Implementing post-normal science with or for EU policy actors: using quantitative story-telling.

There is increasing recognition of the wicked nature of the intertwined climate, biodiversity and economic crises, and the need for adaptive, multi-scale approaches to understanding the complexity of both the problems and potential responses. Most science underpinning policy responses to sustainability issues, however, remains overtly apolitical and focussed on technical innovation; at odds with a critical body of literatures insisting on the recognition of systemic problem framing when supporting policy processes. This paper documents the experience of implementing a mixed method approach called quantitative story-telling (QST) to policy analysis that explicitly recognises this normative dimension, as the methodology is part of a post-normal science (PNS) toolkit. The authors reflect on what was learnt when considering how QST fared as a tool for science-policy interaction, working with European Union (EU) level policy actors interested in sustainable agriculture and sustainable development goal 2. These goals-also known as UN Agenda 2030-are the latest institutionalisation of the pursuit of sustainable development and the EU has positioned itself as taking a lead in its implementation. Thus, the paper illustrates our experience of using PNS as an approach to science policy interfaces in a strategic policy context; and illustrates how the challenges identified in the science-policy literature are amplified when working across multiple policy domains and taking a complex systems approach. Our discussion on lessons learnt may be of interest to researchers seeking to work with policy-makers on complex sustainability issues.

Surgical outcomes after radioactive 125I seed versus hookwire localization of non-palpable breast cancer: a multicentre randomized clinical trial.

BACKGROUND: Previous studies have suggested improved efficiency and patient outcomes with 125I seed compared with hookwire localization (HWL) in breast-conserving surgery, but high-level evidence of superior surgical outcomes is lacking. The aim of this multicentre pragmatic RCT was to compare re-excision and positive margin rates after localization using 125I seed or hookwire in women with non-palpable breast cancer. METHODS: Between September 2013 and March 2018, women with non-palpable breast cancer eligible for breast-conserving surgery were assigned randomly to preoperative localization using 125I seeds or hookwires. Randomization was stratified by lesion type (pure ductal carcinoma in situ (DCIS) or other) and study site. Primary endpoints were rates of re-excision and margin positivity. Secondary endpoints were resection volumes and weights. RESULTS: A total of 690 women were randomized at eight sites; 659 women remained after withdrawal (125I seed, 327; HWL, 332). Mean age was 60.3 years in the 125I seed group and 60.7 years in the HWL group, with no difference between the groups in preoperative lesion size (mean 13.2 mm). Lesions were pure DCIS in 25.9 per cent. The most common radiological lesion types were masses (46.9 per cent) and calcifications (28.2 per cent). The localization modality was ultrasonography in 65.5 per cent and mammography in 33.7 per cent. The re-excision rate after 125I seed localization was significantly lower than for HWL (13.9 versus 18.9 per cent respectively; P = 0.019). There were no significant differences in positive margin rates, or in specimen weights and volumes. CONCLUSION: Re-excision rates after breast-conserving surgery were significantly lower after 125I seed localization compared with HWL. Registration number: ACTRN12613000655741 (http://www.ANZCTR.org.au/).

MRI screening-detected breast lesions in high-risk young women: the value of targeted second-look ultrasound and imaging-guided biopsy.

AIM: To analyse the value of targeted second-look ultrasound and imaging-guided biopsy in high-risk young women eligible for screening magnetic resonance imaging (MRI) in a tertiary referral centre in Perth, Western Australia. MATERIALS AND METHODS: A retrospective analysis of eligible high-risk young women who underwent screening breast MRI and targeted second-look ultrasound between June 2012 and June 2014 was performed with review of data. RESULTS: Over a 2-year period, 139 women underwent high-risk screening MRI. Of these, 30 women (with a total of 45 lesions) were recalled for targeted second-look ultrasound. Thirty-four MRI-detected lesions were identified on targeted ultrasound with 19 of them proceeding to ultrasound-guided biopsy, while the remaining 15 lesions were considered benign on ultrasound, were not biopsied, and were stable on follow-up imaging 12 months later. One lesion proceeded to an MRI-guided biopsy to confirm a benign result. Of the 11 lesions not seen on ultrasound, nine underwent MRI biopsy, one proceeded directly to hook wire localisation and excision, and one did not return for biopsy and was lost to follow-up. The overall biopsy rate was 14.4%. The cancer detection rate was 1.4%. CONCLUSION: The results of this study indicate that targeted second-look ultrasound and ultrasound-guided biopsy is a cost-effective and time-efficient approach for MRI-detected lesions in young women at high risk of developing breast cancer. MRI-guided biopsy should be considered for ultrasonographically occult suspicious lesions as there is a low, but definite, risk of cancer.

