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Background: Nigeria has one of the highest age-standardized breast cancer (BC) mortality rates globally and the highest in Africa. Late presentation and diagnosis have been studied extensively as causes of high BC morbidity and mortality, while treatment and outcomes are under-reported. We aggregated data on BC treatment and outcomes in Nigeria to identify gaps in research, challenges, and potential targets for future interventions. Methods: Articles on female BC management in Nigeria published between 2011 and 2021 were reviewed for the prevalence of different treatment modalities and outcomes. The meta-analytical procedure was a random effect model. Results: We identified 15 articles that reported on the treatment and outcomes of 3857 BC patients. The most prevalent treatment modality was chemotherapy alone. The probability of receiving each treatment modality was 85% (95% CI 66-97) for chemotherapy, 62% (95% CI 51-73) for surgery, and 31% (95% CI 8-59) for radiotherapy. Multimodality treatment, including chemotherapy, surgery, and radiation, was administered to 24% (95% CI 10-43) of patients. In studies with available data, nearly half of patients who initiated chemotherapy did not complete the recommended number of doses or received treatments at irregular intervals. The radiotherapy utilization was five times higher when patients received treatment in centers with radiation facilities. Overall survival estimates were 80% at one year, 43% at two years, and 32% at five years. Patients with early-stage (AJCC I/II) disease survived longer, with a 5-year survival difference of 32% compared to patients with late-stage (AJCC III/IV) disease. Patients receiving multimodality therapy survived longer. Three-year survival for patients who received chemotherapy, surgery and radiotherapy was 68%. Whereas it was 43% in patients who received chemotherapy and surgery only. Conclusion: Improving access to complete systemic therapy, surgery, and radiation for breast cancer patients in Nigeria is imperative and should be the target of future interventions.

Purpose: Understanding the epidemiology of breast cancer (BC) in Africa, as well as regional variation is essential for planning future intervention. Our objective was to describe summary estimates of socio-demographic and clinical characteristics of BC in Africa, thus providing researchers and policymakers baseline data for planning diagnostic and treatment programs to improve BC outcomes in the future. Method: We screened African publications on BC between 2010 and 2019 in PubMed, AJOL, Google, ScienceDirect, and ResearchGate to estimate the distribution of socio-demographic and clinical tumor characteristics. The meta-analysis used the random effect model. Result: Eighty articles were eligible, including 33,199 total patients. Overall, 58% of patients were

Educators have observed that our college graduates are not equipped with the complex problem-solving skills to contribute to the many challenges of industry and other professional contexts. This paper describes an experiential problem-based multifaceted instructional design and teaching model at the New York University School of Professional Studies, developed by instructional design and technological experts. The model combines traditional instructional design, evidence-based strategies, and learning theories for development of student critical thinkers who can transfer their new knowledge and capabilities to industry and various other professional contexts. This model includes unique faculty and student orientations and guides, students as active contributors, instructors as facilitators, and collaborative projects. Student surveys of four cohorts (68 students) over four academic quarters indicated strong positive results. Students practiced through experiential problem-based learning and thereby learned critical and creative thinking that increased their communication skills. The program, to continue through New York University, can also be adapted for professionally-oriented education degrees, certifications, and lifelong learning courses.

The collection and selection of the data used in learning analytics applications deserve more attention. Optimally, selection of data should be guided by pedagogical purposes instead of data availability. Using design science research methodology, we designed an artifact to collect time-series data on students' self-regulated learning and conceptual thinking. Our artifact combines curriculum data, concept mapping, and structured learning diaries. We evaluated the artifact in a case study, verifying that it provides relevant data, requires a limited amount of effort from students, and works in different educational contexts. Combined with learning analytics applications and interventions, our artifact provides possibilities to add value for students, teachers, and academic leaders.

