Mammographic density is a strong breast cancer risk factor and a major determinant of screening sensitivity. However, there is currently no validated estimation method for full-field digital ...mammography (FFDM).
The performance of three area-based approaches (BI-RADS, the semi-automated Cumulus, and the fully-automated ImageJ-based approach) and three fully-automated volumetric methods (Volpara, Quantra and single energy x-ray absorptiometry (SXA)) were assessed in 3168 FFDM images from 414 cases and 685 controls. Linear regression models were used to assess associations between breast cancer risk factors and density among controls, and logistic regression models to assess density-breast cancer risk associations, adjusting for age, body mass index (BMI) and reproductive variables.
Quantra and the ImageJ-based approach failed to produce readings for 4% and 11% of the participants. All six density assessment methods showed that percent density (PD) was inversely associated with age, BMI, being parous and postmenopausal at mammography. PD was positively associated with breast cancer for all methods, but with the increase in risk per standard deviation increment in PD being highest for Volpara (1.83; 95% CI: 1.51 to 2.21) and Cumulus (1.58; 1.33 to 1.88) and lower for the ImageJ-based method (1.45; 1.21 to 1.74), Quantra (1.40; 1.19 to 1.66) and SXA (1.37; 1.16 to 1.63). Women in the top PD quintile (or BI-RADS 4) had 8.26 (4.28 to 15.96), 3.94 (2.26 to 6.86), 3.38 (2.00 to 5.72), 2.99 (1.76 to 5.09), 2.55 (1.46 to 4.43) and 2.96 (0.50 to 17.5) times the risk of those in the bottom one (or BI-RADS 1), respectively, for Volpara, Quantra, Cumulus, SXA, ImageJ-based method, and BI-RADS (P for trend <0.0001 for all). The ImageJ-based method had a slightly higher ability to discriminate between cases and controls (area under the curve (AUC) for PD = 0.68, P = 0.05), and Quantra slightly lower (AUC = 0.63; P = 0.06), than Cumulus (AUC = 0.65).
Fully-automated methods are valid alternatives to the labour-intensive "gold standard" Cumulus for quantifying density in FFDM. The choice of a particular method will depend on the aims and setting but the same approach will be required for longitudinal density assessments.
There is converging evidence that maintenance of function in the multiple connectivity networks involving the cerebellum is a key requirement for healthy aging. The present study evaluated the ...effectiveness of a home-based, internet-administered "cerebellar challenge" intervention designed to create progressive challenges to vestibular function, multi-tasking, and dynamic coordination. Participants (
= 98, mean age 68.2, SD 6.6) were randomly allocated to either intervention (the cerebellar challenge training for 10 weeks) or no intervention. All participants undertook an initial series of pre-tests, and then an identical set of post-tests following the intervention period. The test battery comprised five suites of tests designed to evaluate cognitive-sensori-motor-affective functions, including Physical Coordination, Memory, Language Dexterity, Fluid Thinking and Affect. The intervention group showed significant pre- to post improvements in 9 of the 18 tests, whereas the controls improved significantly on one only. Furthermore, the intervention group showed significantly greater improvement than the controls on the "Physical Coordination" suite of tests, with evidence also of differential improvement on the Delayed Picture Recall test. Frequency of intervention use correlated significantly with the improvement in balance and in peg-moving speed. It is concluded that an internet-based cerebellar challenge programme for older adults can lead to benefits in balance, coordination and declarative memory. Limitations and directions for further research are outlined.
The mechanisms underlying the progressive changes in tissues and organs that characterise normal ageing remain unclear. The cerebellum is known to play a major role in motor function, but recent ...research suggests it plays an equivalent role in cognition. Working with the hypothesis that cortico-cerebellar loops ensure smooth and coordinated activity in both domains, this thesis investigates the possible role of the cerebellum in normal ageing and in interventions to improve function, seeking to contribute to both theoretical and applied approaches to ageing. Study one investigated relationships between motor and cognitive function using raw data from a national normative sample of adults aged 16 to 75, employing a test battery assessing motor and cognitive skills. Differences between age groups were demonstrated in some tests of complex processing speed, working memory and executive function, with suggestive evidence that senescence in tests is reflected in tests sensitive to cerebellar function. Study two refined the battery, while including further measures of motor and memory performance to investigate linkages between cognitive and cerebellar function. Using a sample of 256 older adults, results were variable but provided evidence that pegboard performance could act as a predictor of some cognitive functions. Study three investigated a proactive intervention for healthy older adults designed to improve cerebellar function, and therefore balance and executive function. This involved an 8-10 week self-administered, internet-based coordinative exercise intervention using a ‘cerebellar challenge’ suite of graded activities. Performance on a basket of tests was assessed before and after, and also compared with performance changes in a no-intervention control group. Significantly greater benefits for the intervention group than the controls were found for balance physical coordination and controlled information processing. Overall, these studies support current research indicating cerebellar contribution to both cognitive and motor problems arising in old age, and present evidence that non-verbal memory and controlled speeded information problems may be alleviated through targeted activities affecting cerebellar function improving postural stability and physical coordination.
