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Flexibility is often associated with resilience from adversity. Youth with autism spectrum disorder (ASD) are at risk of stress and trauma yet have inherent difficulties with flexibility, including rigid behaviors, routines, "insistence on sameness," and lack of social reciprocity. This review highlights literature of physiological and psychological processes related to inflexibility in ASD and proposes a heuristic model to understand mechanisms of resilience in the aftermath of adversity. This article presents the Biosocial Model for Resilience, which posits that interventions that target changes in central, autonomic, and endocrine dysregulation may in turn enhance processes of psychological flexibility (i.e., executive cognitive, emotional, and interpersonal regulation) that increase the likelihood of resilient adjustment in response to stressful experiences. This model of resilience is optimistic in positing that, in addition to critical programs on the prevention of social adversity, future research on flexibility can inform intervention programs that target this specific mechanism to minimize harmful aftereffects in youngsters with ASD.

Abstract Background In addition to breast imaging, ultrasound offers the potential for characterizing and distinguishing between benign and malignant breast tissues due to their different microstructures and material properties. The aim of this study was to determine if high-frequency ultrasound (20-80 MHz) can provide pathology sensitive measurements for the ex vivo detection of cancer in margins during breast conservation surgery. Methods Ultrasonic tests were performed on resected margins and other tissues obtained from 17 patients, resulting in 34 specimens that were classified into 15 pathology categories. Pulse-echo and through-transmission measurements were acquired from a total of 57 sites on the specimens using two single-element 50-MHz transducers. Ultrasonic attenuation and sound speed were obtained from time-domain waveforms. The waveforms were further processed with fast Fourier transforms to provide ultrasonic spectra and cepstra. The ultrasonic measurements and pathology types were analyzed for correlations. The specimens were additionally re-classified into five pathology types to determine specificity and sensitivity values. Results The density of peaks in the ultrasonic spectra, a measure of spectral structure, showed significantly higher values for carcinomas and precancerous pathologies such as atypical ductal hyperplasia than for normal tissue. The slopes of the cepstra for non-malignant pathologies displayed significantly greater values that differentiated them from the normal and malignant tissues. The attenuation coefficients were sensitive to fat necrosis, fibroadenoma, and invasive lobular carcinoma. Specificities and sensitivities for differentiating pathologies from normal tissue were 100% and 86% for lobular carcinomas, 100% and 74% for ductal carcinomas, 80% and 82% for benign pathologies, and 80% and 100% for fat necrosis and adenomas. Specificities and sensitivities were also determined for differentiating each pathology type from the other four using a multivariate analysis. The results yielded specificities and sensitivities of 85% and 86% for lobular carcinomas, 85% and 74% for ductal carcinomas, 100% and 61% for benign pathologies, 84% and 100% for fat necrosis and adenomas, and 98% and 80% for normal tissue. Conclusions Results from high-frequency ultrasonic measurements of human breast tissue specimens indicate that characteristics in the ultrasonic attenuation, spectra, and cepstra can be used to differentiate between normal, benign, and malignant breast pathologies.

Importance: Active monitoring for low-risk ductal carcinoma in situ (DCIS) of the breast has been proposed as an alternative to guideline-concordant care, but the safety of this approach is unknown., Objective: To compare rates of invasive cancer in patients with low-risk DCIS receiving active monitoring vs guideline-concordant care., Design, Setting, and Participants: Prospective, randomized noninferiority trial enrolling 995 women aged 40 years or older with a new diagnosis of hormone receptor-positive grade 1 or grade 2 DCIS without invasive cancer at 100 US Alliance Cancer Cooperative Group clinical trial sites from 2017 to 2023., Interventions: Participants were randomized to receive active monitoring (follow-up every 6 months with breast imaging and physical examination; n = 484) or guideline-concordant care (surgery with or without radiation therapy; n = 473)., Main Outcomes and Measures: The primary outcome was 2-year cumulative risk of ipsilateral invasive cancer diagnosis, according to planned intention-to-treat and per-protocol analyses, with a noninferiority bound of 0.05%., Results: The median age of the 957 participants analyzed was 63.6 (95% CI, 55.5-70.5) years in the guideline-concordant care group and 63.7 (95% CI, 60.0-71.6) years in the active monitoring group. Overall, 15.7% of participants were Black and 75.0% were White. In this prespecified primary analysis, median follow-up was 36.9 months; 346 patients had surgery for DCIS, 264 in the guideline-concordant care group and 82 in the active monitoring group. Forty-six women were diagnosed with invasive cancer, 19 in the active monitoring group and 27 in the guideline-concordant care group. The 2-year Kaplan-Meier cumulative rate of ipsilateral invasive cancer was 4.2% in the active monitoring group vs 5.9% in the guideline-concordant care group, a difference of -1.7% (upper limit of the 95% CI, 0.95%), indicating that active monitoring is not inferior to guideline-concordant care. Invasive tumor characteristics did not differ significantly between groups., Conclusions and Relevance: Women with low-risk DCIS randomized to active monitoring did not have a higher rate of invasive cancer in the same breast at 2 years compared with those randomized to guideline-concordant care., Trial Registration: ClinicalTrials.gov Identifier: NCT02926911.

