bluuebunny/crossref_metadata_2025 huggingface dataset:
Engineer intelligence and the Pacific geologic mapping program
Authors: Corwin Gilbert
Published: May 2013

Lack of terrain data contributed significantly to the high costs of lives and operations during the Pacific campaign of World War II. After the war the U.S. Army Corps of Engineers contracted with the Military Geology Branch of the U.S. Geological Survey to gather detailed terrain information about the occupied islands under direct U.S. jurisdiction in the event they or comparable oceanic islands became sites of future military operations. The U.S. Geological Survey established a headquarters in Tokyo and initiated field studies of Okinawa during 1946. Subsequent detailed studies were launched at the Palau Islands (1947), Yap Islands (1947), Saipan (1948), Tinian (1949), Guam (1951), Pagan, Marianas Islands (1954), Truk (1954), Ishigaki and Miyako (1955), and the Marshall Islands (reconnaissance, 1951). Initial plans for detailed studies of all mandated islands were abandoned for lack of time, but members of the field parties briefly visited nearly all. Field teams included geologists, hydrologists, soils scientists, a plant ecologist, and a climatologist. The Tokyo office gathered and translated existing Japanese literature about the islands; more than 600 articles were translated. A by-product was the establishment of a joint U.S.-Japanese project to compile and publish a series of 1:250,000 geologic maps of formerly held Japanese territories, including Korea, Manchuria, northeast China, southern Sakhalin Island, and the Kuriles.

Results of the field studies were published in a series of military geology folios composed of both basic and interpretive chapters. U.S. Geological Survey professional papers presented many of the scientific results.
Methodology for remote characterization of fracture systems in bedrock of enemy underground facilities
Authors: Jacobi Robert D. , Eastler Thomas E. , Xu Jiandong
Published: May 2013

Weaponry can be conveniently and safely concealed in enemy underground bedrock facilities (UGF). The bedrock environment surrounding UGF offers a high degree of protection for the assets contained within. Physical characteristics of the surrounding bedrock constrain the effects of conventional and even nuclear weapons. Brittle structures in the bedrock such as fracture systems have anisotropic characteristics and present a formidable obstacle to the survival of penetrating weapons. Knowledge of the three-dimensional (3-D) characteristics of bedrock fracture systems in enemy UGF, which may be covered by soil or vegetation, is of paramount importance to the weapons development community in its quest to penetrate anisotropic environments.

We utilize rigorous methodologies to predict fracture characteristics in overburden-covered regions from outcrop, core, borehole, and remote sensing data. We have established digital scanline and scangrid methodologies to characterize fracture geometries. The digital data allow us to easily analyze the fractures in terms of fractal and more advanced geostatistical techniques. We have developed theoretical and practical guidelines for determining the two-dimentional (2-D) density of fractures from one-dimentional (1-D) (scanline) data. Additionally, we have developed theoretical relationships between 2-D and 3-D fracture densities. Integration of digital field data with density and spatial structure of the fracture networks allows us to predict the distribution of fractures in areas removed from the outcrop. These methodologies, once refined, fully tested, and verified, will allow us to characterize three-dimensional fracture systems in potential target areas worldwide by remote sensing means alone.
A consumer’s guide to instrumental methods for determination of hypocenters
Authors: Dewey James W.
Published: May 2013

In nuclear power plant siting, redetermination of hypocenters of instrumentally recorded earthquakes in the site region may be better than relying on routinely determined hypocenter locations listed in standard earthquake catalogues. Routinely determined hypocenters, particularly those of small earthquakes or of earthquakes occurring before the mid-1950s, may be so mislocated that they present a misleading picture of the seismo-tectonics of the site region. The preferred method for redetermining a hypocenter depends on the earthquake being considered. The hypocenters of many pre-1954 earthquakes may be more accurately redetermined by now-standard computerized location techniques that were not available when the earthquakes were initially catalogued. Some important earthquakes are so poorly recorded that they cannot be assigned a hypocenter that is mathematically unique; however, it may be possible to pose a hypothesis such that the significance of the earthquake to a proposed power plant can be tested without explicitly locating the earthquake. A well-recorded earthquake whose hypocenter is suspected of being biased by lateral variations of seismic wave velocities can be more accurately located by ray-tracing methods, provided that the lateral variations of velocity are known. In an attempt to infer a fault or seismic zone from a group of hypocenters, a relative-location method—such as the master-event method or joint hypocenter determination—should be used. All methods for determining hypocenters involve assumptions over which seismologists may disagree; in the safety analysis of a nuclear power plant, these assumptions must be explicitly discussed and shown to be conservative as to their implication for the design of the plant. In addition, confidence ellipses should be given for the hypo-central coordinates, in order to assess the errors that might occur even if the assumptions of the location method are correct.
Geophysics as related to siting of nuclear power plants
Authors: Murphy V.J. , Sexton T.F. , Levine E.N.
Published: May 2013

The safe siting of nuclear power plants requires knowledge of foundation conditions and faulting. Geophysical surveys and measurements are necessary to provide needed data in the early stages of a siting program, in order to supplement geologic studies. Later, detailed licensing studies may require additional geophysical measurements to supplement geotechni-cal engineering studies.