We examine the characteristics and causes of southeast Australia's Tinderbox Drought (2017 to 2019) that preceded the Black Summer fire disaster. The Tinderbox Drought was characterized by cool ...season rainfall deficits of around -50% in three consecutive years, which was exceptionally unlikely in the context of natural variability alone. The precipitation deficits were initiated and sustained by an anomalous atmospheric circulation that diverted oceanic moisture away from the region, despite traditional indicators of drought risk in southeast Australia generally being in neutral states. Moisture deficits were intensified by unusually high temperatures, high vapor pressure deficits, and sustained reductions in terrestrial water availability. Anthropogenic forcing intensified the rainfall deficits of the Tinderbox Drought by around 18% with an interquartile range of 34.9 to -13.3% highlighting the considerable uncertainty in attributing droughts of this kind to human activity. Skillful predictability of this drought was possible by incorporating multiple remote and local predictors through machine learning, providing prospects for improving forecasting of droughts.
The limited grazeable size of renosterveld vegetation in the Western Cape warranted assessment of chemical and fibre composition of the species to determine their nutritive value. We hypothesised ...that Fabaceae has chemically superior palatable species relative to Poaceae, Asteraceae and Asparagaceae species in the area. Plant samples were collected in the Overberg region from 11 sites. The species sampled from these four families Fabaceae, Poaceae, Asteraceae, and Asparagaceae were analysed for macro- and micro-elements, fibre and secondary compounds. At each site, replicated soil samples were also collected and analysed for pH, macro- and micro-elements. Fabaceae recorded the greatest concentration of crude protein, but the Poaceae was the most fibrous relative to Fabaceae and Asteraceae. All the species contained adequate levels of nutrients except P, Zn and sometimes Cu. Soil concentration of macronutrients and carbon in the soil varied with location. Based on crude protein, neutral detergent fibre and digestibility, the three most important parameters defining forage quality, the Fabaceae species Aspalathus hispida, A. angustifolia, A. nigra and A. submissa were regarded as superior forage species in the Mediterranean renosterveld. Livestock relying on only the renosterveld species in the Western Cape as forages should receive P and Zn supplements.
•Fabaceae recorded greatest concentrations of crude protein and medium to low fibre content .•All the species contained adequate levels macro- and micro-nutrients except P, Zn and sometimes Cu.•Total phenolic and condensed tannins were low in all species irrespective of plant family.•Livestock relying on only the renosterveld species in the Western Cape as forages should receive P and Zn supplements.•The Fabaceae species A. hispida, A. angustifolia, A. nigra and A. submissa were superior forage species in renosterveld.
Background
When time is of the essence in critical care cases, a fast molecular diagnosis is often necessary to help health care providers quickly determine best next steps for treatments, prognosis, ...and counseling of their patients. In this paper, we present the diagnostic rates and improved quality of life for patients undergoing clinical rapid exome sequencing.
Methods
The clinical histories and results of 41 patients undergoing rapid exome sequencing were retrospectively reviewed.
Results
Clinical rapid exome sequencing identified a definitive diagnosis in 13/41 (31.7%) and other relevant findings in 17 of the patients (41.5%). The average time to verbal report was 7 days; to written report was 11 days.
Conclusions
Our observations demonstrate the utility and effectiveness of rapid family‐based diagnostic exome sequencing in improving patients care.
The ability of a health care provider to order testing and counsel families within 7 days is advantageous for patients. About 31.7% received a diagnosis and 92.7% of providers reported ordering testing to aid in prognosis and medical management decisions, including potential end of life decisions.
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