With numbers of returnees expected to rise in 2008, the UN High Commissioner for Refugees (UNHCR) expects that it will have to expand its shelter programme in Burundi, one of the poorest countries in sub-Saharan Africa. All returnee families without homes are eligible to receive assistance from UNHCR to build a small three-room house, which cost the agency about $500 each. Priority is given to the most vulnerable households, particularly those headed by females and those including disabled or elderly members. The majority of refugees receiving assistance under the programme are provided with materials and then construct their new houses themselves, which helps to impart a greater sense of ownership and helps them acquire additional skills. Burundi has welcomed back some 380,000 refugees – or 5 per cent of the population – from surrounding countries since 2002. The housing programme is one of several reintegration measures that are vital to ensuring a sustainable return. UNHCR notes that most of the returnees making use of return programmes since 2002 have been subsistence farmers – and most have been able to recover their land. But more than 80 per cent of returnees have had to construct or buy new shelter, according to a study conducted earlier this year by UNHCR and the World Food Programme. Thanks to contributions from donors such as the European Commission and Japan, UNHCR will be able to provide at least 14,300 vulnerable families with shelter over the next year. 2 January 2008Over the past five yeas, the United Nations refugee agency has assisted 58,000 Burundians returning to the small Central African country – which is emerging from decades of ethnic conflict – by helping them build their own homes, improve living conditions and ensure a sustainable return.
The year-long operation in five of the region’s poorest provinces is “a tangible peace dividend,” WFP country coordinator Nileema Noble said. “Sixty per cent of the population of the targeted provinces will benefit directly.” More than 170,000 school children are to receive take-home rations of rice, helping to reduce the high drop-out rate, under the project which is being carried out in cooperation with the Government and will provide food aid to families displaced by the violence, former combatants and poor women in a region where poverty, nutrition and education levels are far worse than anywhere else in the country.WFP Regional Director for Asia Anthony Banbury underlined the critical importance of contributions from the international community to help in securing the peace process in Mindanao. “The Government and people of the Philippines cannot take on this challenge alone – the contribution of those nations that are willing to support this process of peace and reconciliation must also be recognized,” he said. Pledges amounting to $4.1 million have been made by the governments of Australia, Germany, Japan, the Netherlands, New Zealand and Sweden as well as by corporations including global financial services provider Citigroup and TNT, the logistics company.
In an annual meeting of the World Health Organization’s (WHO) regional commission in Addis Ababa, Ethiopia, on Sunday, all 47 African member States unanimously adopted the new framework on how to implement the Global Technical Strategy for malaria in the region. It proposes specific priority interventions and actions to be implemented by member states to reach “an African region free of malaria.”“Malaria is no longer the leading cause of death among children in sub-Saharan Africa,” said WHO Regional Director for Africa Matshidiso Moeti in a news release. “We have made substantial progress in controlling malaria within our region. Since 2000, malaria death rates have plunged by 66 per cent, translating into 6.2 million lives saved, the vast majority of them being children.”Between 2000 and 2015, the number of malaria cases and deaths within Africa declined by 42 per cent and 66 per cent, respectively. However, Africa still bears the biggest malaria burden with roughly 190 million cases and 400,000 deaths in 2015 alone, accounting for 89 per cent and 91 per cent of the world’s total, respectively.In addition, over 800 million people in Africa are still at risk of malaria. In line with the Sustainable Development Goals, WHO reassures a firm commitment to eliminate the epidemic from the African continent by 2030, a target that would require an estimated $66 billion to achieve.“In 2015, two in three households in Africa did have their own insecticide-treated mosquito net, compared to only 2 per cent back in 2000,” said Ms. Moeti. “More and more children get to sleep under a net, and we need to continue to invest in changing people’s behaviours.”Some of the main challenges to tackle malaria include gaps in access to available prevention methods, the limited number of interventions available and increasing resistance to medicines and insecticides. In addition, weak health systems present a very high risk to malaria control and elimination. During the 2014 Ebola epidemic in West Africa, malaria control gains were lost in the severely affected countries of Liberia, Sierra Leone and Guinea.