Seismic methods are most commonly used for exploring localized geologic and foundation conditions at and near a plant site; gravity and magnetic measurements are often helpful in regional geologic studies.

Other geophysical exploration techniques are usually reserved for specialized applications such as the search for subsurface cavities, determination of stratigraphy, slope stability studies, hydrogeology, and locating construction materials. Special seismic techniques are employed to determine dynamic elastic properties.
Borehole geophysics in nuclear power plant siting
Authors: Crosby James W. , Scott John D.
Published: May 2013

Miniaturized borehole geophysical equipment designed for use in ground-water investigations can be adapted to investigations of nuclear power plant sites. This equipment has proved to be of value in preliminary and comprehensive studies of interior basins where thick sequences of Quaternary clastic sediment, occasionally with associated volcanic rocks, pose problems of stratigraphic correlation. The unconsolidated nature of the deposits generally requires that exploratory holes be cased, which ordinarily restricts the borehole geophysical studies to the radiation functions—natural gamma, gamma-gamma, neutron-gamma, and neutron-epithermal neutron logs. Although a single log response may be dominant in a given area, correlations derive from consideration of all log responses as a composite group. Because major correlations usually are based upon subtle differences in the physical properties of the penetrated sediment, high-resolution logging procedures are employed with some sacrifice of the quantitative parameters important to petroleum technology. All geophysical field data are recorded as hard copy and as digital information on punched paper tape. Digital data are subsequently computer processed and plotted to scales that enhance the stratigraphic data being correlated. Retention of the data in analog format permits rapid review, whereas computer plotting allows playback and detailed examination of log sections and sequences that may be attenuated on hard copy because of the logarithmic nature of the response to the physical property being examined.
The state-federal partnership in siting of nuclear power plants
Authors: James Davis F. , Slosson James E. , Fakundiny Robert H.
Published: May 2013

Geology and seismology studies are becoming increasingly important in nuclear power plant siting decisions. Earthquake hazard assessment is perhaps the most challenging application of these disciplines to siting. Techniques for determination of the probabilities of damaging earthquakes and forecasting of seismic events need further development before they can be routinely applied as prescribed standards to power plant siting. Although the plate-tectonics model provides a functional explanation for the loci of earthquake activity along plate boundaries, the genesis of seismicity within lithospheric plates is less well understood. The seismic potential of numerous mapped, geologic structures in many portions of the North American continent are still matters of conjecture and disagreement.

The current siting criteria provide a normative procedure for establishing seismic design bases using the regional earthquake history and structural geology, together with detailed observations at the site. This process of prescribed analysis can, and has, led different investigators to contrasting conclusions.

States review the seismic design conclusions of the applicant utility and the safety evaluations of the Nuclear Regulatory Commission (NRC). Outside of the utilities and the NRC, the States are virtually the only other entities with scientific expertise that regularly participate in the siting process. The State role is usually advisory and nonregulatory. States contribute extensive knowledge of regional geology and seismicity to the decision-making process. Increasingly, the State geological surveys provide comments and suggestions to the Federal government and to utilities at an early enough stage so that an extensive and helpful dialogue precedes the State’s ultimate, formal review of siting reports.

In this discussion, we examine the State roles in determining the site-specific seismic-design bases for nuclear power plants. We consider the roles and perspectives of other parties as well. The scientific and procedural limitations that affect the siting process are analyzed. Finally, recommendations are made to improve the manner in which conclusions about seismic hazards at nuclear power plant sites are presented.
Geology and space beneath a city—Kansas City
Authors: Parizek Eldon J.
Published: May 2013

Kansas City geology is favorable to secondary development of subsurface space created by mining for commercial activities. Upper Pennsylvanian shales and lime-stones, including the Bethany Falls limestone, which is the principal source of limestone products for western Missouri, comprise the bedrock. Activities like ware-housing, controlled temperature food storage, manufacturing, and office and laboratory space, have been relocated below the surface to the extent that Kansas City has become the world leader in secondary subsurface space utilization.

Problems, most importantly, floor heave from volume changes caused by oxidation of sulfides in black shales, present limitations to growth of underground usage. Many surface facilities throughout the region are similarly affected, and measures used to counter heave problems in both surface and subsurface facilities have proved only moderately successful.
Coal mine subsidence—eastern United States
Authors: Gray Richard E. , Bruhn Robert W.
Published: May 2013

Underground coal mining has occurred beneath eight million acres of land in the United States, two million acres of which have been affected by subsidence. Most of this mining has taken place in the eastern half of the United States (east of the 100th meridian) where thousands of acres in urban areas are threatened by subsidence.

Early mining was not as efficient as today. Unrecovered coal pillars, often of variable size and spacing, remain to support the overlying strata for an indefinite period of time after mining has ceased. Roof collapse, crushing of pillars, or punching of pillars into the floor is now resulting in sinkhole or trough subsidence tens or even hundreds of years after mining.

