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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.]

Background It is well known that swallowing problems are a common symptom in palliative care patients (Bogaardt et al., 2015). The emotional, physiological and psychological impact of swallowing problems cannot be underestimated on the patient, their families and carers. Aims To reduce the impact of swallowing difficulties by ensuring patients can eat and drink safely, efficiently and nutritiously. To develop and roll out a training programme for healthcare professionals involved in the preparation, formation and delivery of modified diets/fluids. Method A collaborative working party including Speech and Language Therapy(SLT), Dietetics, Catering and Housekeeping was set up to review and improve the modified diets and fluids that are offered to our patients with swallowing difficulties. The review included patient and staff feedback and focused on consistency, appearance, taste and texture. As a multi-disciplinary team, each discipline provided a different knowledge base: SLT focusing on swallowing safety, Dietician focusing on nutritional content, Catering with the preparation and cooking of the food and Housekeeping with food presentation. Results A new puree menu has been developed with standardised texture and consistency with the use of puree moulds to improve appearance. A daily smoothie round is now offered to our inpatients and day hospice. A formal evaluation is in progress. Initial feedback from patients and staff has been positive. ‘It looked like chicken and even tasted like chicken. This is the first puree meal I have actually enjoyed!’ A training programme on modified diets was developed and is being delivered on a rolling basis. Conclusions We believe by evaluating and improving our modified diets and fluids that are offered to patients with swallowing difficulties, these patients can continue to eat and drink safely and nutritiously through the development of an innovative new modified diet menu thus reducing the distress that can be caused by the impact of these difficulties.

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.

The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.

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.

Two experiments examined whether impairments in recognition memory in early stage Alzheimer's disease (AD) were due to deficits in encoding contextual information. Normal elderly (NE) and patients diagnosed with mild stage AD learned one of two tasks. In Experiment 1 correct recognition memory required participants to remember not only what items they had experienced on a given trial but also when they had experienced them; Experiment 2 required that participants remember only what they had seen, not when they had seen it. Large recognition memory differences were found between the AD and NE groups in the experiment where time tagging was crucial for successful performance. An error analysis indicated that this was not due to the perseveration of previous learned responses. In Experiment 2, the only requisite for successful recognition was remembering what one had experienced; memory of the temporal record was not necessary for successful performance. In this instance, recognition memory for the NE and AD...

The Mattis Dementia Rating Scale (DRS), a widely used dementia screening instrument, generates five subscale scores in the areas of Attention (ATT), Initiation-Perseveration (IP), Construction (CN), Conceptualization (CON), and Memory (MEM). The present study sought to determine the criterion validity of the DRS subscales in a sample of 50 patients with Alzheimer's disease (25 with mild and 25 with moderate dementia). Subject performance on the five DRS subscales was correlated with performance on five well-validated neuropsychological criterion measures using Pearson r and stepwise regression. On a univariate level, each DRS subscale correlated most strongly with its assigned neuropsychological criterion measure. On a multivariate level, each DRS subscale emerged as the Step 1 predictor of its assigned criterion measure, with the exception of DRS CN, which was the Step 2 predictor. The results suggested that overall the DRS subscales are valid measures of their respective constructs and have value for both clinical and research purposes in mild and moderate dementia.

In this work, we report the use of ultrasound RF time series analysis for separating benign and malignant breast lesions with similar B-mode appearance. The RF time series method is versatile and requires only a few seconds of imaging. We have employed the spectral and fractal features of ultrasound RF time series and used support vector machines with leave-one-patient-out cross validation of the classification. We have also produced cancer probability maps, by estimating the posterior malignancy probability of regions of size 1 mm2 in the suspicious lesions. The first 12 patient cases of our ongoing study are reported here. Pathologic analysis of the cores using ultrasound guided needle biopsy confirmed the tissue type. We report an area under receiver operating characteristic curve of 0.82. We were able to successfully classify 6 out of 7 patients with malignant breast lesions and 4 out of 5 patients with benign lesions, with success defined as correct classification of at least 75% of the 1 mm2 regions in the area of the lesion. The above findings suggest that ultrasound time series along with support vector machines can help in differentiating malignant from benign breast lesions.