Objective: We present the development of a non-contrast multi-parametric magnetic resonance (MPMR) imaging biomarker to assess treatment outcomes for magnetic resonance-guided focused ultrasound (MRgFUS) ablations of localized tumors. Images obtained immediately following MRgFUS ablation were inputs for voxel-wise supervised learning classifiers, trained using registered histology as a label for thermal necrosis., Methods: VX2 tumors in New Zealand white rabbits quadriceps were thermally ablated using an MRgFUS system under 3 T MRI guidance. Animals were re-imaged three days post-ablation and euthanized. Histological necrosis labels were created by 3D registration between MR images and digitized H&E segmentations of thermal necrosis to enable voxel-wise classification of necrosis. Supervised MPMR classifier inputs included maximum temperature rise, cumulative thermal dose (CTD), post-FUS differences in T2-weighted images, and apparent diffusion coefficient, or ADC, maps. A logistic regression, support vector machine, and random forest classifier were trained in red a leave-one-out strategy in test data from four subjects., Results: In the validation dataset, the MPMR classifiers achieved higher recall and Dice than a clinically adopted 240 cumulative equivalent minutes at 43 ° C (CEM 43 ) threshold (0.43) in all subjects. The average Dice scores of overlap with the registered histological label for the logistic regression (0.63) and support vector machine (0.63) MPMR classifiers were within 6% of the acute contrast-enhanced non-perfused volume (0.67)., Conclusions: Voxel-wise registration of MPMR data to histological outcomes facilitated supervised learning of an accurate non-contrast MR biomarker for MRgFUS ablations in a rabbit VX2 tumor model.