In areas of active mining, where nominal total extraction is practiced, subsidence is essentially contemporaneous with mining. Limited observational data on ground movements over total extraction mines–room and pillar and longwall–suggest subsidence over deep longwall mines in Europe is similar in general respects, but different in detail, to subsidence in the United States.

Ground deformations resulting from subsidence have often been assumed to cause damage to structures in terms of simple tension and compression transferred by friction and adhesion to the undersides of foundations. Differential settlement, intensified pressure on subgrade walls, and other modes of soil-structure interaction are of equal significance in the eastern United States.
Coal mine subsidence—western United States
Authors: Richard Dunrud C.
Published: May 2013

Coal mine subsidence is the local lowering of the ground surface caused by coal mining. Subsidence processes above underground mines consist of a gradual downwarping of the overburden into coal extraction panels, which causes depressions, or a sudden collapse into individual mine openings, which causes pits. Subsidence type (depressions, pits), amount, areal extent, rate, and duration are controlled by (1) thickness of coal mined, (2) mine geometry and mining methods, and (3) thickness, lithology, structure, and hydrology of the bedrock and surficial material in the mining area. Subsidence in surface mining areas is caused by compaction of rehandled overburden material (spoil), dewatering of aquifers near surface mines, and (or) stress and strain readjustments. Depressions (troughs), cracks, and pits (sinkholes) can occur under either underground or surface mining procedures.

Maximum vertical displacement in depressions above extraction areas large enough to cause maximum subsidence in the western United States ranges from about 45 to 90 percent of the thickness of coal mined. However, pits may be deeper than the mining thickness, where the caved material can move laterally into adjacent mine openings. In surface mining areas, although little detailed information is available in the western United States, subsidence may range from a few percent to perhaps as much as 10 percent or more of the thickness of the reclaimed spoil. The limit angle, which determines the area of subsidence above underground mines, ranges from about 5° to 30° (from a vertical reference) above underground mines in the western United States. In surface mining areas, however, the subsidence area can range from nearly equal to the mining area, where compaction of rehandled spoil occurs, to many times the mining area, where aquifers are dewatered and undergo compaction.

The time or duration between mining and complete subsidence above underground mines commonly ranges from a few months to a few years, where downwarping occurs above extraction panels, to many years or decades, where pillars are not mined. The duration between mining and the occurrence of pits (sinkholes), however, can vary from a few decades to many decades or even centuries. The time necessary for depressions and pits in surface mining areas is not well known but apparently depends on factors such as methods of emplacing and grading and rate of wetting the rehandled material, rate of dewatering of aquifers near the mine, and stress-strain readjustments.
Use of bispectral index to monitor the depth of sedation in mechanically ventilated patients in the prehospital setting
Authors: Duchateau François-Xavier , Saunier Monique , Larroque Béatrice , Josseaume Julien , Gauss Tobias , Curac Sonja , Wojciechowski-Bonnal Estelle , Mantz Jean
Published: May 2013

Background

Sedative drug administration is a challenging aspect of the management of mechanically ventilated patients in the out-of-hospital critical care medicine. We hypothesised that the bispectral index of the EEG (BIS) could be a helpful tool in evaluating the depth of sedation in this difficult environment. The main objective of the present study was to assess the agreement of BIS with the clinical scales in the out-of-hospital setting.

Methods

This prospective study included mechanically ventilated patients. BIS values were blindly recorded continuously. A Ramsay score was performed every 5 min. The main judgement criterion was the correlation between BIS values and the Ramsay score.

Results

72 patients were included, mostly presenting with toxic coma (36%) or neurological coma (21%). The median (IQR) BIS value was 85 (84–86) when the Ramsay score was 3, 80 (76–84) when the Ramsay score was 4, 61 (55–80) when the Ramsay score was 5 and 45 (38–60) when the Ramsay score was 6. According to Receiver operating characteristic (ROC) curves, BIS was categorised into three classes (BIS<54 corresponding to Ramsay score 6, 54≤BIS<72 for Ramsay score 5 and BIS≥73 for Ramsay score ≤4). Based on these categories, the proportion of appropriate BIS values was 67% (217/323). The concordance correlation coefficient for repeated measurements was 0.54 (0.43–0.64). The agreement between BIS and the Ramsay score is moderate.

Conclusions

Prehospital measured BIS values appear poorly correlated with clinical assessment of the depth of sedation. For this reason, the use of BIS to guide prehospital sedation cannot be recommended.
Neonatal screening for congenital hypothyroidism in Estonia
Authors: Mikelsaar R V , Zordania R , Viikmaa M , Kudrjavtseva G
Published: May 2013

Screening for congenital hypothyroidism was carried out by measuring thyroid stimulating hormone (TSH) on dried blood spots (mean + 2SD cut off value 12 μU/ml) by fluoroimmunoassay using DELFIA kits. A total of 20 021 infants were screened, and seven cases with congenital hypothyroidism were detected, giving an incidence of congenital hypothyroidism of 1:2860 (female:male ratio 6:1). In four of seven infants with congenital hypothyroidism (57%) the mother also had thyroid disease, supporting the importance of genetic factors as a cause of congenital hypothyroidism. Transient hyperthyrotropinaemia occurred in 654 infants (recall rate 3.3%). There was a significant association of transient hyperthyrotropinaemia only with cardiac failure at birth or caesarean section (p<0.01). Family studies showed no predisposition to thyroid diseases associated with a transient increase of TSH.
Can postal prompts from general practitioners improve the uptake of breast screening? A randomised controlled trial in one east London general practice
Authors: O'Connor A M , Griffiths C J , Underwood M R , Eldridge S
Published: May 2013

Objective To determine the effect on the uptake of breast screening of a personalised letter from the general practitioner recommending mammography, sent to coincide with an invitation from the NHS breast screening programme.