Model development to study strategies of younger and older adults getting up from the floor.

BACKGROUND: Long lies after a fall remain a public health challenge. Many successful fall prevention programmes have been developed but only few of them include recovery strategies after a fall. Once better understood, such movement strategies could be implemented into training interventions. AIMS: A model of motion sequences describing successful movement strategies for rising from the floor in different age groups was developed. Possible risk factors for poor rising performance such as flexibility and muscle power were evaluated. METHODS: Fourteen younger subjects between 20 and 50 years of age and 10 healthy older subjects (60+ years) were included. Movement strategies and key components of different rising sequences were determined from video analyses. The temporal parameters of transfers and number of components within the motion sequences were calculated. Possible explanatory variables for differences in rising performance were assessed (leg extension power, flexibility of the knee- and hip joints). RESULTS: Seven different components were identified for the lie-to-stand-walk transfer, labelled as lying, initiation, positioning, supporting, elevation, or stabilisation component followed by standing and/or walking. Median time to rise was significantly longer in older subjects (older 5.7s vs. younger 3.7s; p < 0.001), and leg extension power (left p = 0.002, right p = 0.013) and knee flexibility (left p = 0.019, right p = 0.025) were significantly lower. The number of components for rising was correlated with hip flexibility (r = 0.514) and maximal power (r = 0.582). The time to rise was correlated with minimal goniometric knee angle of the less flexible leg (r = 0.527) and maximal leg extension power (r = 0.725). CONCLUSIONS: A motion sequence model containing seven different components identified by individual key-frames could be established. Age-related differences in rising strategies and performance were identified.

Sex investment ratios in eusocial Hymenoptera support inclusive fitness theory.

Inclusive fitness theory predicts that sex investment ratios in eusocial Hymenoptera are a function of the relatedness asymmetry (relative relatedness to females and males) of the individuals controlling sex allocation. In monogynous ants (with one queen per colony), assuming worker control, the theory therefore predicts female-biased sex investment ratios, as found in natural populations. Recently, E.O. Wilson and M.A. Nowak criticized this explanation and presented an alternative hypothesis. The Wilson-Nowak sex ratio hypothesis proposes that, in monogynous ants, there is selection for a 1 : 1 numerical sex ratio to avoid males remaining unmated, which, given queens exceed males in size, results in a female-biased sex investment ratio. The hypothesis also asserts that, contrary to inclusive fitness theory, queens not workers control sex allocation and queen-worker conflict over sex allocation is absent. Here, I argue that the Wilson-Nowak sex ratio hypothesis is flawed because it contradicts Fisher's sex ratio theory, which shows that selection on sex ratio does not maximize the number of mated offspring and that the sex ratio proposed by the hypothesis is not an equilibrium for the queen. In addition, the hypothesis is not supported by empirical evidence, as it fails to explain 'split' (bimodal) sex ratios or data showing queen and worker control and ongoing queen-worker conflict. By contrast, these phenomena match predictions of inclusive fitness theory. Hence, the Wilson-Nowak sex ratio hypothesis fails both as an alternative hypothesis for sex investment ratios in eusocial Hymenoptera and as a critique of inclusive fitness theory.

Handling of radioactive seed localisation breast specimens in the histopathology laboratory: the Western Australian experience.

Radio-guided occult lesion localisation using iodine-125 seeds (ROLLIS) is a novel method of localisation for impalpable in situ and invasive carcinomas that has been the subject of a recent pilot study and pilot study extension in Western Australia. Robust protocols for radiation safety, specimen labelling, specimen tracking, seed retrieval and seed disposal were developed at two Western Australian laboratories to minimise the risk of seed loss. The processes are safe and effective with no significant radiation exposure to pathologists and with acquisition of all seeds intact and undamaged. The success can be attributed to developing specific seed retrieval techniques, suited to local preferences at each institution, with input from surgeons, radiologists and medical physics personnel. These techniques are now routine and will continue in the randomised control phase of the ROLLIS study.

Temporal and kinematic variables for real-world falls harvested from lumbar sensors in the elderly population.