CHICAGO — Lexi Held made five 3-pointers and scored a season-high 28 points, Chante Stonewall had 20 points, five rebounds and three steals, helping No. 16 DePaul beat Savannah State 124-61 on Monday night.DePaul scored 24 straight points in the first quarter and held Savannah State in single digits until Myasia Jones’ basket with 11 seconds left in the quarter. DePaul led 33-12 entering the second quarter, and the Lady Tigers had just 23 points by halftime.Dee Bekelja added 16 points with 12 rebounds and Sonya Morris made four 3-pointers and scored 13 points for DePaul (4-2). Stonewall had 50 points, 28 rebounds, 10 steals and seven assists in three games at the Cancun Challenge over the weekend.DePaul, which was edged Saturday on a last-second shot in overtime by No. 14 Syracuse, played its fourth of five games in a seven-day stretch. The Blue Demons play at No. 2 UConn on Wednesday.Heniaya Moton scored 11 points for Savannah State (2-3), which was held to 30.3 per cent shooting.The Associated Press
Josh Smith, the most diverse talent on the Atlanta Hawks’ roster, might not be on it beyond Thursday’s NBA trade deadline.The team’s leading scorer and shot-blocker is due to become an unrestricted free agent at the end of the season. He wants a maximum contract extension. The Hawks do not want to pay him a max contract. And so, to prevent him from leaving without receiving any compensation, Atlanta could trade him by 3 p.m. Thursday.Inquiries for Smith’s services are coming in, but as of late Tuesday, no offer made sense to Hawks general manager Danny Ferry.“We’re in a unique situation with the current roster being competitive but also having good cap flexibility going forward,” Ferry told The Atlanta Journal-Constitution. “Like most teams, we’re evaluating ourselves and looking at the opportunities that come to us, especially this time of year. If there’s an opportunity that makes sense for us for the long-term interest of the Hawks, we’ll look at it closely.”Smith said to the AJC: “I’ve just been going out and playing basketball and not worrying about anything but that. As long as I’m an Atlanta Hawk, my main concern is getting wins for this team.”The Hawks can offer Smith a maximum five-year contract worth approximately $94 million. The most any other team can offer him is four years at $70 million.Smith is one of eight expiring contracts on the Hawks’ roster. When all is over, they could have as much as $36 million in salary cap space.Other unrestricted free agents include Devin Harris, Zaza Pachulia, Kyle Korver, Anthony Morrow, Johan Petro and Anthony Tolliver. Only Al Horford ($12 million), Lou Willliams ($5.225 million) and John Jenkins ($1.258) are guaranteed next season. Jeff Teague and Ivan Johnson are eligible for qualifying offers. The Hawks have team options on DeShawn Stevenson and Mike Scott.“I don’t know,” Hawks coach Larry Drew said about a potential trade. “I have no idea. … I’ve been in situations where there have been potential deals that were right at the cusp and fell apart. I’ve been in situations where there has been a lot of talk and nothing happened. I have been in situations where things have happened. These situations, you never know. You don’t allow it to distract you. You don’t look at the what-ifs, the maybes. You keep taking it a day at a time.”Smith is averaging 24.5 points, 10 rebounds, 6.25 assists, 1.75 blocks and one steal. He is shooting 58.2 percent (39 of 67) from the field, including 10 for 15 from 3-point range.“Only because I’m tired of answering the same questions, ”Smith said when asked if he was anxious for the trade deadline to pass. “Like I’ve said a couple times, I understand it’s a business. This is like my fourth year where my name has been brought up in trade rumors and trade talks. For four years, I’ve had to consistently give the same answers. Other than that, I’m not worried about anything. I think my game speaks to where my mental edge is. I’m not worried about anything but being concerned with what I have to do on the court.”
The millionaire businessman who has admitted he was the mystery benefactor who donated a Rolls-Royce to Glasgow City Council said he was surprised by the furore it had caused.Boyd Tunnock, 84, boss of the eponymous confectionary firm that makes Tunnock’s Teacakes and Caramel Wafers, said he wanted the gift of his luxury car to be a “good thing”.But politicians criticised the move, with one Labour MP claiming it was“Dickensian” to have Lord Provost Eva Bolander – the first SNP politician to hold the post – driven around in a Rolls-Royce while local services were cut by “SNP austerity”.Mr Tunnok, who backed the Union in the 2014 independence referendum, said: “I have to say I’ve been a bit surprised by the reaction to this.All sorts of important people come to Glasgow and I thought it would be right to give them a nice experience.”Glasgow always had a Rolls Royce and I was able to give mine to the city so I thought, why not? “I really wanted this to be a good thing, but I didn’t want any credit for it so I asked the city to keep my name quiet, but I’m quite happy for people to know it’s me.” The Rolls-Royce Ghost, with a new price of around pounds230,000, is meant to replace one of the council’s fleet of Volkswagen Phaetons, and the authority said the gift would save it money.The car, bearing the council’s unique “G0” number-plate, will be used by the Lord Provost and other city representatives for civic duties as well as VIPs needing transportation.However, Ms Bolander used one of the VWs on Thursday to get to the reopening of the Willow Tea Rooms building in the city centre.Paul Sweeney, the MP who said it was like something out of Dickens, tweeted earlier this week: ”Nursery fees doubled and free swimming for kids the latest cuts. Auction it off to fund services for Glaswegians.”A spokesman for the local authority said: “It would clearly not be appropriate to buy a car such as this but having received it as a donation there will be occasions when it is appropriate to use it.”When she accepted the two-year-old vehicle on Tuesday, Ms Bolander said she it was a “show-stopping car and a tremendous asset”. Boyd Tunnock at the re-opening of the Willow Tea Rooms, designed by Charles Rennie MackintoshCredit:Wattie Cheung Want the best of The Telegraph direct to your email and WhatsApp? Sign up to our free twice-daily Front Page newsletter and new audio briefings.