Design Randomised control trial with stratification of prognostic variables.

Setting A group practice in Hackney, east London.

Subjects 473 women invited for breast screening by the City and East London Breast Screening Service.

Outcome measureAttendance for mammography.

Results All women in the randomised trial were followed up; 134 of 236 (57%) randomly allocated to receive the prompting letter attended for mammography compared with 120 of 234 (51%) controls. This difference was not significant (χ2 =1.43, p=0.23)

Conclusion Personal recommendation by a letter prompting attendance for mammography from the general practitioner known best to women due to be screened did not improve uptake of breast screening in this east London practice. Other strategies are needed to increase uptake of mammography in inner cities.
Screening digital rectal examination and prostate cancer mortality: a case-control study
Authors: Richert-Boe K E , Humphrey L L , Glass A G , Weiss N S
Published: May 2013

Background Prostate cancer is the second most common cause of death from cancer in men in the United States. Digital rectal examination is the oldest and most commonly used screening test for prostate cancer, but as yet there are no studies which demonstrate its effectiveness.

Methods A case-control study was conducted among members of a large health maintenance organisation to estimate the effect of screening digital rectal examination on mortality from prostate cancer. 150 men, aged 40–84 when cancer was diagnosed, who developed fatal prostate cancer, and 299 male controls matched for age who did not die from prostate cancer were studied. A history of screening digital rectal examination during the 10 years before the date on which cancer was diagnosed was determined from medical records.

Results A similar proportion of men who died from prostate cancer and controls had undergone at least one screening digital rectal examination during the 10 year interval (odds ratio = 0.84, 95% confidence interval 0.48 to 1.46). Similar results were obtained when a shorter interval (such as five years before diagnosis) during which screening histories were evaluated was considered, or in analyses in which men with a history of benign prostatic hypertrophy were excluded.

Conclusions The data suggest that screening digital rectal examination does not reduce mortality from prostate cancer to any appreciable degree.
Second trimester screening for Down's syndrome using maternal serum dimeric inhibin A
Authors: Haddow J E , Palomaki G E , Knight G J , Foster D L , Neveux L M
Published: May 2013

Objectives To determine the second trimester Down's syndrome screening performance of maternal serum dimeric inhibin A, both alone and in combination with existing serum markers.

Setting A case-control set of serum samples from patients with Down's syndrome (52) and subjects with matched unaffected pregnancies obtained in a previous cohort study before second trimester amniocentesis and karyotyping. The amniocenteses were performed for reasons other than a positive serum screening test result.

Methods For each serum from a Down's syndrome pregnancy, five serum samples from pregnancies with a normal karyotype were matched for recruitment centre, gestational age, maternal age, and date of amniocentesis. A specific form of inhibin (dimeric inhibin A) was measured using monoclonal antibodies. Measurements of α fetoprotein, unconjugated oestriol, and human chorionic gonadotrophin and its free β subunit were already available. Screening performance was modelled using distribution variables of the analytes coupled with the 1993 age distribution of pregnant women in the United States.

Results The median dimeric inhibin A level was 2.10 times higher in Down's syndrome pregnancies. When dimeric inhibin A was combined with maternal age and three other serum markers (α fetoprotein, unconjugated oestriol, and human chorionic gonadotrophin) the Down's syndrome detection rate increased to 75% (from 66%) at a 5% false positive rate. If dimeric inhibin A could be added for less than $31 (ranging from $16 to $39 depending on the detection rate, markers chosen, and method of dating), the cost of detecting each Down's syndrome pregnancy and the number of procedure related fetal losses would both be reduced.

Conclusions The addition of dimeric inhibin A to prenatal screening programmes for Down's syndrome should be considered, or possibly it could be substituted for an existing serum marker. One barrier to implementation in the United States, however, is the unavailability of kits with Food and Drug Administration approval.
Cost-benefit analysis of a national thalassaemia prevention programme in Israel
Authors: Ginsberg G , Tulchinsky T , Filon D , Goldfarb A , Abramov L , Rachmilevitz E A
Published: May 2013

Objective In Israel (population 5.7 million) there are around 200 known living subjects with thalassaemia major, of whom around 80% are from the northern district. This study aims at examining the costs and benefits of a national screening programme to prevent thalassaemia in Israel.

