Search Results (27)

Background/Objectives: Surveillance of women at increased risk for breast cancer requires high-sensitivity imaging. This study compared contrast-enhanced mammography (CEM) with low-energy CEM (LE-CEM) and breast MRI in this population. Methods: This retrospective analysis included 461 women enrolled in a high-risk imaging protocol (March 2019–October 2022). Lifetime breast cancer risk was estimated using the Tyrer–Cuzick model. All participants underwent CEM and breast MRI ≥ 72 h apart. LE-CEM images were used as a surrogate for digital mammography. Four readers independently interpreted LE-CEM and CEM; a separate group of four readers interpreted MRI. Diagnostic performance was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) within a multireader, multicase framework. Noninferiority testing was performed with Δ = 0.05. Mean glandular dose (MGD) for CEM was recorded. Results: CEM showed higher sensitivity than LE-CEM (83.0% vs. 68.9%, p < 0.001) with similar specificity (90.8% vs. 92.5%, p = 0.176). Mean AUC increased from 0.856 for LE-CEM to 0.936 for CEM (p < 0.001). CEM and MRI showed comparable sensitivity (82.9% vs. 86.1%, p = 0.547), specificity (90.8% vs. 86.5%, p = 0.318), and mean AUC (0.936 vs. 0.933; p = 0.839), confirming noninferiority of CEM. MGD per view ranged from 1.56 to 3.10 mGy. Conclusions: Contrast-enhanced mammography provides diagnostic accuracy equivalent to breast MRI and superior to LE-CEM, with acceptable radiation dose, supporting its use for surveillance in women at increased breast cancer risk. Full article

Background/Objectives: This study explored the associations of normal breast tissue characteristics on multiparametric MRI with clinical assessments of breast cancer risk in women with dense breasts. Methods: Women with dense breasts who underwent multiparametric MRI were included. Breast cancer risk was determined based on Tyrer–Cuzick (TC) lifetime risk scores, categorized as high (TC ≥ 20%) or low risk. Qualitative background parenchymal enhancement (BPE) assessment was obtained from imaging reports. Quantitative imaging markers were calculated, including median BPE, median apparent diffusion coefficient, and volume measures of the whole breast, fibroglandular tissue (FGT), blood vessels, and BPE regions. The associations between imaging markers and TC risk groups were evaluated using age-adjusted logistic regression and summarized by area under the receiver operating characteristic curve (AUC). Results: Seventy-seven women were evaluated; a total of 20 (26%) were low risk, and 57 (74%) were high risk. After adjusting for age and multiple testing, BPE:breast ratio (adj. p = 0.037), FGT:breast ratio (adj. p = 0.046), and BPE:vessel ratio (adj. p = 0.037) were positively associated with risk, while qualitative BPE was not (adj. p = 0.11). Overall, risk categorizations based on imaging markers were concordant with TC score in up to 70% of women. Conclusions: In women with dense breasts, quantitative measures from multiparametric MRI (BPE:breast, FGT:breast, and BPE:vessel ratios) moderately discriminated high- and low-risk groups, warranting further investigation of their value to supplement conventional breast cancer risk assessment tools. Full article

The use of recycled glass powder (RCGP) is investigated as a partial replacement for ground granulated blast furnace slag in blended CEM II/A-LL cements using thermodynamic modelling to simulate cement paste hydration at a water-to-cement (w/c) ratio of 0.5. This study allows a rapid means of examining the likely evolution of these materials over the first two to three years, allowing experimental work to focus on promising formulations. A comparison is made between the evolving solid phase and solution chemistries of four materials: a standard Portland-limestone (CEM II/A-LL), a ‘control’ blend, comprising equal quantities of CEM II/A-LL with GGBS and two novel blended cements containing RCGP. These represent 15% replacement (by mass) of GGBS by RCGP blended with either 40% or 60% CEM II/A-LL. The simulations were performed using the code HYDCEM, a cement hydration simulator, which calls on the thermodynamic model PHREEQC to sequentially simulate the evolution of the four cements. The results suggest that partial replacement of GGBS by 15% RCGP results in no significant change in system chemistry. The partial replacement of cementitious slag by waste container glass provides a route by which this material can be diverted from the landfill inventory, and the mass-balance and energy balance implications will be reported elsewhere. Full article