Vibroelastography is a technique to measure tissue elasticity using a multi-frequency shear wave approach. The method uses ultrasound to image dynamic deformation of soft tissue while an actuator applies surface vibrations. In this paper we evaluate vibroelastography for the first time in differentiating between malignant and benign breast lesions. A dataset of 20 lesions, including fibroadenoma and invasive ductal carcinoma (IDC) lesions was analysed. Ultrasound radio-frequency data were captured while the breast tissue was vibrated with a snap-on actuator at multiple frequencies at an amplitude of less than 100 microns. After the VE exam, the subjects underwent core-needle biopsy. The pathology report was used as the ground truth to validate the VE result. The VE results indicate that both benign fibroadenoma and IDC result in hardening of the tissue; however, IDC lesions exhibits higher values of elasticity compared to benign masses which can be captured using absolute and relative elasticity maps provided by VE.

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.

The issue of whether to screen women aged 40-49 for breast cancer is debated usually in terms of the potential mortality reduction achievable by the application of screening in this age group. Theories regarding why a significant reduction in mortality has not been observed in trials relate to the biologic behavior of tumors in this age group and the screening process itself. Survival curves with respect to node status, size, and grade of the tumor were compared among age groups in the Swedish two-county trial

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.

Emergency response planning is required for water and wastewater utilities to prepare for any type of emergency, whether human-caused or natural disasters. This article contains background information on why utilities need an emergency response plan (ERP), and summarizes legislative directives that relate to utility emergency planning. Utility resiliency can be best achieved when an ERP is part of an overarching preparedness program that includes business continuity planning, training and exercises, and plans updates to keep the program current. In this article, the phases of emergency management are explained, along with the National Incident Management System (NIMS) and the Incident Command System, both required for use by utilities because utility staff are considered “first responders” under the Homeland Security Presidential Directive 5. Development of an ERP is discussed, and an example table of contents for a NIMS compliant ERP is included. Sections of an ERP are described and include communications, suggestions for use with staff, external agencies, the public, and critical customers. Keywords: emergency response planning; business continuity; personnel safety; emergency operations; water supply; wastewater; incident command system

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.

Cognitive interventions are increasingly used and accepted as components of rehabilitation programs after head trauma. A number of recent reviews assess the general effectiveness of cognitive retraining in general (Butler & Namerow, 1988; Gouvier, Webster, & Blanton, 1986; Rimmele & Hester, 1987). Others have reviewed the effectiveness of particular cognitive rehabilitation programs (Ben-Yishay, Rattok, Lakin, Piasetsky, Ross, Silver, Zide, & Ezrachi, 1985; Prigatano, 1987; Williams, 1987) and of retraining in specific cognitive domains, such as attention (Sohlberg & Mateer, 1987; Wood, 1986) and memory (Glisky & Schacter, 1986). Despite varying perspectives among practitioners, a general consensus appears to be evolving regarding effective intervention strategies, and this consensus is reflected in current cognitive rehabilitation texts (Adamovich, Henderson, & Auerbach, 1985; Najenson, Rahmani, Elazar, & Auerbach, 1984; Sohlberg & Mateer, 1989; Szekeres, Ylvisaker, & Holland, 1985; Trexler, 1982).

The core of a sustainable social and economic development of any nation is education. A key issue in Aotearoa New Zealand is the development of education for Maori. Historically, there have been significant problems for Maori to achieve education goals. Current education policies seek to foster and develop education for Maori as a means of creating an education for a sustainable future. The purpose of this exploratory study is to investigate the effectiveness of such policies.

Annie Smith is a 72-year-old widowed woman who responded to an advertisement for volunteers interested in learning skills to improve their memory functions. Although she continues to live an active and independent life, managing all of her own household and financial affairs and volunteering two days per week at a local hospital, she reports a number of memory problems that are sources of embarrassment and inconvenience in her daily life. Most of these problems are focused around several situations that are important to her. First, at church, she finds herself having difficulty remembering the names of some of the other members of her congregation. When in a crowd of people, she often has trouble remembering what people have told her; she may lose her train of thought or have trouble finding the right words. On several occasions, she has forgotten to put her money into her purse before going to church, and has been embarrassed at being unable to give her offering. Mrs. Smith has played bridge with a small group of women on a weekly basis over the past 12 years. Lately, she notes that she forgets the cards which have been played, and has occasionally even forgotten the bid. While she used to take pride in her ability to do her grocery shopping completely from memory, lately she has relied on making hurried lists on scraps of paper, which she frequently cannot find in her purse. She also misplaces important objects, such as her eyeglasses or purse, while at home. Sometimes she spends hours looking for lost bills or objects. She is also distressed that she is unable to remember friends’ telephone numbers, and relies on her address book for all of this information.