Skin pigmentation is paused after sun exposure; however, the mechanism behind this pausing is unknown. In this study, we found that the UVB-induced DNA repair system, led by the ataxia telangiectasia mutated (ATM) protein kinase, represses MITF transcriptional activity of pigmentation genes while placing MITF in DNA repair mode, thus directly inhibiting pigment production. Phosphoproteomics analysis revealed ATM to be the most significantly enriched pathway among all UVB-induced DNA repair systems. ATM inhibition in mouse or human skin, either genetically or chemically, induces pigmentation. Upon UVB exposure, MITF transcriptional activation is blocked owing to ATM-dependent phosphorylation of MITF on S414, which modifies MITF activity and interactome toward DNA repair, including binding to TRIM28 and RBBP4. Accordingly, MITF genome occupancy is enriched in sites of high DNA damage that are likely repaired. This suggests that ATM harnesses the pigmentation key activator for the necessary rapid, efficient DNA repair, thus optimizing the chances of the cell surviving. Data are available from ProteomeXchange with the identifier PXD041121., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Over the years empirical evidence has shown that traffic enforcement reduces traffic violations, crashes, and casualties. However, less attention has been paid to enforcement coverage across different populations and driver characteristics. The current study develops and explores a method for estimating police enforcement coverage, by comparing the share of drivers across several characteristics who received tickets from automatic speed and red-light cameras - as an objective estimate of offenses committed - to the share of drivers who received tickets through manual police enforcement. Using data from all speeding and red-light tickets issued to Israelis over a period of one and a half years, we found under-enforcement by police officers for female drivers, two-wheeled vehicle drivers (for speeding), and drivers with previous tickets. We found over-enforcement for younger drivers, truck drivers, and two-wheeled vehicle drivers (for red-light offenses). The findings suggest that the method developed in the research is able to identify groups of drivers who are over- or under-enforced. Police authorities can use this information to create evidence-based enforcement policies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: Conflicting data exist on the diagnostic sensitivity of core-needle biopsy (CNB) compared to fine-needle aspiration (FNA) in the evaluation of axillary lymph node metastasis from breast cancer. Our purpose was to evaluate the sensitivity of CNB and FNA using subsequent axillary surgery as the gold standard and to compare the patients' subjective pain levels for each biopsy method., Methods: This IRB-approved prospective study enrolled 140 patients from February 2014 to May 2019 with known or suspected breast cancer. Patients underwent both US-guided FNA and 14-gauge CNB of the same node with clip placement and rated their pain level using a verbal numerical rating scale of 0 to 10. The diagnostic sensitivities were determined by pathology of the surgically excised lymph node using the McNemar test of correlated proportions. Changes in pain scores for CNB and FNA were determined using the Wilcoxon rank sum test., Results: A total of 94 patients had confirmatory excision of the biopsied node with nodal metastasis detected in 71.3% (67/94). The sensitivity of CNB for detection of nodal metastasis was 95.5% (64/67), while the sensitivity of FNA was 67.2% (45/67) (P < 0.05). Overall pain score ratings for CNB increased by 0.6 from baseline on an 11-point numerical rating scale, while overall pain score rating for FNA decreased by 0.2 from baseline (P < 0.05)., Conclusion: Our study demonstrates that 14-gauge CNB has superior sensitivity for detection of axillary nodal metastases and mildly increased pain compared with 25-gauge FNA in patients with breast cancer., (© Society of Breast Imaging 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Myeloid sarcoma (MS) is a rare extramedullary solid tumor arising most often in patients with current or subsequent acute myeloid leukemia (AML). Patients of all ages may present with involvement of the skin, lymph nodes, intestinal tract, bone, and/or central nervous system. Isolated involvement of the breast is rare, and only a small number of cases have been described in the literature. Breast MS may present as a palpable mass on clinical evaluation. In this broad literature review from 2010 to 2022, the most common findings on mammography are either solitary or multiple masses, followed by architectural distortion and, less commonly, no discrete findings. Sonography may demonstrate hypoechoic or mixed echogenicity mass(es) with circumscribed or indistinct, not discrete margins. Myeloid sarcoma may present as an enhancing mass or nonmass enhancement on breast MRI and is typically moderately radiotracer avid on 18F-fluorodeoxyglucose-PET. At histopathology, MS is characterized by myeloid blasts in varying stages of granulocytic or neutrophilic maturation; diagnosis typically requires immunophenotyping. There is no consensus for treatment of MS, although systemic chemotherapy for AML is often used as MS is considered the tissue equivalent of AML. This article will discuss and illustrate imaging and pathology findings when the breast is involved by MS., (© Society of Breast Imaging 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The communities we live in are central to our health. Neighborhood disadvantage is associated with worse physical and mental health and even early mortality, while resident sense of safety and positive neighborhood sentiment has been repeatedly linked to better physical