Measurements and main resultsThe lifetime healthcare costs of caring for a person born with thalassaemia major are $284 154. The costs of the home infusion service (33.1%) actually exceed the costs of the chelating agent itself (22.1%). The remaining 44.8% of costs are due to stay in hospital, operations, outpatient visits, laboratory tests, therapists, etc. Lost earnings and premature mortality costs account for a further $51 843 and $141 944 respectively for each case. A national screening programme would cost $900 197 and prevent around 13.4 homozygotes being born, at a cost of $67 369 for each birth prevented. The benefit-cost ratio of the programme to the health services is 4.22:1, which increases to 6.01:1 when a societal perspective is taken. However, around 13.0 homozygote births are still expected to occur, the majority owing to lack of compliance of patients at various stages in the screening process. The addition of a national health education programme for the higher risk non-Jewish population either nationally or in selected regions will incur extra costs, which may be covered by increased benefits as a result of better compliance with the screening programme.

Conclusion Israel should start to provide a nationwide thalassaemia screening programme as the monetary benefits to society (and even to the health services alone) will exceed the screening programmes costs.
Normal growth in the short normal prepubertal child: the Wessex Growth Study
Authors: Voss L D , Mulligan J
Published: May 2013

Objective The study aimed at defining the normal rate of growth for short, prepubertal children, and comparing their pattern of growth with those of average stature.

Setting Community based.

Design Observation of an unselected population of 109 very short, normal prepubertal children (<3rd height centile) and 107 controls matched for age and sex (10th to 90th centile).

Main outcome measuresHeight, velocity, change in height standard deviation score, from 6 to 9 years of age.

Results The absolute mean rate of growth was significantly different between groups—short normal 5.3 cm/year, controls 5.9 cm/year—corresponding to velocities on the 25th and 50th centiles, respectively. The relative growth rates, however, as shown by the changes in height standard deviation score (short normal 0.10 (SD 0.22), controls 0.10 (SD 0.24) did not differ, and each group remained close to its original 3rd and 50th centiles. Two short children showed “catch up” growth after adoption, but, otherwise, the divergence from their original height centile was the same for short normal and control children. No social or biological factors were found to predict growth rate in the short normal children, and only target height in controls. “Normal” velocity is conditional on height. Short normal children do grow more slowly than children of average stature, but they do not necessarily grow more poorly. From 6 to 9 years of age they are no more likely to fall off their height centiles than children of average stature. The value of height monitoring at this age is questioned.
Early rescreen/recall in the UK National Health Service breast screening programme: epidemiological data
Authors: Ong G J , Austoker J , Michell M
Published: May 2013

Objective In the United Kingdom in 1994–95 about 16 500 women aged 50 to 64 were asked to come back earlier than the usual three yearly screening interval for further mammography (early rescreen (ES)) or for a range of further investigations at an assessment centre (early recall (ER)). This study aimed at providing epidemiological data on ES/ER, in particular, how often and why it is used, and what the outcome is of using it.

Setting National Health Service breast screening programme in the United Kingdom.

Methods All breast screening units were invited to complete a postal questionnaire. Two reminders were sent. The units were asked retrospectively to provide breast screening data about women aged 50 to 64 from their local computer systems. Women placed on ES/ER were followed up for at least one year.

Results The response rate was 71% (69/97), of which 14% (10/69) were unable to provide the required data, leaving 59 completed questionnaires (61%). The rate of placing women on ES/ER was above 1.0% for 26/54 (48%) responding breast screening units and above 2.0% for 13/54 (24%) units. Women were placed on ES/ER because of ( a) previous breast cancer (21% of cases; cancer detection rate 2.4%), ( b) diagnostic uncertainty (51%; cancer detection rate 3.0%), or ( c) family history (27%; cancer detection rate 0.6%). Breast screening units with a high rate of placing women on ER were significantly more likely to have a high recall rate ( rS=0.63; n=53; p<0.0005) or a high benign surgical biopsy rate ( rS=0.33; n=49; p<0.05), or both. The cancer detection rate of ES/ER tended to decrease with increasing ES/ER rates ( rS=−0.37; n=51; p<0.01).

Conclusions A relatively large number of women were placed on ES or ER for a range of reasons. If the recommendations given are followed, the number of women placed on ER may be reduced while maintaining the cancer detection rate at the required level. The option of ES should not be used.
General practitioner screening for melanoma: sensitivity, specificity, and effect of training
Authors: Burton R C , Howe C , Adamson L , Reid A L , Hersey P , Watson A , Watt G , Relic J , Holt D , Thursfield V , Clarke P , Armstrong B K
Published: May 2013

Objective To measure the performance of trained and untrained general practitioners (GPs) in screening men and women aged 50 or more for melanomas.

Methods GPs trained in melanoma diagnosis, untrained GPs, and skin cancer specialists examined groups of volunteers, each of which included a small number of subjects with prediagnosed suspicious pigmented lesions (SPLs) that were subsequently excised for histopathological examination.