PEACHES GELDOF HAS apologised for tweeting the names of the mothers involved in the recent, high-profile paedophilia case which led to the conviction of Lostprophets singer Ian Watkins.However, the journalist also defended her actions in a series of tweets to her 166,000 followers this morning. She said:“For all of those out there tweeting me about naming the paedophile mothers involved in the Ian Watkins case, the names have been in the public domain since 12 December when the court named them and put them up on their website for all to see – half of twitter had tweeted out the names also aside from my (now deleted) tweet.“The babies will most probably be given new identities to protect them from future abuse from other paedos who know who they are/ their names from the videos Watkins uploaded to Paedo websites (sic).The question of wether (sic) or not to give anonymity to criminals in cases like this will go on forever. However these women and Watkins will be getting three meals a day, a double bed, cable TV etc – all funded by the tax payer alongside not being named apparently. It makes me sad.“I deleted my tweets however and apologise for any offence caused as at the time of tweeting had only seen everyone tweeting the names at me so had assumed as they were also up on news websites and the crown courts public file that they had been released for public knowledge. Will check my facts before tweeting next time. apologies and lesson learned.”Geldof could face criminal charges for the indiscretion. South Wales police have confirmed they are investigating and will examine if prosecutions should be brought against her and others for identifying sexual offence victims who have lifetime anonymity under law.The victims’ mothers have been granted lifetime anonymity to ensure their children are protected. They were both convicted of serious sexual offences earlier this week. Lostprophets lead singer, Watkins, also pleaded guilty to a string of guilty offences, including the attempted rape of a baby and conspiring to sexually assault a child.Following the court case, Geldof had urged newspapers to print the names of the two female co-accused.Identifying victims of sexual offences is a crime in the UK under the Sexual Offences Act. A conviction can carry a fine of up to £5,000.“Anonymity for victims of sexual offences is a vital component of the criminal justice process,” commented the Crown Prosecution Service yesterday.“The CPS is liaising with South Wales police in relation to their investigation into allegations that the names of two women convicted alongside Ian Watkins have been placed in the public domain, contrary to legislation that protects the identity of victims by banning the publicising of information which would identify them.”A spokesperson for the Attorney General also made comment on the case. She said:“We understand that the names of the co-defendants in the Ian Watkins case were posted online but have now been removed.“As has been previously reported, the co-defendants were the mothers of the victims.“Victims of sexual offences have automatic lifetime anonymity and the publication of names or information which can lead to their being identified is a criminal offence. This is a police matter.”Read: Lostprophets lead singer pleads guilty to attempted baby rape
Not to be outdone by Amazon’s recent announcement marking the Kindle its “best-selling product of all-time,” Barnes & Noble declared its own eBook reader, the Nook Color, its “biggest bestseller ever in its nearly 40-year history.”Like Amazon’s own announcement, Barnes & Noble isn’t offering much in the way of concrete sales figures, but this certainly doesn’t bode well for print media–particularly not when quotes like “Barnes & Noble also announced that it now sells more digital books than its large and growing physical book business on BN.com” are bandied about.In the same press release the company noted that it moved almost one million NOOKbooks on Christmas Day this year, thanks to new titles by James Patterson, Stieg Larsson, John Grisham, and that George W. Bush guy. The Nook Color first hit the market on November 16th.
The fortunes of the euro zone’s most vulnerable economies have darkened markedly since June, according to a Reuters poll of economists that showed Spain will apply for an EU bailout within months.Forecasters polled this week slashed their 2013 economic outlook for Greece, Portugal and Spain, and said they will all fail to achieve budget deficit targets agreed with the European Commission.Among the struggling euro zone peripheral economies, only Ireland looks on course for a return to modest growth any time soon.While the survey pointed to a reduced likelihood Greece will exit the euro zone soon, it also underlined why Spain is the new focal point of the bloc’s sovereign debt crisis.Its economic woes – with spiralling unemployment topping the list – have further to run.“As Spain is stuck in a deep recession, markets will continue to have doubts on the medium-term solvency of Spain,” said Gernot Griebling, head of bond research at LBBW in Stuttgart.“As a consequence Spanish (government bond) yields and the corresponding spreads over Bunds will stay high or even climb further.”Spanish Prime Minister Mariano Rajoy last week inched closer to asking for an European Union bailout for his country, where government borrowing costs have failed to recede much from near-unsustainable levels.Economists said there was a median 68 percent chance of a full sovereign bailout, involving the EU’s official rescue funds, before the end of the year. June’s poll showed 35 out of 59 economists thought that was “likely” or “very likely”.ECB President Mario Draghi last week signalled it was preparing to buy Spanish and Italian bonds, but only after EU bailout funds were triggered and countries had asked for help.The poll suggested Spain’s economy will contract 1.6 percent this year and then 1.1 percent in 2013 – the latter forecast representing a sharp downgrade from the 0.7 percent decline in June’s survey.The unemployment rate, which at 24.6 percent in the second quarter hit its highest level since the Franco dictatorship ended in the mid-1970s, has further to climb.The poll showed it ending this year at 25 percent, and next year at 25.6 percent.The euro zone’s No.3 economy will also fall further behind on its budget deficit targets, even in light of euro zone ministers last week granting Madrid an extra year until 2014 to reach its goals.While it will come close to meeting this year’s budget deficit target of 6.3 percent of gross domestic product, the shortfall will only shrink to 5.0 percent in 2013, short of the 4.5 percent target, the poll showed.Dismissing the drachmaThere was a strong consensus that Greece will remain in the euro zone over the next 12 months, with 45 out of 64 economists in agreement – a stronger majority than the 35 of 64 in June’s poll.