport mode more so perhaps than aviation. However, aviation has served as both the salvation and the aggressor, having also itself been the victim of terrorist attacks. Arguably (to date) in 2016, the world could consider itself fortunate not to have witnessed a devastating cyber-terrorist attack on an aircraft. Certainly concerns were raised after the disappearance of MH370 in terms of cockpit tampering; and yet, these reports only touched upon the surface of an effervescing iceberg – set to erupt into a tsunami of devastation. The question inevitably remains ‘when’ rather than ‘if’ this will occur. This research reviews the vulnerability of air travel and the preparedness of the industry in terms of coordination (prevention and protection) from the perspective of policy, legislation (regulation) and organisation.

This research paper considers the ‘new space race’ – and the desire to extend sovereignty and ownership higher - the sky is no longer the limit.\ud \ud In 2015 the U.S. passed the Federal Space Resource Exploration and Utilization Act, which would permit mining in outer space; however, it remains highly controversial and in essence goes against the United Nations rationale that some areas are beyond the limits of national jurisdiction and cannot be claimed. This paper considers both the Bill and the final Act. Comparison analysis of other Treaties is considered and therefore the validity of State commercialization of assets deemed as being ‘mankind’s heritage’ is questioned. In doing so, the research provides comment on the similarities of lessons learnt from Earth and other UN International Treaties and Conventions, with correlation-reference made to the current situation in the South China Sea. The paper illustrates the U.S.’s reluctance to ratify any treaty, which does not allow the freedom …. of its competitive advantage.