Automatic fall detection will reduce the consequences of falls in the elderly and promote independent living, ensuring people can confidently live safely at home. Inertial sensor technology can distinguish falls from normal activities. However, <;7% of studies have used fall data recorded from elderly people in real life. The FARSEEING project has compiled a database of real life falls from elderly people, to gain new knowledge about fall events. We have extracted temporal and kinematic parameters to further improve the development of fall detection algorithms. A total of 100 real-world falls were analysed. Subjects with a known fall history were recruited, inertial sensors were attached to L5 and a fall report, following a fall, was used to extract the fall signal. This data-set was examined, and variables were extracted that include upper and lower impact peak values, posture angle change during the fall and time of occurrence. These extracted parameters, can be used to inform the design of fall-detection algorithms for real-world falls detection in the elderly.

Evaluation of accelerometer based multi-sensor versus single-sensor activity recognition systems.

Physical activity has a positive impact on people's well-being and it had been shown to decrease the occurrence of chronic diseases in the older adult population. To date, a substantial amount of research studies exist, which focus on activity recognition using inertial sensors. Many of these studies adopt a single sensor approach and focus on proposing novel features combined with complex classifiers to improve the overall recognition accuracy. In addition, the implementation of the advanced feature extraction algorithms and the complex classifiers exceed the computing ability of most current wearable sensor platforms. This paper proposes a method to adopt multiple sensors on distributed body locations to overcome this problem. The objective of the proposed system is to achieve higher recognition accuracy with "light-weight" signal processing algorithms, which run on a distributed computing based sensor system comprised of computationally efficient nodes. For analysing and evaluating the multi-sensor system, eight subjects were recruited to perform eight normal scripted activities in different life scenarios, each repeated three times. Thus a total of 192 activities were recorded resulting in 864 separate annotated activity states. The methods for designing such a multi-sensor system required consideration of the following: signal pre-processing algorithms, sampling rate, feature selection and classifier selection. Each has been investigated and the most appropriate approach is selected to achieve a trade-off between recognition accuracy and computing execution time. A comparison of six different systems, which employ single or multiple sensors, is presented. The experimental results illustrate that the proposed multi-sensor system can achieve an overall recognition accuracy of 96.4% by adopting the mean and variance features, using the Decision Tree classifier. The results demonstrate that elaborate classifiers and feature sets are not required to achieve high recognition accuracies on a multi-sensor system.

Suitability of commercial barometric pressure sensors to distinguish sitting and standing activities for wearable monitoring.

Despite its medical relevance, accurate recognition of sedentary (sitting and lying) and dynamic activities (e.g. standing and walking) remains challenging using a single wearable device. Currently, trunk-worn wearable systems can differentiate sitting from standing with moderate success, as activity classifiers often rely on inertial signals at the transition period (e.g. from sitting to standing) which contains limited information. Discriminating sitting from standing thus requires additional sources of information such as elevation change. The aim of this study is to demonstrate the suitability of barometric pressure, providing an absolute estimate of elevation, for evaluating sitting and standing periods during daily activities. Three sensors were evaluated in both calm laboratory conditions and a pilot study involving seven healthy subjects performing 322 sitting and standing transitions, both indoor and outdoor, in real-world conditions. The MS5611-BA01 barometric pressure sensor (Measurement Specialties, USA) demonstrated superior performance to counterparts. It discriminates actual sitting and standing transitions from stationary postures with 99.5% accuracy and is also capable to completely dissociate Sit-to-Stand from Stand-to-Sit transitions.

Fall detection with body-worn sensors : a systematic review.

BACKGROUND AND AIMS: Falls among older people remain a major public health challenge. Body-worn sensors are needed to improve the understanding of the underlying mechanisms and kinematics of falls. The aim of this systematic review is to assemble, extract and critically discuss the information available in published studies, as well as the characteristics of these investigations (fall documentation and technical characteristics). METHODS: The searching of publically accessible electronic literature databases for articles on fall detection with body-worn sensors identified a collection of 96 records (33 journal articles, 60 conference proceedings and 3 project reports) published between 1998 and 2012. These publications were analysed by two independent expert reviewers. Information was extracted into a custom-built data form and processed using SPSS (SPSS Inc., Chicago, IL, USA). RESULTS: The main findings were the lack of agreement between the methodology and documentation protocols (study, fall reporting and technical characteristics) used in the studies, as well as a substantial lack of real-world fall recordings. A methodological pitfall identified in most articles was the lack of an established fall definition. The types of sensors and their technical specifications varied considerably between studies. CONCLUSION: Limited methodological agreement between sensor-based fall detection studies using body-worn sensors was identified. Published evidence-based support for commercially available fall detection devices is still lacking. A worldwide research group consensus is needed to address fundamental issues such as incident verification, the establishment of guidelines for fall reporting and the development of a common fall definition.