“We would expect the euro zone to strive to keep Greece in the euro as long as it proceeds with reforms. However, there is a tail risk of an uncontrolled exit, in the case official funding is cut,” said Marcus Sonntag, economist at Merrill Lynch.Still, the poll showed Greece faces vast challenges in escaping its depression, as analysts downgraded their GDP outlook for the fifth time in a row.The economy will shrink around 6.6 percent this year and then 2.0 percent next year, much worse than June’s poll which pencilled in declines of 5.8 percent and 1.3 percent, respectively.“The stabilisation of economic sentiment from its current weak fragile state will require a more constructive stance from EU partners, especially regarding the targeted speed of fiscal adjustment,” said Nicholas Magginas, economist at the National Bank of Greece.Indeed, economists see slow progress on Greece’s budget deficit. It will shrink from last year’s 9.3 percent to 8.0 percent this year, compared with its target of 7.3 percent, and just 6.8 percent in 2013.That would put Athens well off-track from its aim of getting the deficit below 3 percent by the end of 2014 from 9.3 percent in 2011.Portugal too suffered a cut to its outlook for next year. After shrinking 3.0 percent this year, the Portuguese economy is expected to decline around 1.0 percent in 2013, compared with a 0.6 percent contraction in the last poll.Similarly, it looks unlikely to meet its target of cutting its budget deficit to 3.0 percent in 2013, with the poll instead showing it at 3.7 percent by the end of next year.Ireland at least looks on track to return to modest economic growth, starting with 0.3 percent this year and quickening to 1.5 percent next year.That would put it more in line with the outlook for Europe’s bigger and more resilient economies.And unlike its peripheral peers, Ireland looks likely to beat its deficit target of 8.6 percent this year, with the poll suggesting it will come in at 8.3 percent of GDP.The findings backed up a separate poll of economists on Wednesday, which showed Ireland will benefit from stronger exports. Source: Reuters Facebook Twitter: @NeosKosmos Instagram
WhatsApp 11 matches scheduled for WWE Clash of Champions tonight in Charlotte, Live Post-Show Pinterest Now Playing Up Next WWE Lists The Shields Top 10 Wins Now Playing Up Next Videos Articles Ronda Rousey Smackdown Live Preview: Daniel Bryan still wants an apology, King of the Ring Quarterfinals Now Playing Up Next WWE And WrestleMania 34 Bring New Orleans A Big Payday Videos Articles Videos Articles Now Playing Up Next Brock Lesnar Takes WWE Universal Championship Drew Mcintyre WWE Confirms The Shield And Ronda Rousey At Super Show-Down Nikki Bella Facebook Adam Martin RELATED ARTICLESMORE FROM AUTHOR Now Playing Up Next WrestleMania Could Be Biggest Ever WWE will present the Crown Jewel event later today from Riyadh, Saudi Arabia at King Saud University Stadium live on the WWE Network this afternoon.Advertised for the show is Brock Lesnar vs. Braun Strowman to determine a new WWE Universal Champion and Shawn Michaels returning to the ring for the first time since 2010 when he teams with Triple H against The Undertaker and Kane.AJ Styles will also defend the WWE Championship against Samoa Joe, while an eight-man WWE World Cup Tournament will be taking place as well.The event itself had been in question for weeks following the disappearance and death of Washington Post journalist Jamal Khashoggi. WWE announced last Thursday that they would be going forward with the show after facing a “very difficult decision.”The company has received a tremendous amount of media backlash for continuing to remain associated with the Kingdom of Saudi Arabia following the death of the journalist, who was blatantly murdered in Istanbul according to Turkish authorities.Just announced this week was that newly reinstated Hall of Famer Hulk Hogan would be making an appearance and hosting the show later today. As of early Friday morning, WWE had yet to publicly confirm or advertise Hogan’s involvement with the show.Here is the card for today’s show beginning at Noon Eastern/11:00 a.m. CT:Match to crown a new WWE Universal ChampionBrock Lesnar vs. Braun StrowmanWWE ChampionshipAJ Styles (c) vs. Samoa JoeTriple H and Shawn Michaels vs. The Undertaker and KaneEight-Man WWE World Cup TournamentBrackets include:* Seth Rollins vs. Bobby Lashley (Winner faces Angle or Ziggler)* Kurt Angle vs. Dolph Ziggler (Winner faces Rollins or Lashley)* Jeff Hardy vs. The Miz (Winner faces Mysterio or Orton)* Rey Mysterio vs. Randy Orton (Winner faces Hardy or Miz)Smackdown Tag Team ChampionshipsThe Bar (c’s) vs. The New DayKickoff Show:WWE United States ChampionshipShinsuke Nakamura (c) vs. RusevWrestleview.com will have live coverage of WWE Crown Jewel later today beginning at Noon Eastern/11:00 a.m. CT along with live thoughts on Twitter via @wrestleview.Join us live on YouTube following Crown Jewel for a new Wrestleview Live! Google+ Twitter Recommended videosPowered by AnyClipWWE Confirms The Shield And Ronda Rousey At Super Show-DownVideo Player is loading.Play VideoPauseUnmuteDuration 0:32/Current Time 0:01Loaded: 100.00%0:01Remaining Time -0:31 FullscreenUp NextThis is a modal window.Beginning of dialog window. Escape will cancel and close the window.TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaqueFont Size50%75%100%125%150%175%200%300%400%Text Edge StyleNoneRaisedDepressedUniformDropshadowFont FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall CapsReset restore all settings to the default valuesDoneClose Modal DialogEnd of dialog window.Replay the list Chris Jericho takes on Hangman Page to crown first AEW Champion tonight on All Out
KUSI Newsroom SAN DIEGO (KUSI) – A man convicted of sex crimes against children was released from custody and placed in an East County home.Despite public outcry, sexually violent predator Alan James will live in a house in Jacumba Hot Springs.A judge had ordered James be released from custody by April 25th.Alan Earl James, 56, was convicted in 1981 and 1986 of numerous sex-related felonies involving several minor victims — which included James’ younger relatives– and sentenced to 28 years in state prison.James, who is classified as a “sexually violent predator,” was committed to Coalinga State Hospital, where he was undergoing treatment “for an indeterminate term,” until he petitioned for a monitored conditional release last summer, prosecutors said.RELATED: Hearing held to determine placement of convicted sex offender Alan James Categories: Local San Diego News FacebookTwitter KUSI Newsroom, Posted: April 11, 2019 Alan James placed in Jucumba Hot Springs home April 11, 2019
PORTLAND — The Oregon state medical examiner’s office said Tuesday a climber who died on Mount Hood suffered multiple injuries in a fall.The body of 59-year-old Dr. Kinley Adams, a Salem dentist, was recovered from the mountain Sunday, more than a week after he went missing.Adams was a longtime mountaineer who was on Mount Hood in preparation for a climb in Nepal.