and mental health outcomes. Therefore, understanding where negative neighborhood sentiment and safety are salient concerns can help inform public health interventions and as a result, improve health outcomes. To date, fear of crime and neighborhood sentiment data or indices have largely been based on the administration of time consuming and costly standardized surveys., Objective: The current study aims to develop a Neighborhood Sentiment and Safety Index (NSSI) at the census tract level, building on publicly available data repositories, including the US Census and ACS surveys, Data Axle, and ESRI repositories., Methods: The NSSI was created using Principal Component Analysis. Mineigen and minimum loading values were 1 and 0.3, respectively. Throughout the step-wise PCA process, variables were excluded if their loading value was below 0.3 or if variables loaded into multiple components., Results: The novel index was validated against standardized survey items from a longitudinal cohort study in the Northeastern United States characterizing experiences of (1) Neighborhood Characteristics with a Pearson correlation of -0.34 (p < 0.001) and, (2) Neighborhood Behavior Impact with a Pearson correlation of -0.33 (p < 0.001). It also accurately predicted the Share Care Community Well Being Index (Spearman correlation = 0.46) and the neighborhood deprivation index (NDI) (Spearman correlation = -0.75)., Significance: Our NSSI can serve as a predictor of neighborhood experience where data is either unavailable or too resource consuming to practically implement in planned studies., Impact Statement: To date, fear of crime and neighborhood sentiment data or indices have largely been based on the administration of time consuming and costly standardized surveys. The current study aims to develop a Neighborhood Sentiment and Safety Index (NSSI) at the census tract level, building on publicly available data repositories, including the US Census and ACS surveys, Data Axle, and ESRI repositories. The NSSI was validated against four separate measures and can serve as a predictor of neighborhood experience where data is either unavailable or too resource consuming to practically implement in planned studies., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Traffic crashes take well over a million lives every year and are mainly caused by driver behavior and traffic violations. Drivers' attitudes and beliefs are at the root of whether traffic violations will be committed, making it important to explore what contributes to disobedience of traffic law. Generalized trust is one of the most influential factors in interpersonal behavior but has not yet been studied empirically in the context of driving behavior in general, and traffic violations in specific. Using data from about 30,000 participants from 20 European countries, this study examines the relationship between generalized trust and committing traffic violations while paying attention to differences between countries scoring high and low in individualism. A multilevel mixed-effects logistic regression analysis shows that in countries with high individualism scores, the probability to commit traffic violations increases significantly as generalized trust increases, while the association between generalized trust and traffic violations decreases as the country's individualism level decreases. The findings and their implications are discussed with suggestions for future research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Fibromatosis of the breast is a rare, benign locally infiltrative tumor without metastatic potential. Patients typically present with a painless, palpable, firm breast mass, which may be mobile or fixed to the pectoralis muscle. While some cases are related to familial mutations in the adenomatous polyposis coli (APC) gene, the majority are sporadic due to somatic mutations or prior injury to the breast tissue. On mammography, fibromatosis is typically seen as an irregular, dense, spiculated mass. US demonstrates a hypoechoic, irregular mass with indistinct margins. Fibromatosis is indistinguishable from breast cancer on imaging, and core biopsy is required for definitive diagnosis. Wide local excision is the historical standard for treatment; however, recurrence rates are high, and other emerging therapies are being explored. This article reviews the clinical features, imaging and histopathologic findings, along with brief overview of management., (© Society of Breast Imaging 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This study aimed to investigate differences between emotion regulation (ER), emotionality, and expression of emotions in children with Autism Spectrum Disorder (ASD) and their typically developing (TD) peers; and to examine the potential links between these areas of development with social skills in both groups, as well as with behavioral, emotional, and social problems in ASD. Forty-four children (40 males and 4 females, ages 3 to 7 years) with ASD (n = 22) and their TD peers (n = 22) were included in this study. Mothers reported about their children's ASD symptoms, social, emotional, and behavioral functioning. As predicted, children with ASD were described as showing decreased ER, increased emotionality, and decreased expression of emotions when compared to their TD peers. Moreover, in the ASD group, increased social skills were associated with enhanced ER and increased expression of emotions; and in the TD group, increased social skills were correlated with decreased emotionality. Finally, enhanced ER was linked to decreased peer problems, and increased prosocial behaviors; and decreased emotionality was linked to decreased behavior and emotional problems in the ASD group. Implications for further research are discussed., (Published by Elsevier Ltd.)