Experiences of crisis pregnancy among Irish and non-Irish adults living in Ireland: findings from the Irish Contraception and Crisis Pregnancy Survey 2010 (ICCP-2010).

BACKGROUND: Using nationally representative data, this paper investigates the experience of crisis pregnancy (CP) among Irish and non-Irish adults living in Ireland in 2010. AIMS: To generate a detailed profile of Irish and non-Irish adults living in Ireland who have had an experience of CP and to investigate the differences in the experiences of CP between Irish and non-Irish adults. METHOD: A national cross-sectional telephone survey methodology recruited 3,002 adult (18-45 years) participants (69 % response). Descriptive statistics and Chi-square analysis were used to compare the differences between the Irish (n = 334) and non-Irish sample (n = 57) with an experience of CP. RESULTS: The majority of respondents with an experience of CP had a higher education level and were aged between 18 and 25 years. Significant differences, in terms of outcome of CP, were also found between groups; with more Irish respondents choosing parenthood over abortion, compared with their non-Irish counterparts. CONCLUSION: This paper presents a unique profile of Irish and non-Irish adults living in Ireland with an experience of CP. Enhanced promotion of longer-acting contraceptives to all younger adults, and targeted awareness raising of post-abortion services among the non-Irish community, is recommended.

Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors.

Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.

Squamous metaplasia of lactiferous ducts (SMOLD).

The aim of this review is to illustrate the mammographic and sonographic appearances of squamous metaplasia of the lactiferous ducts (SMOLD) and to discuss the disease processes of this uncommon breast disease, which shows a strong correlation with smoking. The most common mammographic appearance is of a retro-areolar asymmetrical density. Ultrasonography of the symptomatic breast typically shows a retro-areolar, predominately medial, ill-defined, hypoechoic lesion with either abscess or sinus/fistula formation. Duct dilatation and continuity with lactiferous ducts is commonly seen. Increased vascularity is occasionally seen on colour Doppler ultrasound. Pathology tissue confirmation is always required and this can be by histology of a core biopsy or excision specimen, or fine-needle aspiration (FNA) cytology. Occasionally smears of an associated abundant nipple or sinus discharge may be of value.

Periconceptional folic acid supplementation in a nationally representative sample of mothers.

This study reports recent trends in periconceptional folic acid use in Ireland using archived data from Growing Up in Ireland--the National Longitudinal Study of Children. Of a sample of 10,891 mothers, 6,936 (64%) reported taking folic acid before conception and 10,157 (93%) reported taking folic acid during the first trimester of pregnancy. Younger (OR = 0.38, 95% CI = 0.29-0.50), lower income (OR = 0.59, 95% CI = 0.51-0.68), lower educated (OR = 0.77, 95% CI = 0.66-0.89), and single mothers (OR = 0.46, 95% Cl = 0.40-0.52) were less likely to have taken folic acid pre-conception. A similar pattern was found post-conception with younger (OR = 0.58, 95% Cl = 0.40-0.84), lower income (OR = 0.40, 95% Cl = 0.30-0.53), lower educated (OR = 0.50, 95% Cl = 0.38-0.66), and single mothers (OR = 0.74, 95% CI = 0.60-0.91) less likely to have taken folic acid post-conception. The findings highlight an ongoing need for targeted promotional campaigns to increase supplementation rates among younger and socially disadvantaged mothers.

Bumble bee species' responses to a targeted conservation measure depend on landscape context and habitat quality.

The global decline of insect pollinators, especially bees, is cause for concern, and there is an urgent need for cost-effective conservation measures in agricultural landscapes. While landscape context and habitat quality are known to influence species richness and abundance of bees, there is a lack of evidence from manipulative field experiments on bees' responses to adaptive management across differently structured landscapes. We present the results of a large-scale study that investigated the effects of a targeted agri-environment scheme (AES) on bumble bees (Bombus spp.) over three years in the United Kingdom. Forage patches of different sizes were sown with a conservation flower mixture across eight sites covering a broad range of agricultural land use types. Species richness and worker densities (especially of the longer-tongued Bombus species for which the mixture was targeted) were significantly higher on sown forage patches than on existing non-crop control habitats throughout the three-year study, but the strength of this response depended on both the proportions of arable land and abundance of herbaceous forb species in the surrounding landscape. The size of sown patches also affected worker density, with smaller patches (0.25 ha) attracting higher densities of some species than larger patches (1.0 ha). Our models show that a targeted AES can deliver greater net benefits in more intensively farmed areas, in terms of the number and species richness of bumble bees supported, than in heterogeneous landscapes where other foraging habitats exist. These findings serve to strengthen the evidence base for extending agri-environment schemes to boost declining pollinator populations to a larger number of agricultural landscapes across the globe.