Results Trained and untrained GPs achieved mean sensitivities of 0.73 and 0.71, and mean predictive values of 0.40 and 0.37, respectively, for the detection of prediagnosed SPLs. When the SPLs had been excised and examined histopathologically, reanalysis showed mean sensitivities of 0.98 and 0.95, mean specificities of 0.52 and 0.49, and mean positive predictive values of 0.24 and 0.22 for the detection of subjects with melanomas by trained and untrained GPs respectively. Trained GPs were significantly better than untrained GPs at diagnosing as melanomas SPLs that subsequently proved to be melanomas (p=0.04).

Conclusions GPs in this study achieved high sensitivities in screening older Australian men and women for melanomas, but at the cost of low specificities and positive predictive values. Training in melanoma diagnosis had no significant effect on sensitivity, specificity, and positive predictive value for screening. Data from the study were tested in a model of population screening for melanomas, and costs per life year saved for men aged 50–70 ranged from $A11 852 to $A40 259 depending upon the screening interval and whether the GPs excised the SPLs diagnosed, or referred all patients to skin cancer specialists; this would be as cost effective as cervical cancer screening.
Acceptance of amniocentesis by women in the state of Montana (USA) who are screen positive for Down's syndrome
Authors: Priest J H , FitzGerald J M , Haag M M , Streets K , Vanisko M , Johnson J P
Published: May 2013

Objective To assess factors influencing uptake of amniocentesis after a positive Down's syndrome screening result.

Methods Interviews of 53 Montana women with screening risks ≥1 in 300 after delivery.

Results Thirty had accepted amniocentesis (“yes” group) and 23 had declined (“no” group) (57% uptake). Age at delivery was significantly higher (p=0.02) for the “no” than the “yes” group (mean 35.3 v 31.7 years). The mean risk of Down's syndrome ascertained by screening was 1 in 190 for the “no” group and 1 in 115 for the “yes” group (p=0.05). Statistically significant differences (p≤0.05) between opinions in the two groups included: ( a) desire to know if the fetus had Down's syndrome; ( b) perception of the burden of care for an affected child; ( c) support of doctor, spouse, and relatives for choice about amniocentesis; ( d) attitudes toward abortion; ( e) importance of religion; and ( f) concerns about the amniocentesis procedure. The most important factor for those choosing amniocentesis was knowing if the fetus had Down's syndrome, and for those not choosing amniocentesis, attitude about abortion.

Conclusion Our results show the need for prescreening education to enable pregnant women to make informed decisions about screening for Down's syndrome and diagnostic testing.
Mammographic parenchymal patterns and mode of detection: implications for the breast screening programme
Authors: Sala E , Warren R , McCann J , Duffy S , Day N , Luben Robert
Published: May 2013

Objectives To assess the effects of mammographic parenchymal patterns on the risk of breast cancer detected at first screen, second screen, and in the interval between these two screens.

Settings A nested case-control study within a screening cohort in East Anglia was designed. The study group comprised 502 patients with cancer at the prevalence screening round, 198 patients with interval cancer, and 175 with cancer at the first incidence screen. These patients were matched with 2601 controls.

Methods The mammographic parenchymal patterns of breast tissue were assessed according to Wolfe's classification. Statistical analysis was by conditional logistic regression.

Results Overall, 67% of patients and 59% of controls were considered to have high risk pattern (P2+DY) mammogram. The risk associated with P2 or DY mammographic patterns compared with N1 was higher for interval cancers (odds ratios (ORs) 2.2 and 2.4 respectively) than for screen detected cancers (ORs 1.7 and 1.1 respectively). For interval cancers in the first 18 months after the last negative mammogram, the risk was particularly high (ORs 3.8 for P2 and 4.1 for DY compared with N1). The high risk associated with P2 and DY patterns was concentrated on invasive ductal grade III cancers (ORs 2.7 and 3.8) rather than grade I or II cancers (ORs 1.6 and 1.2).

Conclusions The study strongly suggests that screening effectiveness is reduced for high risk parenchymal patterns which are associated with high grade cancers. Changes should aim at improving screening sensitivity for dense parenchymal patterns, and the diagnosis of high grade tumours.
Outcomes of universal antenatal screening for haemoglobinopathies
Authors: Greengross P. , Hickman M. , Gill M. , Dugan B. , Davies S.C.
Published: May 2013

Objective To evaluate universal antenatal screening for haemoglobinopathies.

Setting District general hospital serving a London borough with 45% ethnic minorities.

Methods Retrospective cohort study of 1444 women referred in 1688 pregnancies and 95 tertiary referrals during 101 pregnancies.

Results Unselected women at risk for sickle cell disease booked 2.7 weeks (95% confidence interval (CI) 0.14 to 5.1) later in gestation than those at risk for β thalassaemia were less likely to attend counselling (83% v93%, relative risk (RR) 0.89; 95% CI 0.85 to 0.94), their partners were less likely to be tested (77% v 95%, RR 0.81; 0.77 to 0.83), and they were less likely to accept prenatal diagnosis (22% v 90%, RR 0.37; 0.24 to 0.57). Over 99% of tertiary referrals attended counselling and had their partners tested. There were no significant differences in acceptance of prenatal diagnosis between those at risk of sickle cell disease and β thalassaemia (55% v 67%). Unselected women at risk of sickle cell disease were significantly less likely to have their partner tested or to accept prenatal diagnosis than tertiary referrals, but not those at risk of β thalassaemia. 80% of β thalassaemia and 16% of SS births were prevented.