Six police personnel, including two sub-inspectors and two assistant sub-inspectors, of Kosba police station were suspended on Tuesday night over allegedly hiding the information of drug recovery, reports UNB.The suspended policemen are sub-inspectors – Shyamal Mazumdar and Monir Hossain, assistant sub-inspectors – Faruque Hossain and Salauddin and constables – Shahjahan and Kashem.Police officials said the suspended police personnel recovered drug and seized two private cars on Tuesday morning from T-Ali intersection of Kosba upazila. Later, they hid the information of those recovery.Allegations of irregularities and negligence of duties were raised against them and they were suspended temporally, said Md Mohiuddin, officer-in-charge of Kosba police station.A probe body, headed by additional superintendent of Brahmanbaria police Md Iqbal Hossain, was formed to look into the matter, he added.
Technology | Mammography Reporting Software | July 25, 2019 Hologic Partners With MagView to Develop Unifi EQUIP Solution Hologic announced a partnership with mammography information solutions provider MagView to develop Unifi EQUIP, an… read more Figure 1Breast cancer screening has been on the forefront with the issue of breast density taking center stage. However, controversy surrounds the many contradicting studies that currently dictate the standards for breast cancer screening.At the recent 25th Annual Interdisciplinary Breast Center Conference (NCoBC), Sarah M. Friedewald, M.D., division chief of breast and women’s imaging, and medical director at Lynn Sage Comprehensive Breast Center, Northwestern Memorial Hospital in Chicago, discussed the main criticisms of screening mammography. These include recommendations by the United States Preventive Services Task Force (USPSTF) and the Swiss Medical Board, as well as concerns regarding overdiagnosis of breast cancer and the survival benefit in women who have been screened. Mammography is only approximately 70 percent sensitive for all breast types. For women with dense breasts, it’s even more limited — closer to 50 percent.1 According to Friedewald, because of these major differences in standard mammography, the limited sensitivity and high recall rate, traditional mammography has been highly criticized. USPSTF RecommendationsThe USPSTF was formed in 1984 as an independent volunteer panel of 16 members, with a mission to improve the health of the U.S. population. These members specialized in prevention and primary care, and targeted areas such as behavioral health, family medicine, geriatrics, internal medicine, pediatrics, OB/GYN and nursing. The task force made evidence-based recommendations about clinical, preventive services such as screening, counseling services and preventive medicine. In 1998, the Agency for Healthcare Research and Quality (AHRQ) was authorized by Congress to convene the task force and provide ongoing scientific, administrative and dissemination support. It continues to provide an annual report for Congress, which includes critical evidence gathered in research that relates to clinical preventive services, and also recommends key areas that deserve further examination. The result is a scorecard that was released in 2009, which is currently in the process of being updated. The new USPSTF set of recommendations is anticipated to be released this summer. In late April, USPSTF declined to expand its recommendation on which women should receive regular mammography screening, instead issuing a draft of new breast screening guidelines that parallel its 2009 findings. According to the U.S. Preventive Services Task Force website, the task force’s draft recommendations are designed for women 40 and older who do not show any signs or symptoms of breast cancer, who have not been previously diagnosed with breast cancer and who are not at high-risk for breast cancer, meaning they do not have a known genetic mutation or a history of chest radiation at a young age. Women at high-risk of breast cancer should consult their doctors for individualized recommendations regarding screening. It goes on to say that the task force recognizes mammograms can help women in their 40s reduce the risk of dying from breast cancer. Because the risk of developing breast cancer is lower in women under 50, the potential benefit of mammography for women under 50 is also smaller, according to USPSTF.As of April 20, 2015, the USPSTF screening recommendations were proposed as follows. For a complete definition of what these grades mean, see Figure 1: A Definition of USPSTF Grades.Women ages 50-74The USPSTF recommends screening mammography every two years for women ages 50 to 74 years.B recommendationWomen ages 40-49The decision to start screening mammography in women before age 50 should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin screening between the ages of 40 and 49 years. C recommendationWomen 75 and olderThe current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years and older.I statementIn a rebuttal to these new proposed recommendations, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) have issued a statement saying that adoption of the proposed USPSTF breast cancer screening recommendations draft would result in thousands of additional and unnecessary breast cancer deaths each year. Thousands more women would experience more extensive and expensive treatments than if their cancers were found early by a regular mammogram. Adoption of these USPSTF recommendations could also strip millions of women over 40 of private insurance coverage with no copay for mammograms at the time of their choosing previously guaranteed by the Affordable Care Act (ACA).Friedewald explained that according to the 2009 recommendations, it claimed that the harm of the screening outweighed the benefits, and there was psychological harm and unnecessary imaging tests for women without cancer, a significant inconvenience to the false positive screening results, and an overdiagnosis of cancer. “I’m going to tell you a little bit about the USPSTF,” said Friedewald. “There were no oncologists, radiologists or surgeons on the committee, none of the members were involved in breast cancer care, and their recommendations really were for average-risk women, which I think gets lost in the shuffle here. So we have a lot of women who are at high risk, but a lot of people just latch on to these recommendations and think that they are for everybody.