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To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. • Post-operative breast MRI accurately defines residual disease of ≥5 mm. • Surgical cavity sensitivities were high for both invasive carcinoma and DCIS. • Post-surgical changes and very small residual disease (

This research was undertaken while E.W. held a NERC-funded Doctoral Training grant (NE/K500847/1). This research was also supported by a Young Research Workers award to E.W. from the Quaternary Research Association.

High-resolution analyses of plant macrofossils, testate amoebae, pollen, mineral content, bulk density, and carbon and nitrogen were undertaken to examine the late Holocene dynamics of two permafrost peatlands in Abisko, Subarctic Sweden. The peat records were dated using tephrochronology, 14C and 210Pb. Local plant succession and hydrological changes in peatlands were synchronous with climatic shifts, although autogenous plant succession towards ombrotrophic status during peatland development was also apparent. The Marooned peatland experienced a shift ca. 2250 cal yr BP from rich to poor fen, as indicated by the appearance of Sphagnum fuscum. At Stordalen, a major shift to wetter conditions occurred between 500 and 250 cal yr BP, probably associated with climate change during the Little Ice Age. During the last few decades, the testate amoeba data suggest a deepening of the water table and an increase in shrub pollen, coinciding with recent climate warming and the associated expansion of shrub communities across the Arctic. Rates of carbon accumulation vary greatly between the sites, illustrating the importance of local vegetation communities, hydrology and permafrost dynamics. Multiproxy data elucidate the palaeoecology of S. lindbergii and show that it indicates wet conditions in peatlands. Copyright © 2017 John Wiley & Sons, Ltd.

Fine ash produced during volcanic eruptions can be dispersed over a vast area, where it poses a threat to aviation, human health and infrastructure. We analyse the particle size distributions, geochemistry and glass shard morphology of 19 distal (>1000 km from source) volcanic ash deposits distributed across northern Europe, many geochemically linked to a specific volcanic eruption. The largest glass shards in the cryptotephra deposits were 250 µm (longest axis basis). For the first time, we examine the replicability and reliability of glass shard size measurements from peatland and lake archives. We identify no consistent trend in the vertical sorting of glass shards by size within lake and peat sediments. Measuring the sizes of 100 shards from the vertical sample of peak shard concentration is generally sufficient to ascertain the median shard size for a cryptotephra deposit. Lakes and peatlands in close proximity contain cryptotephras with significantly different median shard size in four out of five instances. The trend toward a greater amount of larger shards in lakes may have implications for the selection of distal sites to constrain the maximum glass shard size for modelling studies. Although the 95th percentile values for shard size generally indicate a loss of larger shards from deposits at sites farther from the volcano, due to the dynamic nature of the controls on tephra transport even during the course of one eruption there is no simple relationship between median shard size and transport distance.

To assess the incidence of benign and malignant internal mammary lymph nodes (IMLNs) at magnetic resonance (MR) imaging among women with a history of treated breast cancer and silicone implant reconstruction.The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women were identified who (a) had breast cancer, (b) underwent silicone implant oncoplastic surgery, and (c) underwent postoperative implant-protocol MR imaging with or without positron emission tomography (PET)/computed tomography (CT) between 2000 and 2013. The largest IMLNs were measured. A benign IMLN was pathologically proven or defined as showing 1 year of imaging stability and/or no clinical evidence of disease. Malignant IMLNs were pathologically proven. Incidence of IMLN and positive predictive value (PPV) were calculated on a per-patient level by using proportions and exact 95% confidence intervals (CIs). The Wilcoxon rank sum test was used to assess the difference in axis size.In total, 923 women with breast cancer and silicone implants were included (median age, 46 years; range, 22-89 years). The median time between reconstructive surgery and first MR imaging examination was 49 months (range, 5-513 months). Of the 923 women, 347 (37.6%) had IMLNs at MR imaging. Median short- and long-axis measurements were 0.40 cm (range, 0.20-1.70 cm) and 0.70 cm (range, 0.30-1.90 cm), respectively. Two hundred seven of 923 patients (22.4%) had adequate follow-up; only one of the 207 IMLNs was malignant, with a PPV of 0.005 (95% CI: 0.000, 0.027). Fifty-eight of 923 patients (6.3%) had undergone PET/CT; of these, 39 (67.2%) had IMLN at MR imaging. Twelve of the 58 patients (20.7%) with adequate follow-up had fluorine 18 fluorodeoxyglucose-avid IMLN, with a median standardized uptake value of 2.30 (range, 1.20-6.10). Only one of the 12 of the fluorodeoxyglucose-avid IMLNs was malignant, with a PPV of 0.083 (95% CI: 0.002, 0.385).IMLNs identified at implant-protocol breast MR imaging after oncoplastic surgery for breast cancer are overwhelmingly more likely to be benign than malignant. Imaging follow-up instead of immediate metastatic work-up may be warranted.