Conclusions Uptake of prenatal diagnosis among unselected women at risk of β thalassaemia is similar to that reported by tertiary centres. It is considerably lower for sickle cell disease but could increase considerably if screening occurred earlier in gestation. Acceptance of counselling is universally high, suggesting that informed choices are made, and indicating a need to measure these outcomes for cost effectiveness studies.
Reanalysis of the Mayo Lung Project data: the impact of confounding and effect modification
Authors: Marcus P.M. , Prorok P.C.
Published: May 2013

Objectives To examine whether age at entry, history of cigarette smoking, exposure to non-tobacco lung carcinogens, or previous pulmonary illnesses were confounders or effect modifiers of the relation between screening and lung cancer mortality in the Mayo Lung Project.

Setting —The Mayo Lung Project was a randomised, controlled, clinical trial conducted between 1971 and 1986 in 9211 male smokers over the age of 45 in Minnesota (USA). The group screened received chest x ray examination and sputum cytology every four months for six years. The unscreened group were recommended to obtain usual care (annual chest x ray examination and sputum cytology). After follow up, lung cancer mortality was similar in both groups.

Methods —Proportional hazard models were used to analyse data. A variable was considered a confounder if its inclusion in a model changed the rate ratio for screening by more than 15%; a variable was considered an effect modifier if its stratum-specific rate ratio for screening differed by a factor of two.

Results None of the four aforementioned variables changed the rate ratio associated with screening (1.07) by more than 2%. The effect of screening may have differed by years smoked (rate ratio for smoking fewer than 30 years 2.4; rate ratio for smoking 30 or more years 1.0), though we suspect that this result occurred by chance.

Conclusion Adjustment for or stratification by four established lung cancer risk factors did not alter the original findings of the Mayo Lung Project.
Trends in mammography 1991–96 and the impact of nationwide screening in the Netherlands
Authors: van Leiden H.A. , van Gessel-Dabekaussen A.A.M.W. , van der Maas P.J. , de Koning H.J.
Published: May 2013

Objectives To investigate the impact of the population based breast screening programme on total uptake of mammography in the Netherlands.

Setting The Netherlands; breast screening programme for women aged 50–69; 21 820 women who participated in the 1991–96 Health Interview Survey (HIS).

Methods HIS data linked to data related to the start of the screening programme in different municipalities investigating mammography use, reasons for mammography, and further assessment procedures.

Results Among women aged 50–69 the percentage who had recently undergone mammography (in the year of the HIS or two years before) increased from 20% in 1991 to 70% in 1996, which was entirely due to screening. The percentage of women in this age group who had had a recent clinical mammogram (outside the screening programme) varied between 8 and 12% and did not change significantly in municipalities without screening. There was no change in the uptake of mammography among women under 50 years of age. Among women over 70 there was only a small increase in this percentage from 6 to 13%, partially due to screening mammograms. In municipalities in which screening had started, precaution is mentioned as a reason for a recent clinical mammogram among women aged less than 70 more often than in municipalities without screening. Furthermore, mammography performed because of complaints is mentioned less in all age groups after the introduction of screening. After a clinical mammogram, further assessment procedures (cytology/needle biopsies 8%, biopsies 10%) were considered necessary about 10 times more often than after a screening mammogram.

Conclusions Although the screening programme has almost no impact on the frequency of mammography in women who underwent a clinical mammogram, there has been a shift in reasons for these mammograms more towards reasons of prevention. Screening mammograms lead to a much smaller percentage of additional examinations than do clinical mammograms.
A trial to study the effect on breast cancer mortality of annual mammographic screening in women starting at age 40
Authors: Moss S.
Published: May 2013

Objective Although there is clear evidence from randomised trials of the effectiveness of mammographic screening in women over 50 in reducing mortality from breast cancer, the benefit of screening in younger women remains less certain. This paper describes a randomised controlled trial in progress to study the effect on breast cancer mortality of annual mammographic screening of women starting at age 40–41.

Setting Screening centres of the NHS Breast Screening Programme.

Methods In 1991 a national multicentre randomised controlled trial was set up by the United Kingdom Coordinating Committee on Cancer Research (UKCCCR). This trial (the “age” trial) aims at recruiting 195 000 women aged 40–41 such that 65 000 form a study group and the remaining 130 000 a control group. Women in the study group are invited for annual screening by mammography, and become eligible for the National Health Service Breast Screening Programme (NHSBSP) after age 50. Those in the control group are not offered any additional services, but will also join the national programme after age 50. All malignant breast histology in trial women is recorded.

Analysis The principal method of evaluation will be the comparison of cumulative breast cancer mortality rates in the study and control groups; interim analyses of prognostic factors of breast cancers will also be possible. Additional NHS screening costs incurred owing to lowering the age of screening will be assessed as part of an economic evaluation. The amount of unscheduled screening occurring in the control group of the trial will also be assessed.
Proficiency test for screening mammography: results for 117 volunteer Italian radiologists
Authors: Ciatto S. , Ambrogetti D. , Catarzi S. , Morrone D. , Rosselli del Turco M.
Published: May 2013

Objective To analyse the performance of a large sample of Italian radiologists undergoing a proficiency test for screening mammography.