“This review was based on data going back to 1963, rather than gathering new information, so there wasn’t a big study that came out that led to these new recommendations,” she continued. “Their data did not incorporate digital mammography. Interestingly, they were commissioned by Congress to determine the recommendations, but that was also the same year that the Affordable Care Act was passed into law. So there are some questions as to what the motivations were of the USPSTF.”To break this information down further, it’s important to look at the recommendation for screening given at age 50. “Age 50 is an arbitrary threshold not supported by trials, and it was historically chosen because it was a marker for menopause,” said Friedewald, explaining there is a concept of breast cancer being related to hormonal status. “But again, there is no data to support that screening should be given starting at age 50. In fact, we have data showing that it really should begin at age 40. We also did dispute the fact that there was a 15 percent reduction in mortality of women in their 40s, but they felt that the absolute number of women benefitting was small because of the incidence of cancer in that age group. There are varied numbers of people in this age group depending on the population at this time. So with the baby boomers, there were a lot of women in this age group; just because there may be a lower incidence, there still may be an absolute large number of women in this age group that would benefit from screening.”That’s starting at age 50, but what about bi-annual screening? The difficulty with this, said Friedewald, is that it decreases the opportunity to identify cancers at an earlier stage. She suggested that optimal screening time for women really should be half the sojourn time. Sojourn time is defined as the time between a tumor first becoming mammographically visible and the moment when the tumor was actually detected by mammogram.2 “The longer the screening intervals make the screening less effective. It’s important to recognize what the sojourn time is,” stressed Friedewald, explaining why screening every other year is problematic. “Estimates for the sojourn time are dependent on multiple factors, but the study done at Mass General used a median doubling time of 130 days and we were able to calculate the mean sojourn time for invasive breast cancers at 1.7 years. The USPSTF concluded that the harms could be cut in half if there was a change to biannual screening, but the benefit would be reduced if greater than 24-month intervals between screening. They obviously didn’t recognize the issue of sojourn time.”CNBSS StudyAnother controversial study is the Canadian National Breast Screening Study (CNBSS), where nearly 90,000 women participated. It was a prospective randomized control trial for women aged 40 to 59, broken down into two groups: women who had physical examinations plus screening mammography, and women who had a physical exam and usual care after the initial physical examination without screening. The patients were divided into two age groups: women in their 40s and women in their 50s. These seven-year results were published in 1992.“Their conclusion was screening with yearly mammography plus physical examination decreased significantly more, with no negative small tumors in the control group, no impact on the rate of death of breast cancer up to seven years follow-up from entry,” said Friedewald, stressing that a greater than seven-year follow-up is needed because a statistically significant number of women will need to die to demonstrate a benefit in the group. “Seven years is basically too short to show that there was no statistically significant difference in mortality.”A 25-year follow-up was conducted on patients in this study, and their conclusion was the same: It did not reduce the mortality of breast cancer beyond that physical examination and usual care, when screening for breast cancer is readily available. “Let’s dive a little bit deeper into the problems with this study,” said Friedewald. “There was poor randomization, all women had a physical examination prior to participation, allocation was not blinded and randomization was performed by a study coordinator at each of the study’s 15 sites. I think what shows proof of this is there is an excess of node-positive women in the screened group, which was statistically significant, and the survival in the control group was better than expected.” She explained that this meant there were healthier people in the control group, more than anticipated, and there were more serious cancers in the screened group. In addition, there was contamination and non-compliance. Friedewald went on to explain that the quality of imaging was poor, the technologists weren’t taught proper positioning and the radiologists had no specific training, which left it open for interpretation. “And then finally there was the separation of the two age groups. The women in their 40s really lacked the physical power, there weren’t enough people in those groups to show statistical significance,” she said. “There is no biological significance between the two age groups. For example, women who are age 49 are not statistically different from women who are 52.”OverdiagnosisIn a paper published in JAMA, Laura Esterman, M.D., discussed the difficulties of overdiagnosis, which Friedewald summarized in her presentation, saying