Background: The effect of weight reduction following bariatric surgery is already well known., Objectives: To investigate the effects of abdominoplasty on metabolic markers indicative of weight loss., Methods: The authors prospectively enrolled consecutive obese patients after laparoscopic sleeve gastrectomy. They were candidates for post-bariatric surgery abdominoplasty. The authors measured metabolic markers one day prior to surgery, 24 hours after, and 3 months following surgery. They recorded medical and demographic parameters., Results: Sixteen patients were recruited for participation in the study. Mean age was 47 years and 88% of the patients were female. Bariatric surgery achieved a mean decline in body mass index of 13.8 kg/m2. All patients underwent abdominoplasty. Leptin and insulin levels were slightly increased at 3 months postoperative. No significant changes were observed in glucose, hemoglobin, or triglycerides throughout the study., Conclusions: In a cohort of obese patients undergoing laparoscopic sleeve gastrectomy followed by abdominoplasty, no significant changes were noted in a patient's metabolic profiles. The results suggest that abdominoplasty has no effect on the metabolic markers tested in contrast to other reports; however, the cosmetic, behavioral, and psychological advantages of abdominoplasty are well established.

The current study tests an innovative public participation process for designing and implementing a tailored traffic enforcement program in minority localities. The quasi-experiment used two matched pairs of randomly selected Israeli Arab localities, where one locality in each pair was randomly assigned to the experimental group and the other to the control group. The intervention's main features were the public participation process and implementation by police of the traffic enforcement program designed during the process. Systematic field observations on 12,236 vehicles in the four localities found a meaningful and significant reduction in traffic violations in the experimental localities following the intervention, while a small increase in violations was observed in the control localities. The most meaningful decline, indicating improvement in drivers' behavior, was in non-use of seatbelts and small children in the front seat. The study suggests that a public participation process which identifies local road traffic problems and "dark" hot spots (places where offenses and risky behavior recur but might not be known to the police), followed by implementing tailored solutions for these problems, can reduce traffic violations. Future research should aim to separate out the independent effects of the two phases (the public participation process and tailored enforcement)., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Noise pollution is a common phenomenon of the 21st century. Noise prediction models tend to estimate noise levels mainly from road traffic sources (such as cars, public transportation etc.). This paper describes the adoption of land use regression (LUR) modeling methodology to assess noise pollution in two periods of the day (rush hour and off-peak), in two major cities in Israel (Tel Aviv and Beer Sheva). For both rush hour and off-peak times, 20 min short term measurements were used to develop a LUR noise estimation model. We used GIS-based predictors alongside commonly used traffic predictors. The findings show good fits for our model, with rush hour "out of sample" ten folds cross-validated R² of 0.79 (Tel Aviv) and 0.52 (Beer Sheva). The Tel Aviv model performance was also tested with independent monitoring data in an adjacent city (Bat Yam), presenting a good performance as well (R² of 0.93). The findings demonstrate the viability of using a LUR approach for applying high-resolution spatial data to estimate and map noise pollution for environmental noise assessment.

Objectives: To present the results of bariatric surgery performed in the elderly population at the Wolfson Medical Center., Methods: The study population consisted of all elderly patients (aged 65 years and older) who had undergone bariatric surgery between 2009 and 2016. Data was collected from the medical records and by a phone questionnaire. The percentage of excess BMI lost (%EBMIL) was the percentage of BMI lost after the surgery, out of the target BMI of 27 kg/m2. Improvement of obesity related co-morbidities was defined as the decrease in the number of medications and/or dosage, or remission., Results: Forty eight patients aged 65 years or older underwent bariatric surgery during the study acquisition period (mean age 67.9±2.8 years, 60% females). The types of surgery performed were: laparoscopic sleeve gastrectomy (LSG, 79%), mini gastric bypass, (MGB, 17%), and Roux and Y gastric bypass (RYGB, 4%). The weight decreased significantly (average BMI units lost was 9.4±5.6 units, p<0.001), and the mean EBWL% was 66.8±32.5%. The surgery was also very effective in improving co-morbidities: DM-65.2%, HTN-54.3%, hyperlipidemia-40%. After a follow-up period longer than 4.2 years the failure rate (EBWL<50%) was 53.3%, however, these patients still presented a lower postoperative weight. All the patients who failed underwent LSG., Conclusions: Bariatric surgery is very effective in terms of long term weight loss in the geriatric patient.