Design Evaluation of performance indicators according to reference standards determined by a panel of experts (sensitivity (reference standard ≥80%), recall rate (reference standard ≤15%)).

Setting 117 Italian radiologists of varying experience (years of practice 0.5–18, average 5.9; mammograms read 500–51 000, average 13 000), all currently reporting clinical mammography and planning to take part in screening in the near future.

Results Eighty four of 117 (72%) radiologists reached the standard for sensitivity, 88 (75%) reached the standard for recall rate, and only 59 (50%) reached both standards and passed the proficiency test. The probability of passing the test was significantly correlated with mammographic practice (p=0.015), mammograms read (p=0.024), and mammograms read/year (p=0.043).

Discussion The performance of a large sample of Italian radiologists currently reporting clinical mammography was disappointing, indicating the need for proper training of at least 50% of the tested subjects. When implementing organised screening the health authority should set up a proper process for training and accrediting radiologists, and a proficiency test should be part of such a process.
Quantifying the decline in the birth prevalence of neural tube defects in England and Wales
Authors: Morris J.K. , Wald N.J.
Published: May 2013

In England and Wales there has been a large decline in the birth prevalence of neural tube defects (NTDs) from the early 1970s (reported rates of about 3.2 per 1000 births) to the present (0.1 per 1000 births in 1997). The reported number of terminations of NTD pregnancies increased from 0.02 per 1000 in 1970 to 0.66 per 1000 in 1997, much too small an increase to explain the decline in NTD births. Some underreporting of NTD terminations is recognised. We estimated its extent using 1976–80 data on reported central nervous system (CNS) defect terminations and NTD births in an analysis in which the true total number of NTD pregnancies during this short period was assumed to have either remained constant or else to have been changing by a constant amount per year. The estimate was that 56% of NTD terminations were not reported as such and this fitted the data well. In 1997 the estimated birth prevalence of NTDs was 0.14 per 1000 births, a fall of 96% since 1970. This 96% was apportioned as 40% due to antenatal screening and termination of pregnancy and 56% due to a decline in incidence. Over the period 1970–97 there was an increase in dietary folate, and this will have at least in part caused the decline in incidence of NTDs.
Comparison of the CAPAS and Ewing tests for screening of hearing in infants
Authors: Rovers M.M. , Zielhuis G.A. , Straatman H. , Ingels K. , van der Wilt G-J. , Kauffman-de Boer M.
Published: May 2013

Objective To study the similarities and differences between the non-automated labour intensive Ewing hearing test and the less labour intensive automated CAPAS (Compact Amsterdam Paedo-Audiometrical Screening) hearing test.

Setting A multicentre study in which all the children born in the eastern part of the Netherlands between 1 January 1996 and 1 April 1997 were routinely screened for hearing impairment at 9 months of age.

Methods Differences and similarities between the two methods were described for the proportion of children who failed every test, the percentage of referred children, the yield of bilateral and unilateral otitis media with effusion (OME), the positive predictive value of the third test result, and the yield of persistent OME after 4–6 months' follow up at an ENT department.

Results 12 603 infants were screened with the CAPAS test and 17 496 with the Ewing test. There were differences between the CAPAS and Ewing tests respectively in the proportions of children lost to follow up (10.1% v 15.2%), the proportions of children referred diagnosed with OME (59% v 81%), the yield of bilateral otitis media with effusion (2.4% v 3.0%), and the yield of persistent OME after 4–6 months' follow up (1.1% v 1.6%).

Conclusions The CAPAS test is more practical than the Ewing test, but the non-automated Ewing test seems to be more reliable and valid for detecting conductive hearing loss.
Should genetic analysis in newborn screening and a heterozygote test for hyperphenylalaninaemia be recommended? An Italian study
Authors: Rottoli A. , Gianní M.L. , Verduci E. , Biondi M.L. , Fiori L. , Giovannini M. , Riva E.
Published: May 2013

Objective To determine whether the introduction of genetic analysis for phenylalanine hydroxylase (PAH) deficiency into regional screening programmes can be supported by the benefit-cost ratio.

Method Tests for the genetic PAH locus were carried out in 151 patients with hyperphenylalaninaemia originally from all of the Italian regions. PAH mutations were identified by extraction of genomic DNA from leucocytes (whole blood in EDTA), PAH exon amplification was determined by polymerase chain reaction, restriction enzyme analysis was carried out for some recognised mutations, and DNA sequence analysis for the other mutations.

Results It was found that the eight most common mutations in the population accounted for 49% of the mutant alleles, which is well below the required standard for effective population screening (90%).

Conclusions Genetic screening for PAH deficiency in Italy does not increase the sensitivity of the methodology and the benefit-cost ratio, and thus provides no advantage, particularly as the correlation between genotype and the metabolic phenotype needed to optimise dietary intervention is still being studied.