that physicians, patients and the general public must recognize overdiagnosis as common, and that it occurs more frequently with cancer.3“So what is overdiagnosis? The concept is that many cancers detected by mammography are not clinically significant and do not cause death in patients,” said Friedewald. “When we’re talking about overdiagnosis we’re usually referring to ductal carcinoma in situ (DCIS). But it’s very difficult to estimate overdiagnosis because at the time of diagnosis, you can’t tell whether it’s a problem concerning a lesion or not. It really can only be estimated by the excess of incidence of breast cancer over a long period of time when you are screened compared to those who were not.”Many estimates wrongfully state an increased incidence of cancer in the screening group because they don’t have enough lead-time bias. “Screening mammography detects cancers prior to being clinically evident, but at the beginning of the screening program prevalent cancers get incorporated with the incident cancers because they are detected earlier, and by physical examination,” said Friedewald. “There’s a false sense that there are actually more cancers, but there is no change in the state of depth. That’s really what the lead-time bias is. So not only do they not account for the lead-time bias, but there is also too short of a follow-up.”It’s important to keep in mind that the incidence of invasive breast cancer is decreasing over time — about 1 percent per year, said Friedewald. “This is likely due to environmental factors, medication, increase in age, childbearing and the number of children a woman has,” she explained. “It’s not clear that all DCIS at some point will progress to this invasive cancer, or whether it will just stay as DCIS. So at the time of diagnosis we don’t have any way of knowing which ones will be the ones that are going to hurt the patient and which ones are not.”Friedewald said the focus should be on the understanding of molecular characteristics of DCIS so physicians can better understand the behavior of those cells and modify a treatment, rather than not screen patients. Swiss Medical Board AssessmentThe Swiss Medical Board, an independent health technology assessment board, prepared a review of mammography screening which was released in February 2014.4 This task force consisted of medical ethicists, clinical radiologists, surgeons and clinical pharmacologists. They published their perspective in the New England Journal of Medicine. Friedewald explained that their conclusion recommended against screening completely. They felt that the survival benefit may not be related to screening, citing studies from 1963-1991 showing a 20 percent reduction in mortality with screening mammography. The Swiss Medical Board concluded that the harms of screening mammography outweighed the benefits. They based this conclusion, in part, on a Canadian study that showed 22 percent of cancers were “overdiagnosed,” and there was no mortality decrease. They also cited that in a survey of women’s perceptions, women overestimate the value of mammography versus its actual benefit.Current U.S. Screening RecommendationsAccording to the American Cancer Society (ACS), American College of Radiology (ACR) and the American Congress of Obstetricians and Gynecologists (ACOG), annual screening mammography can begin at 40 as long as the woman is in good health. The ACS recommends that for early breast cancer detection, mammograms are a substantial benefit for women in their 40s, noting that mammography will miss some cancers, and sometimes can lead to follow-up, including biopsies, that are not cancer. “Women should be told about these benefits and limitations, and mammograms for older women should be based on the individual’s health and other serious illnesses such as congestive heart failure, end-stage renal disease, chronic obstructive pulmonary disease and dementia,” Friedewald said. “Age alone will not be the reason to stop having a regular mammogram.” References1. Bird, RE, Wallace TW, Yankaskas BC. “Analysis of cancers missed at screening mammography.” Radiology 1992. 184:613-617.2. Querci della Rovere, G, Warren R, Benson J. “Early Breast Cancer” Second Edition, Taylor & Francis Group, 2006.3. Esserman, L. “Viewpoint: Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement.” JAMA Aug. 23, 2013. Volume 210:8.4. “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board.” New England Journal of Medicine. May 22, 2014. FacebookTwitterLinkedInPrint分享 Figure 1 Feature | Artificial Intelligence | July 19, 2019 | Michal Chorev AI Models Predict Breast Cancer With Radiologist-level Accuracy Breast cancer is the global leading cause of cancer-related deaths in women, and the most commonly diagnosed cancer… read more News | Breast Imaging | August 02, 2019 Volpara to Distribute Screenpoint Medical’s Transpara AI Solution Volpara Solutions and ScreenPoint Medical BV signed an agreement under which Volpara will sell ScreenPoint’s Transpara… read more News | Mammography | August 14, 2019 Imago Systems Announces Collaboration With Mayo Clinic for Breast Imaging Image visualization company Imago Systems announced it has signed a know-how license with Mayo Clinic. The multi-year… read more Technology | Artificial Intelligence | July 18, 2019 Paragon Biosciences Launches Qlarity Imaging to Advance FDA-cleared AI Breast Cancer Diagnosis System Paragon Biosciences LLC announced the launch of its seventh portfolio company, Qlarity Imaging LLC, which was founded… read more IBM collected a dataset of 52,936 images from 13,234 women who underwent at least one mammogram between 2013 and 2017, and who had health records for at least one year prior to the mammogram. The algorithm was trained on 9,611 mammograms. Image courtesy of Radiology. Image courtesy of Imago Systems Technology | Breast Biopsy Systems | July 24, 2019 Fujifilm Releases Tomosynthesis Biopsy Option