Background: Breast tumor subtyping has failed to provide impact in susceptibility genetics. The PAM50 assay categorizes breast tumors into: Luminal A, Luminal B, HER2-enriched and Basal-like. However, tumors are often more complex than simple categorization can describe. The identification of heritable tumor characteristics has potential to decrease heterogeneity and increase power for gene finding. Methods: We used 911 sporadic breast tumors with PAM50 expression data to derive tumor dimensions using principal components (PC). Dimensions in 238 tumors from high-risk pedigrees were compared with the sporadic tumors. Proof-of-concept gene mapping, informed by tumor dimension, was performed using Shared Genomic Segment (SGS) analysis. Results: Five dimensions (PC1-5) explained the majority of the PAM50 expression variance: three captured intrinsic subtype, two were novel (PC3, PC5). All five replicated in 745 TCGA tumors. Both novel dimensions were significantly enriched in the high-risk pedigrees (intrinsic subtypes were not). SGS gene-mapping in a pedigree identified a 0.5 Mb genome-wide significant region at 12q15 This region segregated through 32 meioses to 8 breast cancer cases with extreme PC3 tumors ( P = 2.6 × 10 -8 ). Conclusions: PC analysis of PAM50 gene expression revealed multiple independent, quantitative measures of tumor diversity. These tumor dimensions show evidence for heritability and potential as powerful traits for gene mapping. Impact: Our study suggests a new approach to describe tumor expression diversity, provides new avenues for germline studies, and proposes a new breast cancer locus. Similar reparameterization of expression patterns may inform other studies attempting to model the effects of tumor heterogeneity. Cancer Epidemiol Biomarkers Prev; 27(6); 644-52. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Objectives: The current study aims to develop a theoretical framework for understanding the antecedents of corruption and the effects of corruption on various health indicators., Methods: Using structural equation models, we analyzed a multinational dataset of 133 countries that included three main groups of variables--antecedents of corruption, corruption measures, and health indicators., Results: Controlling for various factors, our results suggest that corruption rises as GDP per capita falls and as the regime becomes more autocratic. Higher corruption is associated with lower levels of health expenditure as a percentage of GDP per capita, and with poorer health outcomes. Countries with higher GDP per capita and better education for women have better health outcomes regardless of health expenditures and regime type., Conclusions: Our results suggest that there is no direct relationship between health expenditures and health outcomes after controlling for the other factors in the model. Our study enhances our understanding of the conceptual and theoretical links between corruption and health outcomes in a population, including factors that may mediate how corruption can affect health outcomes.

Researchers have studied many interventions to address the core impairment in social interactions in autism spectrum disorder. We reviewed the social skills intervention literature over the past two years (2012-2014). Social skills intervention studies have increased by 35% over our previous review of 2010-2012. Nearly equal numbers of studies reported results using single subject research designs (n = 29) and group designs (n = 25). Consistent with our previous review, many studies focused on joint attention/joint engagement for young children and interventions addressing peer interactions for older children. Advancements in this review period included more replications of intervention models, longitudinal outcomes, and a focus on minimally verbal children. Notably absent are social interventions for adults, and interventions addressing school-based inclusion. In addition to these target areas, future studies should isolate active ingredients of social interventions, include broader participant representation, and further examine the relation between neural development and behavioral outcomes.

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is currently the predominant method for obtaining a preoperative tissue diagnosis for pancreatic lesions suspicious for malignancy. The diagnostic sensitivity and specificity of EUS-FNA are well documented, but malignancy risk associated with the diagnostic categories proposed by the Papanicolaou Society of Cytopathology is poorly defined., Methods: The records of the Departments of Pathology at Duke University and the University of Utah were searched for all cases of EUS-FNA performed for the investigation of pancreatic lesions. All cases with follow-up surgical diagnosis or greater than 3 years of clinical follow-up were selected. Cytologic diagnostic categories were "nondiagnostic," "benign," "atypical (not otherwise specified)," "suspicious for malignancy," "neoplasm," and "malignant." Correlation of cytologic diagnosis with surgical and/or clinical follow-up was made and risk of malignancy calculated for each category., Results: Three hundred seventeen EUS-FNAs with adequate surgical or clinical follow-up were obtained. Risk of malignancy for nondiagnostic specimens was 21%;, benign specimens, 13%; atypical cases, 74%; suspicious for malignancy, 82%; the neoplasm category, 14%; and the malignant category, 97%, Conclusions: The cytologic categories proposed by the Papanicolaou Society of Cytopathology demonstrate an increasing risk for malignancy extending from benign to malignant. Aspirates designated benign have the lowest risk of malignancy (13%) and aspirates designated malignant the highest (97%). The proposed categorization scheme stratifies risk for malignancy giving useful information to clinicians treating patients with pancreatic lesions., (© 2013 American Cancer Society.)

