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.

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.

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.

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.

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.

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.

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.

Lifetime reproductive success and longevity of queens in an annual social insect.

Although central to understanding life-history evolution, the relationship between lifetime reproductive success and longevity remains uncertain in many organisms. In social insects, no studies have reported estimates of queens' lifetime reproductive success and longevity within populations, despite the importance of understanding how sociality and associated within-group conflict affect life-history traits. To address this issue, we studied two samples of colonies of the annual bumblebee, Bombus terrestris audax, reared from wild-caught queens from a single population. In both samples, queens' lifetime reproductive success, measured as either queens' inclusive fitness or as total biomass of queen-produced sexuals (new queens and males), was significantly positively associated with queen longevity, measured from the day the first worker was produced. We suggest that a positive relationship between reproductive success and longevity was inherited from nonsocial ancestors showing parental care and maintained, at least in part, because the presence of workers buffers queens against extrinsic mortality.

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.

Radiological appearances of papillary breast lesions.

This review illustrates the varied appearances of benign and malignant papillary breast tumours, as identified by a breast cancer-screening programme. The commonest mammographic appearance of a papillary tumour is as a soft-tissue mass, with calcification present in less than half of cases. When calcification is present the pattern is variable, but clusters of pleomorphic calcification can occur, sometimes resembling the mammographic appearance of invasive ductal carcinoma. Ultrasonography of papillary lesions typically shows a solid, oval, intraductal mass, often associated with duct dilatation. A cystic component is also commonly seen, and lesions may appear hypervascular on colour Doppler ultrasound. Magnetic resonance imaging (MRI) has a high sensitivity, but low specificity for detecting papillary tumours, and is useful in establishing the extent and distribution of lesions in patients with multiple papillomatosis. Despite a benign histology on core biopsy, an argument exists for complete surgical excision of all papillary tumours, as a significant proportion of papillomas will contain foci of atypia or overt malignant change.

A threshold-based fall-detection algorithm using a bi-axial gyroscope sensor.

A threshold-based algorithm, to distinguish between Activities of Daily Living (ADL) and falls is described. A gyroscope based fall-detection sensor array is used. Using simulated-falls performed by young volunteers under supervised conditions onto crash mats and ADL performed by elderly subjects, the ability to discriminate between falls and ADL was achieved using a bi-axial gyroscope sensor mounted on the trunk, measuring pitch and roll angular velocities, and a threshold-based algorithm. Data analysis was performed using Matlab to determine the angular accelerations, angular velocities and changes in trunk angle recorded, during eight different fall and ADL types. Three thresholds were identified so that a fall could be distinguished from an ADL: if the resultant angular velocity is greater than 3.1 rads/s (Fall Threshold 1), the resultant angular acceleration is greater than 0.05 rads/s(2) (Fall Threshold 2), and the resultant change in trunk-angle is greater than 0.59 rad (Fall Threshold 3), a fall is detected. Results show that falls can be distinguished from ADL with 100% accuracy, for a total data set of 480 movements.

The identification of vertical velocity profiles using an inertial sensor to investigate pre-impact detection of falls.

This study investigates distinguishing falls from normal Activities of Daily Living (ADL) by thresholding of the vertical velocity of the trunk. Also presented is the design and evaluation of a wearable inertial sensor, capable of accurately measuring these vertical velocity profiles, thus providing an alternative to optical motion capture systems. Five young healthy subjects performed a number of simulated falls and normal ADL and their trunk vertical velocities were measured by both the optical motion capture system and the inertial sensor. Through vertical velocity thresholding (VVT) of the trunk, obtained from the optical motion capture system, at -1.3 m/s, falls can be distinguished from normal ADL, with 100% accuracy and with an average of 323 ms prior to trunk impact and 140 ms prior to knee impact, in this subject group. The vertical velocity profiles obtained using the inertial sensor, were then compared to those obtained using the optical motion capture system. The signals from the inertial sensor were combined to produce vertical velocity profiles using rotational mathematics and integration. Results show high mean correlation (0.941: Coefficient of Multiple Correlations) and low mean percentage error (6.74%) between the signals generated from the inertial sensor to those from the optical motion capture system. The proposed system enables vertical velocity profiles to be measured from elderly subjects in a home environment where as this has previously been impractical.

Evaluation of a threshold-based tri-axial accelerometer fall detection algorithm.

Using simulated falls performed under supervised conditions and activities of daily living (ADL) performed by elderly subjects, the ability to discriminate between falls and ADL was investigated using tri-axial accelerometer sensors, mounted on the trunk and thigh. Data analysis was performed using MATLAB to determine the peak accelerations recorded during eight different types of falls. These included; forward falls, backward falls and lateral falls left and right, performed with legs straight and flexed. Falls detection algorithms were devised using thresholding techniques. Falls could be distinguished from ADL for a total data set from 480 movements. This was accomplished using a single threshold determined by the fall-event data-set, applied to the resultant-magnitude acceleration signal from a tri-axial accelerometer located at the trunk.

Hip protectors--a survey of practice in Ireland.

When used appropriately and worn by the user, it has been established that hip protectors can reduce the risk of femoral fractures in older people who fall. While hip protectors receive increasing interest in the scientific literature, it is not clear how widely and appropriately they are being used in Ireland. This national survey aimed to investigate this practice. The survey yielded 185 responses from a variety of settings, response rate of 53%. It noted that only 18% of respondents actually used hip protectors for their clients/patients, despite the fact that the many of the participants in this survey were from nursing homes, where the evidence supports their use. It clearly identifies that a lack of knowledge about hip protectors is one barrier to their use, with 54% of participants reporting they were not aware of hip protectors and their value; but other factors, such as the suitability and compliance of older clients/patients and financial issues also impact on their use. In excess of 70% of respondents reported that financial restrictions influenced their prescription practice. While the majority of the participants were nurses, it is of note that the professional group most frequently involved in prescribing the use of hip protectors was physiotherapists and not nurses or doctors. National guidelines which both educate and advise on the use of hip protectors would lead to optimal use in the context of both clinical and cost effectiveness.

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.

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.