Activity classification using a single chest mounted tri-axial accelerometer.

Accelerometer-based activity monitoring sensors have become the most suitable means for objective assessment of mobility trends within patient study groups. The use of minimal, low power, IC (integrated circuit) components within these sensors enable continuous (long-term) monitoring which provides more accurate mobility trends (over days or weeks), reduced cost, longer battery life, reduced size and weight of sensor. Using scripted activities of daily living (ADL) such as sitting, standing, walking, and numerous postural transitions performed under supervised conditions by young and elderly subjects, the ability to discriminate these ADL were investigated using a single tri-axial accelerometer, mounted on the trunk. Data analysis was performed using Matlab® to determine the accelerations performed during eight different ADL. Transitions and transition types were detected using the scalar (dot) product technique and vertical velocity estimates on a single tri-axial accelerometer was compared to a proven discrete wavelet transform method that incorporated accelerometers and gyroscopes. Activities and postural transitions were accurately detected by this simplified low-power kinematic sensor and activity detection algorithm with a sensitivity and specificity of 86-92% for young healthy subjects in a controlled setting and 83-89% for elderly healthy subjects in a home environment.

Evaluation of waist-mounted tri-axial accelerometer based fall-detection algorithms during scripted and continuous unscripted activities.

It is estimated that by 2050 more than one in five people will be aged 65 or over. In this age group, falls are one of the most serious life-threatening events that can occur. Their automatic detection would help reduce the time of arrival of medical attention, thus reducing the mortality rate and in turn promoting independent living. This study evaluated a variety of existing and novel fall-detection algorithms for a waist-mounted accelerometer based system. In total, 21 algorithms of varying degrees of complexity were tested against a comprehensive data-set recorded from 10 young healthy volunteers performing 240 falls and 120 activities of daily living (ADL) and 10 elderly healthy volunteers performing 240 scripted ADL and 52.4 waking hours of continuous unscripted normal ADL. Results show that using an algorithm that employs thresholds in velocity, impact and posture (velocity+impact+posture) achieves 100% specificity and sensitivity with a false-positive rate of less than 1 false-positive (0.6 false-positives) per day of waking hours. This algorithm is the most suitable method of fall-detection, when tested using continuous unscripted activities performed by elderly healthy volunteers, which is the target environment for a fall-detection device.

Pseudoangiomatous stromal hyperplasia: a study of the mammographic and sonographic features.

AIM: To review the imaging features on mammogram and ultrasound of pseudoangiomatous stromal hyperplasia (PASH) of the breast. MATERIALS AND METHODS: A systematic search of the breast cancer screening centre and pathology department database at a teaching hospital was performed to identify cases reported as PASH between 2000 and 2007. The findings on mammogram and ultrasound were reviewed. Information on demographics and clinical outcome were obtained from the patient's medical records. RESULTS: Seventy-three cases of PASH were identified, which occurred in women with a mean age of 51.1 +/- 10.5 years. The mean size of the lesion was 18 mm. Up to 70.8% of cases were radiologically detected and 29.2% presented as palpable masses. The most common appearance on mammography was of a solitary, non-calcified mass (30.4%) or localized increased stroma (30.4%). The distribution of mammographic findings differed in screen-detected patients compared with those presenting clinically (p = 0.015, Fisher's exact test). The most frequent sonographic appearance was of a well-defined hypoechoic mass (36.7%). CONCLUSION: Although there are emerging patterns associated with PASH on imaging, the features are not sufficiently specific to allow for a prospective diagnosis. Histological confirmation, preferably with core biopsy, should always be considered.

The kin structure of sexual interactions.

The origin of sexual reproduction involved the evolution of zygotes from separate genomes and, like other social processes, should therefore be amenable to analysis using kin selection theory. I consider how kin structure affects sexual interactions in three contexts--the evolution of sexual reproduction, sex allocation and sexual conflict. Kin structure helps explain the even-handed replication of paternal and maternal genes under outbreeding. Under inbreeding, it predicts altruistic failure to replicate by one half of the diploid genome. Kin structure predicts optimal sex ratios and potential conflicts over sex ratio within social groups and individuals. Sexual conflict predictably occurs as a function of (i) the probability that current sexual partners will reproduce together in future and (ii) between-partner relatedness. I conclude that systematically analysing the kin structure of sexual interactions helps illuminate their evolution.