Leaching from cement can lead to a loss in performance and durability and can also have an environmental impact. Therefore, it is an important aspect to consider when new cements are being developed and where concrete is to be placed that could lead to the contamination of groundwater. Calibrated thermodynamic models can provide very useful predictions in a matter of seconds for any cement-based material. However, such models need to include accurate representations of the solid-solution nature of the C-S-H gels that are included for the incongruent dissolution of calcium and silica. This study presents the calibration of a thermodynamic model employing the pH-REdox-Equilibrium geochemical software 3.8.7, written in C (PHREEQC 3.8.7), to model the change in the pH and the leaching of calcium (Ca) and silica (Si) from cement against the Ca/Si ratio and over time. The predicted concentrations of Ca and Si and the pH in the leachate were calculated using three solid-solution C-S-H gel models that were taken from the cemdata18 database, namely, CSHQ, CSH3T, and tobermorite–jennite, which have not been analysed before and show good agreement. The calibrated model was used to predict leaching from a CEM II/A-L cement and a blended CEM I + fly-ash with a cement replacement level of 35%. The effect of a sulphate environment (Na₂SO₄) was also analysed. Full article

Background: Tolerance and dependence stand out as the most relevant risks observed during benzodiazepine (BZD) treatments. Objectives: To evaluate the degree of dependence of patients on BZD treatments using the Tyrer test; to define a profile of patients at risk of developing BZD dependence; and to discuss the role of the pharmaceutical care offered by the community pharmacy during dispensing. Methods: Prospective cross-sectional descriptive observational study (August 2020–February 2021) involving 127 patients using BZD. They voluntarily answered a questionnaire during the dispensing pharmaceutical care service. The study was evaluated and codified (code: DAA-CLO-2020-01) by the Spanish Agency for Drugs and Health Products (AEMPS), and statistical analysis was performed with SPSS 25.0. Results: 19.05% of patients using BZD were suspected of suffering from BZD tolerance, and 77.88% of all patients were identified as being at a high risk of BZD dependence. The Tyrer test for dependence indicated a mean score of 5.59 out of 13 points. An 18-fold increased risk of developing dependence was detected in the case of coexistence of high anxiety or depression. Conclusions: The community pharmacy, through protocolized care practices and supported by tools such as the Tyrer test, can play a decisive role in the detection, prevention, and resolution of the risks associated with BZD treatments. Full article

Obesity is a risk factor for postmenopausal breast cancer (BC), and evidence suggests a role for adiponectin in the relationship between obesity and BC. We investigated whether adiponectin or other biomarkers mediate the effect of body mass index (BMI) on postmenopausal BC risk in a cohort study nested in the IBIS-II Prevention Trial. We measured adiponectin, leptin, IGF-I, IGFBP-1, high-sensitivity C-reactive protein, glycemia, insulin, HOMA-IR index, and SHBG in baseline and 12-month serum samples from 123 cases and 302 matched controls in the placebo arm of the IBIS-II Prevention trial. We conducted the main mediation analysis considering baseline BMI as an exposure and the 12-month adiponectin increase as a mediator after adjustment for the Tyrer–Cuzick score and the lipid-lowering medications/supplements use. In the multivariable Cox model, both the 12-month adiponectin increase (HR, 0.60; 95%CI, 0.36–1.00) and BMI were associated with BC risk (HR, 1.05; 95%CI, 1.00–1.09), with a 40% reduction in women with a 12-month increase in adiponectin. A significantly higher cumulative hazard of BC events was observed in obese women (BMI > 30) with decreased adiponectin (p = 0.0087). No mediating effect of the adiponectin increase on the total effect of BMI on BC risk was observed (natural indirect effect: HR, 1.00; 95%CI, 0.98–1.02). Raising adiponectin levels might be an attractive target for postmenopausal BC prevention. Full article

The purposes of this study were to develop an artificial intelligence (AI) model for future breast cancer risk prediction based on mammographic images, investigate the feasibility of the AI model, and compare the AI model, clinical statistical risk models, and Mirai, a state of-the art deep learning algorithm based on screening mammograms for 1–5-year breast cancer risk prediction. We trained and developed a deep learning model using a total of 36,995 serial mammographic examinations from 21,438 women (cancer-enriched mammograms, 17.5%). To determine the feasibility of the AI prediction model, mammograms and detailed clinical information were collected. C-indices and area under the receiver operating characteristic curves (AUCs) for 1–5-year outcomes were obtained. We compared the AUCs of our AI prediction model, Mirai, and clinical statistical risk models, including the Tyrer–Cuzick (TC) model and Gail model, using DeLong’s test. A total of 16,894 mammograms were independently collected for external validation, of which 4002 were followed by a cancer diagnosis within 5 years. Our AI prediction model obtained a C-index of 0.76, with AUCs of 0.90, 0.84, 0.81, 0.78, and 0.81, to predict the 1–5-year risks. Our AI prediction model showed significantly higher AUCs than those of the TC model (AUC: 0.57; p < 0.001) and Gail model (AUC: 0.52; p < 0.001), and achieved similar performance to Mirai. The deep learning AI model using mammograms and AI-powered imaging biomarkers has substantial potential to advance accurate breast cancer risk prediction. Full article