Road traffic crashes are globally a leading cause of death. The current study tests the effect of traffic tickets issued to drivers on subsequent crashes, using a unique dataset that overcomes some shortcomings of previous studies. The study takes advantage of a national longitudinal dataset at the individual level that merges Israeli census data with data on traffic tickets issued by the police and official data on involvement in road traffic crashes over seven years. The results show that the estimated probability of involvement in a subsequent fatal or severe crash was more than eleven times higher for drivers with six traffic tickets per year compared to those with one ticket per year, while controlling for various confounders. However, the majority of fatal and severe crashes involved the larger population of drivers who received up to one ticket on average per year. The current findings indicate that reducing traffic violations may contribute significantly to crash and injury reduction. In addition, mass random enforcement programs may be more effective in reducing fatal and severe crashes than targeting high-risk recidivist drivers., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Studies have reported differences in the public's understanding of, trust in, and satisfaction with its priority-setting processes and outcomes across countries. How the media frames and reports decision making processes and outcomes may both reflect and affect the public's knowledge of and attitudes toward them. Nevertheless, no studies have analyzed how priority-setting decision making processes are portrayed in the media. We analyzed 202 newspaper articles published over a decade, from January 2000 through December 2009, in leading newspapers of Israel and South Korea. The findings reveal intriguing differences between the countries in both the number and content of the reports. The issue of priority setting is much less salient in Korean than in Israeli society. While the complexity of the task was the most prevalent theme in the Israeli reports sampled, benefits package expansion decisions were most common in the Korean reports. Similarly, the Israeli reports emphasized the qualifications and backgrounds of individual members of the decision making committee, but the equivalent Korean committee was not portrayed as a major actor, and so received less attention. The least reported theme in both countries was priority-setting procedures and principles. These findings, along with results from previous studies which indicate that public satisfaction with the two systems differs between the countries, provoke several interesting future research questions., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The recently developed social resistance framework addresses a widespread pattern in which members of some nondominant minorities tend to engage in various risky and unhealthy behaviors more than the majority group. This pilot study tested the core hypotheses derived from this innovative framework., Methods: We conducted in 2011 a nationally representative Web-based survey of 200 members of a nondominant minority group (African Americans) and 200 members of a majority group (Whites)., Results: The preliminary findings supported the main premises of the framework and suggested that nondominant minorities who felt discriminated and alienated from society tended also to have higher levels of social resistance. Those with higher levels of social resistance also engaged more in risky and unhealthy behaviors-smoking, drinking, and nonuse of seat belts-than did those with lower levels of social resistance. These associations were not found in the majority group., Conclusions: These preliminary results supported the framework and suggested that social resistance might play a meaningful role in risky and unhealthy behaviors of nondominant minorities, and should be taken into account when trying to reduce health disparities.

Respiratory signs are common in African children where malaria is highly endemic, and thus, parsing the role of pulmonary pathology in illness is challenging. We examined the lungs of 100 children from an autopsy series in Blantyre, Malawi, many of whom death was attributed to Plasmodium falciparum malaria. Our aim was to describe the pathologic manifestations of fatal malaria; to understand the role of parasites, pigment, and macrophages; and to catalog comorbidities. From available patients, which included 55 patients with cerebral malaria and 45 controls, we obtained 4 cores of lung tissue for immunohistochemistry and morphological evaluation. We found that, in patients with cerebral malaria, large numbers of malaria parasites were present in pulmonary alveolar capillaries, together with extensive deposits of malaria pigment (hemozoin). The number of pulmonary macrophages in this vascular bed did not differ between patients with cerebral malaria, noncerebral malaria, and nonmalarial diagnoses. Comorbidities found in some cerebral malaria patients included pneumonia, pulmonary edema, hemorrhage, and systemic activation of coagulation. We conclude that the respiratory distress seen in patients with cerebral malaria does not appear to be anatomic in origin but that increasing malaria pigment is strongly associated with cerebral malaria at autopsy., (© 2013.)