for Aspire Cristalle Mammography System Fujifilm Medical Systems U.S.A. Inc. recently expanded its breast imaging solutions with the launch of its… read more Feature | May 04, 2015 | Melinda Taschetta-Millane Controversies in Breast Cancer Screening A look into the controversial and confusing studies that currently dictate the standards for breast cancer screening Qlarity Imaging’s software is used to assist radiologists in the assessment and characterization of breast lesions. Imaging features are synthesized by an artificial intelligence algorithm into a single value, the QI score, which is analyzed relative to a database of reference abnormalities with known ground truth. Image courtesy of Business Wire. Related Content News | PACS | August 09, 2019 Lake Medical Imaging Selects Infinitt for Multi-site RIS/PACS Infinitt North America will be implementing Infinitt RIS (radiology information system)/PACS (picture archiving and… read more News | Artificial Intelligence | August 13, 2019 Artificial Intelligence Could Yield More Accurate Breast Cancer Diagnoses University of California Los Angeles (UCLA) researchers have developed an artificial intelligence (AI) system that… read more News | Ultrasound Women’s Health | July 11, 2019 FDA Clears Koios DS Breast 2.0 AI-based Software Koios Medical announced its second 510(k) clearance from the U.S. Food and Drug Administration (FDA). PreviousNext News | Mammography Reporting Software | July 26, 2019 Ikonopedia Releases Automated Combined Reporting Package at AHRA Ikonopedia showcased its recently released Automated Combined Reporting package and its entire suite of structured… read more read more
4 ways to protect your company from cyber breaches WASHINGTON (AP) — A final hurdle to President Barack Obama’s trade agenda is crumbling as House Democrats abandon any coordinated effort to block a job retraining program that Obama wants.Some anti-free-trade Democrats had urged the defeat of a program that’s usually a Democratic favorite. They saw that strategy as a possible way to thwart Obama’s larger trade priority — special negotiating authority known as fast-track. Sponsored Stories 5 ways to recognize low testosterone Quick workouts for men Top Stories Comments Share Here’s how to repair and patch damaged drywall Ex-FBI agent details raid on Phoenix body donation facility New Valley school lets students pick career-path academies Obama has said he expects to enact fast-track and the retraining program simultaneously.The Senate is poised to give final passage to fast track. Several top Democrats say free-trade opponents no longer have incentives to block the job retraining program.A key Democrat on trade — Michigan Rep. Sander Levin — says he expects a large majority of Democrats to support the program.Copyright © The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Milstead says best way to stop wrong-way incidents is driving sober
AddThis Sharing ButtonsShare to TwitterTwitterShare to FacebookFacebookShare to RedditRedditShare to 電子郵件Email by The Associated Press Posted Nov 18, 2018 12:31 pm PDT NEW YORK — Justin Bieber and Hailey Baldwin are confirming their long rumoured marriage. On Instagram, at least.The 24-year-old Canadian singer posted a picture on Instagram earlier this week of him holding hands with the 21-year-old model with the caption: “My wife is awesome.”Baldwin followed up by changing her Instagram username to “Hailey Bieber.”The young couple got engaged this summer in the Bahamas after about a month of dating. Bieber also confirmed that via Instagram. He posted a photo of Baldwin kissing him and called her the love of his life.Baldwin is the daughter of actor Stephen Baldwin. Bieber released his last album, “Purpose,” in 2015.Bieber’s manager didn’t immediately respond to an email seeking comment.The Associated Press Justin Bieber, Hailey Baldwin confirm marriage on Instagram
BRITISH airline easyJet cancelled all its Gatwick flights on Thursday, including two to Cyprus, after drones flying near the airport grounded flights.The airline said the disruption was expected to continue into Friday.“At this stage, there is no indication of when the airport might re-open and as a result we have cancelled all flights due to operate to or from London Gatwick today (Thursday),” easyJet said in a statement.“We expect disruption to continue into tomorrow (Friday).”At least two easyJet flights from Gatwick to Cyprus were affected. One was to Paphos airport, which had been due to arrive at 1.40pm, the other to Larnaca scheduled to land at 7.35pm.Thousands remained stranded at Gatwick airport after it was closed when two drones were spotted flying over the airfield on Wednesday and one was also seen on Thursday.One of the stuck passengers, Andri Kyprianou from Cyprus, told a British newspaper she saw a pregnant woman sleeping on the floor and passengers with infants spending the night in the “freezing” South Terminal.She said she got to the airport at 12.30am for a 3am flight to Cyprus via Kiev, only to find it had been cancelled and the next connection to Kiev is on Sunday.She said: “I haven’t slept since yesterday morning, we are very tired. It’s freezing, we are cold, having to wear all of these coats for extra blankets.“There were pregnant women, one of them was sleeping on the floor. There were people with small babies in here overnight, we saw disabled people on chairs.”You May LikeFreedom Debt ReliefPeople In Heavy Debt Are In For A SurpriseFreedom Debt ReliefUndoPlarium I Vikings: Free Online GamePlay this for 1 minute and see why everyone is addictedPlarium I Vikings: Free Online GameUndoComparisons.org2019: Little-Known Rule in Rowland Heights, CAComparisons.orgUndo Pensioner dies after crash on Paphos-Polis roadUndoRemand for pair in alleged property fraud (Updated)UndoThree arrested in connection with hotel theftsUndoby Taboolaby Taboola
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