This paper explores the potential of a new source of fly ash, deposited on the site of a coal-fired power plant in Ireland dating from 1985 to 1995, as a cement replacement material. A series of X-ray diffraction (XRD) analyses on binder samples with cement replacement levels of 0, 10, 25 and 35% was undertaken to determine the fly ash’s mineralogical composition and to determine its suitability as a supplemental cementitious material (SCM). The XRD results reveal a unique mineral composition with promising characteristics for enhancing the strength and durability of concrete. The experimental results were used to calibrate a thermodynamic model to predict changing phase assemblage and hydration behaviour over time and per replacement level. Thermodynamic models have been shown to give credible predictions of the long-term performance of cements, including SCMs. The initial experimental results’ thermodynamic modelling demonstrates the feasibility of this fly ash source as a sustainable alternative to traditional cement, paving the way for more eco-friendly construction. Ash deposits dating from 1995 to 2005 and from 2005 to the present will be presented in subsequent publications. Full article

The C(sp²)-aryl sulfonate functional group is found in bioactive molecules, but their synthesis can involve extreme temperatures (>190 °C or flash vacuum pyrolysis) and strongly acidic reaction conditions. Inspired by the 1917 Tyrer industrial process for a sulfa dye that involved an aniline N(sp²)-SO₃ intermediate en route to a C(sp²)-SO₃ rearranged product, we investigated tributylsulfoammonium betaine (TBSAB) as a milder N-sulfamation to C-sulfonate relay reagent. Initial investigations of a stepwise route involving TBSAB on selected anilines at room temperature enabled the isolation of N(sp²)-sulfamate. Subsequent thermal rearrangement demonstrated the intermediary of a sulfamate en route to the sulfonate; however, it was low-yielding. Investigation of the N-sulfamate to C--sulfonate mechanism through control experiments with variation at the heteroatom positions and kinetic isotope experiments (KIE^H/D) confirmed the formation of a key N(sp²)-SO₃ intermediate and further confirmed an intermolecular mechanism. Furthermore, compounds without an accessible nitrogen (or oxygen) lone pair did not undergo sulfamation- (or sulfation) -to-sulfonation under these conditions. A one-pot sulfamation and thermal sulfonation reaction was ultimately developed and explored on a range of aniline and heterocyclic scaffolds with high conversions, including N(sp²)-sulfamates (O(sp²)-sulfates) and C(sp²)-sulfonates, in up to 99 and 80% (and 88% for a phenolic example) isolated yield, respectively. Encouragingly, the ability to modulate the ortho-para selectivity of the products obtained was observed under thermal control. A sulfonated analog of the intravenous anesthetic propofol was isolated (88% yield), demonstrating a proof-of-concept modification of a licensed drug alongside a range of nitrogen- and sulfur-containing heterocyclic fragments used in drug discovery. Full article

The high kaolinite content of metakaolin makes it valuable to other industries, thereby affecting its availability and affordability for the production of limestone calcined clay cement (LC³). This work presents a study on the potential utilization of low-grade clay in place of pure metakaolin in the preparation of LC³ for mortar formulations. CEM I was partially substituted with calcined clay and limestone by 20, 30, 40, and 50 wt.%. The weight ratio of calcined clay and limestone was maintained at 2:1 for all mixes and the water-to-binder ratio was 0.48. X-ray diffraction (XRD), thermogravimetric analysis (TGA), and isothermal conduction calorimetry were used to study the hydration process and products after 28 days. Mechanical and durability assessments of the LC³ mortar specimens were conducted. LC³ specimens (marked LC20%, LC30%, LC40%, and LC50%) trailed the control sample by 1.2%, 4%, 9.8%, and 18%, respectively, at 28 days and 1.6%, 2.3%, 3.6%, and 5.5%, respectively, at 91 days. The optimum replacement of OPC clinker, calcined clay, and limestone was 20% (LC20%). Full article

The use of compacted bentonites in radioactive waste repository barriers is a relevant application of geoenvironmental engineering. The on-site structural characteristics of the bentonites determine the performance and integrity of the barrier. The present work addresses the adaptation of the standardized sand equivalent shaking method for the controlled disaggregation of Wyoming bentonite specimens prepared at low, medium, and high compaction. The evolution of the macrostructural units’ size distribution was determined by sieving at different shaking times. The stability of the compacted material increases with dry density. However, if enough energy is applied in the disaggregation process, the size distribution of the macrostructural units after disaggregation has the same characteristics as that of the uncompacted starting material, regardless of the applied degree of compaction. Since the disaggregation rate is a function of the aggregation level (compaction), it follows that compaction energy is not only spent on reducing porosity but also on generating more stable macrostructural units. These findings pave the way for future research with different materials and test conditions (compaction, moisture, etc.). In addition, the proposed shaking method is adaptable and could also be used in other sectors, such as agriculture, to determine the structural stability of natural soils. Full article