Previous studies have shown that a community's socioeconomic status has a significant impact on its residents' health, and that vulnerability in deprived populations expresses itself as variability in health outcomes. The current study adds to this ecological research approach the notion that underlying community vulnerabilities are also related to the physical environment and population growth of a locality. The paper explores the variability in various health indicators in 252 localities in Israel as a function of the localities' socioeconomic status, population growth, and land use composition measures. The results indicate that a locality's socioeconomic status and its land use composition are both strongly associated with various health outcomes and their variability. These findings are of particular interest in light of the fact that the results were obtained from a country with a universal healthcare system., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: The recently developed social resistance framework addresses a widespread pattern whereby non-dominant minority groups, such as ethnic/racial minorities and people of low socioeconomic status, often engage in unhealthy and risky behaviours at higher rates compared with society at large. The framework suggests that power relations within society may encourage members of non-dominant minority groups to actively engage in acts of everyday resistance, which may include risky and unhealthy behaviours., Methods: The current paper develops and psychometrically evaluates a research tool to test this innovative framework. The UNREST questionnaire measures the key concepts of the framework, along with four high-risk and unhealthy behaviours, as well as demographic and socioeconomic characteristics. A pilot survey was conducted among representative subsamples of a non-dominant group (African-Americans) and a dominant group (Caucasians)., Results: Consistent with the general premises of the framework, the evaluation of the questionnaire produced six valid and reliable scales, which were significantly correlated with some criterion-related items as well as unhealthy and risky behaviours., Conclusions: The preliminary results of our pilot study suggest that the new tool may be useful for testing the framework. The results also provide support for the framework in general.

A significant percentage of fine-needle aspirations (FNAs) is obtained using radiographic image guidance. Such image-guided aspirates are associated with increased costs, and it is highly desirable that adequate material for diagnosis is obtained at the time of the initial procedure. Hence, intraoperative evaluation of smear material is frequently performed to evaluate adequacy and to triage the aspirate to specialized tests such as flow cytometry and cytogenetics for appropriate work-up. Although FNA under radiologic guidance has been shown to be useful, little data exist as to the accuracy of such intraprocedural evaluation. The quality-assurance records between May 2009 and May 2010 were electronically searched for all FNA cases with intraprocedural evaluation. The reports were obtained and reviewed to compare the intraprocedural diagnosis and the final cytopathologic diagnosis. Percentage of deferred cases and percentage of disagreement were calculated. From May 2009 to May 2010, a total of 775 FNAs were performed with intraprocedural review. These cases were reviewed by seven board-certified cytopathologists. In 738 cases, the preliminary interpretation agreed with the final diagnosis. In 2.2% (17 of 775) of cases, the interpretation was deferred until-cell block, and/or cytospin preparations were obtained. In 2.6% (20 of 775) of cases, a disagreement in diagnosis existed between the initial interpretation and the final sign-out diagnosis. Intraprocedural interpretation of FNA material appears to be highly reliable with disagreements occurring in only 2.6% of cases. This degree of disagreement is slightly higher than that reported in some frozen section studies., (Copyright © 2011 Wiley Periodicals, Inc.)

Across different societies, non-dominant minority groups, compared to the dominant group, often exhibit higher rates of involvement in high-risk behaviors, such as smoking, drug and alcohol use, sexual risk behaviors, overeating, and unsafe driving habits. In turn, these behaviors have a well-documented impact on chronic disease, morbidity, and mortality. Previous studies have emphasized macro-structural or micro-agentic explanations for this phenomenon. Such explanations suffer from mirror-image shortcomings, such as, by emphasizing structural barriers, macro-level explanations leave out individual agency ("the over-socialized conception of the individual"), while micro-level theories give short shrift to structural constraints that prevent individuals from engaging in health-promoting behaviors ("the under-socialized conception of the individual"). Moreover, most current theories regard individuals as passive players who are influenced by the social environment or by psychological problems, or who make "bad" choices. The current paper develops an integrated theoretical framework that incorporates structural inequalities while leaving intact the role of individual agency. According to the social resistance framework, power relations in society encourage members of non-dominant minority groups to actively engage in everyday resistance practices that include various unhealthy behaviors. The paper develops propositions from which testable hypotheses can be generated, and discusses the implications and contributions of the social resistance framework., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Development and preclinical testing of new cancer therapies is limited by the scarcity of in vivo models that authentically reproduce tumor growth and metastatic progression. We report new models for breast tumor growth and metastasis in the form of transplantable tumors derived directly from individuals undergoing treatment for breast cancer. These tumor grafts illustrate the diversity of human breast cancer and maintain essential features of the original tumors, including metastasis to specific sites. Co-engraftment of primary human mesenchymal stem cells maintains phenotypic stability of the grafts and increases tumor growth by promoting angiogenesis. We also report that tumor engraftment is a prognostic indicator of disease outcome for women with newly diagnosed breast cancer; orthotopic breast tumor grafting is a step toward individualized models for tumor growth, metastasis and prognosis. This bank of tumor grafts also serves as a publicly available resource for new models in which to study the biology of breast cancer.