The volcanic ash or ‘tephra’ cloud resulting from the relatively small (volume and VEI) eruption of the Icelandic volcano Eyjafjallajokull in 2010 caused major air travel disruption, at substantial global economic cost. On several occasions in the past few centuries, Icelandic eruptions have created ash and/or sulphur dioxide clouds which were detected over Europe (e.g. Hekla in 1947, Askja in 1875, and Laki in 1783). However, these historical observations do not represent a complete record of events serious enough to disrupt aviation in Europe. The only feasible evidence for this is within the geological tephra record. Ash layers are preserved in bogs and lakes where tephra deposited from the atmosphere is incorporated in the peat/mud. In this article we: 1, introduce the analysis of the Northern European sedimentary tephra record; 2, discuss our findings and modelling results; 3, highlight how these were misinterpreted by the popular media; and 4, use this experience to outline several existing problems with current tephra studies and suggest agendas for future research.

The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI. Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT. Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P = 0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT. BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT. • Background parenchymal enhancement significantly decreases at breast MRI following oophorectomy. • Fibroglandular tissue significantly decreases on breast MRI following oophorectomy. • Decrease in background parenchymal enhancement is greater than in fibroglandular tissue. • Decrease in background parenchymal enhancement occurs earlier than in fibroglandular tissue.

Tephra layers can form useful age-equivalent stratigraphic markers for correlating palaeoenvironmental sequences and they provide information about the spatio-temporal nature of past volcanic ash fall events. The use of microscopic ‘cryptotephra’ layers has both increased the stratigraphic resolution of tephra sequences in proximal areas and extended the distal application of tephrochronology to regions of the world situated far from volcanoes. Effective tephrochronology requires the discrimination between in situ tephra deposited directly from volcanic plumes and tephras that have been remobilised since their initial deposition. We present tephrostratigraphic and glass chemistry data from two proximal peat profiles (one lowland, one upland) from the Shetland Islands, UK. Both profiles contain the Hekla-Selsund tephra (deposited c. 1800–1750 cal. BC), whilst the Hekla 4 ash (c. 2395–2279 cal. BC) is present in the upland record. Overlying the Hekla-Selsund tephra are a number of distinct peaks in tephra shard abundance. The geochemistry of these layers shows that they represent re-working of the Hekla 4 and Hekla-Selsund layers rather than primary air-fall deposits. Pollen analysis of the peat sequences illustrates that these re-deposited tephra layers are coincident with a rise in heather-dominated vegetation communities (heath and/or moorland) and a subsequent intensification of burning in the landscape. We suggest that burning caused increased erosion of peats resulting in the remobilisation of tephra shards. The study demonstrates both the need for caution and the opportunities created when applying tephrochronologies in regions heavily affected by past human activity that contain both reworked tephra layers and in situ fallout.

The use of volcanic ash layers for dating and correlation (tephrochronology) is widely applied in the study of past environmental changes. We describe the first cryptotephra (non-visible volcanic ash horizon) to be identified in the Amazon basin, which is tentatively attributed to a source in the Ecuadorian Eastern Cordillera (0–1°S, 78-79°W), some 500-600 km away from our field site in the Peruvian Amazon. Our discovery 1) indicates that the Amazon basin has been subject to volcanic ash fallout during the recent past; 2) highlights the opportunities for using cryptotephras to date palaeoenvironmental records in the Amazon basin and 3) indicates that cryptotephra layers are preserved in a dynamic Amazonian peatland, suggesting that similar layers are likely to be present in other peat sequences that are important for palaeoenvironmental reconstruction. The discovery of cryptotephra in an Amazonian peatland provides a baseline for further investigation of Amazonian tephrochronology and the potential impacts of volcanism on vegetation.

The results of an extensive survey of the alumni of three doctoral- and four master's-level Christian graduate training programs in professional psychology are reported. The purpose of the survey was to assess how programs have done in training students in the integration of psychology and Christian faith. A total of 1,548 surveys were mailed out; a return rate of 41.3% limited the conclusiveness of the findings. The sample was found to be morally and religiously conservative; master's alumni were typically more conservative than were doctoral alumni. Alumni overwhelmingly identified themselves as evangelicals and reported a fairly high frequency of defined “religious behaviors.” Graduate training experiences had a moderately positive impact upon personal faith. Satisfaction with training in the task of integration was quite modest. Various measures indicated substantial commitment to the integration of Christian faith and the practice of professional psychology. Practitioners are most frequently eclectic, psychodynamic, cognitive-behavioral, or family systems in orientation. Frequency of use of specifically “religious” intervention techniques was low.

Re-publication of the mummy of Baket-en-her-nakht (Twenty-second Dynasty) in the Hancock Museum, Newcastle upon Tyne. Results of recent investigation with X-ray and C.A.T.-scan techniques are presented and compared with the previous radiological examination of 1964.