Urban tunnelling can be highly challenging, especially in areas where limited ground settlements and environmental disturbance is required. Mechanised tunnelling is usually preferred in such ground environments, specifically Slurry or EPBM (Earth Pressure Balance Machine), depending on the ground properties. Being able to predict the anticipated tunnel behaviour at the preliminary stages of the project can be very beneficial in optimising not only the design, but also control the construction activities and completion times. In practice, the short-term excavation response and support performance focus primarily on design, since most site characterisation inputs are focused on material properties gained from short-term testing. Although the analysis of tunnelling is a three-dimensional (3D) problem, conventional approaches and design methods employed during the design and construction of underground openings are often based on the ground’s static response in two dimensions (2D). In this paper, an initial 2D model is generated in PLAXIS2D and RS2 (Rocscience) to test advanced constitutive models and compare transverse settlement profiles; subsequently, a complete 3D FEM numerical model in RS3 (Rocscience) was used to simulate an Earth Pressure Balance (EPB) excavation sequence. The 3D numerical model simulates the relevant EPB components such as face pressure, TBM shield, backfilling of the tail void (time-dependent hardening of the grout) and gradual segmental lining erections in the longitudinal direction. The presented numerical approach can be used by tunnel designers and engineers to predict the soil response in EPBM tunnelling. Full article

Background: Image-derived artificial intelligence (AI) risk models have shown promise in identifying high-risk women in the short term. The long-term performance of image-derived risk models expanded with clinical factors has not been investigated. Methods: We performed a case–cohort study of 8110 women aged 40–74 randomly selected from a Swedish mammography screening cohort initiated in 2010 together with 1661 incident BCs diagnosed before January 2022. The imaging-only AI risk model extracted mammographic features and age at screening. Additional lifestyle/familial risk factors were incorporated into the lifestyle/familial-expanded AI model. Absolute risks were calculated using the two models and the clinical Tyrer–Cuzick v8 model. Age-adjusted model performances were compared across the 10-year follow-up. Results: The AUCs of the lifestyle/familial-expanded AI risk model ranged from 0.75 (95%CI: 0.70–0.80) to 0.68 (95%CI: 0.66–0.69) 1–10 years after study entry. Corresponding AUCs were 0.72 (95%CI: 0.66–0.78) to 0.65 (95%CI: 0.63–0.66) for the imaging-only model and 0.62 (95%CI: 0.55–0.68) to 0.60 (95%CI: 0.58–0.61) for Tyrer–Cuzick v8. The increased performances were observed in multiple risk subgroups and cancer subtypes. Among the 5% of women at highest risk, the PPV was 5.8% using the lifestyle/familial-expanded model compared with 5.3% using the imaging-only model, p < 0.01, and 4.6% for Tyrer–Cuzick, p < 0.01. Conclusions: The lifestyle/familial-expanded AI risk model showed higher performance for both long-term and short-term risk assessment compared with imaging-only and Tyrer–Cuzick models. Full article

Background: The benefits and harms of breast screening may be better balanced through a risk-stratified approach. We conducted a systematic review assessing the accuracy of questionnaire-based risk assessment tools for this purpose. Methods: Population: asymptomatic women aged ≥40 years; Intervention: questionnaire-based risk assessment tool (incorporating breast density and polygenic risk where available); Comparison: different tool applied to the same population; Primary outcome: breast cancer incidence; Scope: external validation studies identified from databases including Medline and Embase (period 1 January 2008–20 July 2021). We assessed calibration (goodness-of-fit) between expected and observed cancers and compared observed cancer rates by risk group. Risk of bias was assessed with PROBAST. Results: Of 5124 records, 13 were included examining 11 tools across 15 cohorts. The Gail tool was most represented (n = 11), followed by Tyrer-Cuzick (n = 5), BRCAPRO and iCARE-Lit (n = 3). No tool was consistently well-calibrated across multiple studies and breast density or polygenic risk scores did not improve calibration. Most tools identified a risk group with higher rates of observed cancers, but few tools identified lower-risk groups across different settings. All tools demonstrated a high risk of bias. Conclusion: Some risk tools can identify groups of women at higher or lower breast cancer risk, but this is highly dependent on the setting and population. Full article