Recruiting for a multicentre DoD and VA longitudinal study: lessons learned.

PRIMARY OBJECTIVE: The primary objective of the study is to identify and delineate effective recruitment practises in a large, multi-site, longitudinal, observational study employing both military service members and Veterans. SETTING: Four Chronic Effects of Neurotrauma Consortium sites. DESIGN: A descriptive study. RESULTS: Overall and cohort-specific recruitment increased with the addition of focused recruitment strategies and a military/Veteran-centric recruitment director. CONCLUSION: Use of site-specific strategies aligned with local Institutional Review Board procedures and emphasizing awareness of service member organizational allegiances was the key to effective recruiting. Adding a recruitment director with background similar to study participants coincided with significantly improved overall participant numbers and specific subpopulations of research subjects, thus adding to the value of the study.

Contrast-enhanced Digital Mammography: A Single-Institution Experience of the First 208 Cases.

Contrast-enhanced digital mammography (CEDM) is the only imaging modality that provides both (a) a high-resolution, low-energy image comparable to that of digital mammography and (b) a contrast-enhanced image similar to that of magnetic resonance imaging. We report the initial 208 CEDM examinations performed for various clinical indications and provide illustrative case examples. Given its success in recent studies and our experience of CEDM primarily as a diagnostic adjunct, CEDM can potentially improve breast cancer detection by combining the low-cost conclusions of screening mammography with the high sensitivity of magnetic resonance imaging.

The influence of medical and behavioral evidence on conviction rates in cases of child sexual abuse.

Child sexual abuse cases have one of the lowest conviction rates across all charges. While research has investigated the impact of attitudes and beliefs in judicial decision makers, little is known about the influence of medical evidence. The aim of this study was to examine how the presence or absence of evidence impacts on conviction. A sample of 113 child sexual abuse cases from Australia were coded for the types of evidence that were presented as well as other relevant descriptive data. The most significant predictor of verdict was the behavior of the child rather than the presence of medical evidence. This finding suggests that greater attention might be given to the collection and reporting of this evidence in future trials.

The positive impact of conservation action.

Governments recently adopted new global targets to halt and reverse the loss of biodiversity. It is therefore crucial to understand the outcomes of conservation actions. We conducted a global meta-analysis of 186 studies (including 665 trials) that measured biodiversity over time and compared outcomes under conservation action with a suitable counterfactual of no action. We find that in two-thirds of cases, conservation either improved the state of biodiversity or at least slowed declines. Specifically, we find that interventions targeted at species and ecosystems, such as invasive species control, habitat loss reduction and restoration, protected areas, and sustainable management, are highly effective and have large effect sizes. This provides the strongest evidence to date that conservation actions are successful but require transformational scaling up to meet global targets.

A screening-level human health risk assessment for microplastics and organic contaminants in near-shore marine environments in American Samoa.

Solid waste disposal is a growing concern among Pacific Island nations. With severe limitations in land area, in combination with the lack of reuse or recycling options, many near-shore marine ecosystems across Oceania are highly impacted by locally derived marine debris, including plastics, microplastics and associated chemical contaminants. In order to catalyze improved solid waste management and plastic use policies, the potential ecological and public health risks must be clearly identified and communicated. Using an ecological risk assessment framework, potential risks to marine ecosystems and human health are explored by quantifying microplastics and organic contaminants in 4 study sites located in Tutuila, American Samoa. Results of sampled near-shore marine waters, marine sediments and molluscs indicate that microplastics are unevenly distributed in the marine environment, with the highest concentrations detected in marine molluscs (e.g. average of 15 and 17 particles per organism, the majority of which were microfibers identified as polyethylene terephthalate). These invertebrates also have the highest environmental concentrations of organic contaminants, including phthalates, pesticides and PCBs. However, based on estimated rates of invertebrate consumption, the risk of adverse impacts to human health are likely to be low. Regardless, future studies are recommended to better understand the environmental partitioning of microplastics in dynamic near-shore marine environments, as well as the specific pathways and consequences of the physical and chemical impacts of microplastics on marine species populations and overall marine ecosystem health.

Breast Cancer Screening During Lactation: Ensuring Optimal Surveillance for Breastfeeding Women.

Breast cancer is the most common malignancy among reproductive-aged women, and an increasing number of women are breastfeeding at the time of screening initiation. The literature was reviewed to identify evidence-based guidelines for breast cancer screening during lactation. Health care providers should consider routine age-related or high-risk screening; they should also discuss alternate surveillance strategies, including deferment until cessation of breastfeeding. Shared decision-making and individualized patient care should involve consideration of the limitations of current evidence. Lactation-related radiographic changes may make examination interpretation more challenging; preprocedure milk expression and use of particular supplemental imaging modalities can improve examination sensitivity. Despite these strategies, breastfeeding women may have higher rates of false-positive findings and therefore undergo more biopsies. However, given the increased risk of biologically aggressive breast cancers in postpartum women, these risks may be outweighed by the benefits of routine breast cancer screening for breastfeeding women.

Rare case of male breast intraductal papilloma progressing to invasive ductal carcinoma: A radiologic-pathologic correlation.

Although male breast cancer represents only 0.5%-1% of all breast cancer cases in the United States, the incidence of this disease is slowly rising [1]. Because of its extremely low prevalence, screening and treatment guidelines are not well established. Thus, analyzing cases of male breast cancer can accelerate this process. We present a case of a 52-year-old man, initially diagnosed with biopsy-confirmed intraductal papilloma without atypia, who presented 3 years later with progression of this benign lesion to ductal carcinoma in situ and development of de novo invasive ductal carcinoma. This report stresses the importance of symptom detection and risk factor modification with the goal of decreasing the incidence of this disease.