ObjectiveThe A6702 multisite trial confirmed that apparent diffusion coefficient (ADC) measures can improve breast MRI accuracy and reduce unnecessary biopsies, but also found that technical issues rendered many lesions non-evaluable on diffusion-weighted imaging (DWI). This secondary analysis investigated factors affecting lesion evaluability and impact on diagnostic performance.MethodsThe A6702 protocol was IRB-approved at 10 institutions; participants provided informed consent. In total, 103 women with 142 MRI-detected breast lesions (BI-RADS assessment category 3, 4, or 5) completed the study. DWI was acquired at 1.5T and 3T using a four b-value, echo-planar imaging sequence. Scans were reviewed for multiple quality factors (artifacts, signal-to-noise, misregistration, and fat suppression); lesions were considered non-evaluable if there was low confidence in ADC measurement. Associations of lesion evaluability with imaging and lesion characteristics were determined. Areas under the receiver operating characteristic curves (AUCs) were compared using bootstrapping.ResultsThirty percent (42/142) of lesions were non-evaluable on DWI; 23% (32/142) with image quality issues, 7% (10/142) with conspicuity and/or localization issues. Misregistration was the only factor associated with non-evaluability (P = 0.001). Smaller (≤10 mm) lesions were more commonly non-evaluable than larger lesions (p

Background The Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Cancer Research Group A6702 multicenter trial helped confirm the potential of diffusion-weighted MRI for improving differential diagnosis of suspicious breast abnormalities and reducing unnecessary biopsies. A prespecified secondary objective was to explore the relative value of different approaches for quantitative assessment of lesions at diffusion-weighted MRI. Purpose To determine whether alternate calculations of apparent diffusion coefficient (ADC) can help further improve diagnostic performance versus mean ADC values alone for analysis of suspicious breast lesions at MRI. Materials and Methods This prospective trial (ClinicalTrials.gov identifier: NCT02022579) enrolled consecutive women (from March 2014 to April 2015) with a Breast Imaging Reporting and Data System category of 3, 4, or 5 at breast MRI. All study participants underwent standardized diffusion-weighted MRI (b = 0, 100, 600, and 800 sec/mm2). Centralized ADC measures were performed, including manually drawn whole-lesion and hotspot regions of interest, histogram metrics, normalized ADC, and variable b-value combinations. Diagnostic performance was estimated by using the area under the receiver operating characteristic curve (AUC). Reduction in biopsy rate (maintaining 100% sensitivity) was estimated according to thresholds for each ADC metric. Results Among 107 enrolled women, 81 lesions with outcomes (28 malignant and 53 benign) in 67 women (median age, 49 years; interquartile range, 41-60 years) were analyzed. Among ADC metrics tested, none improved diagnostic performance versus standard mean ADC (AUC, 0.59-0.79 vs AUC, 0.75; P = .02-.84), and maximum ADC had worse performance (AUC, 0.52; P < .001). The 25th-percentile ADC metric provided the best performance (AUC, 0.79; 95% CI: 0.70, 0.88), and a threshold using median ADC provided the greatest reduction in biopsy rate of 23.9% (95% CI: 14.8, 32.9; 16 of 67 BI-RADS category 4 and 5 lesions). Nonzero minimum b value (100, 600, and 800 sec/mm2) did not improve the AUC (0.74; P = .28), and several combinations of two b values (0 and 600, 100 and 600, 0 and 800, and 100 and 800 sec/mm2; AUC, 0.73-0.76) provided results similar to those seen with calculations of four b values (AUC, 0.75; P = .17-.87). Conclusion Mean apparent diffusion coefficient calculated with a two-b-value acquisition is a simple and sufficient diffusion-weighted MRI metric to augment diagnostic performance of breast MRI compared with more complex approaches to apparent diffusion coefficient measurement. © RSNA, 2020 Online supplemental material is available for this article.

Purpose To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ΔADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years ± 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2- disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ΔADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ΔADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P < .001). In a test subset, a model combining tumor subtype and midtreatment ΔADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ΔADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy. © RSNA, 2018 Online supplemental material is available for this article.

Low-income students from underrepresented communities experience significant educational inequalities, including chronic absenteeism, mental health crises, trauma exposure, and social injustices. These conditions escalate risks of dropping out and justice system involvement. Middle-school youth must navigate intense social and emotional change. To address such challenges, The Arthur Project (TAP) provides intensive, in-school, therapeutic mentoring and family support. The program teaches students essential life skills, such as problem-solving, communication, and academic engagement. Students are empowered to strengthen their resilience, perseverance, self-actualization, and confidence. TAP provides up to 500 h of therapeutic mentoring yearly over three years, delivered individually and in small groups by social work interns. The research question was as follows: Does structured, intensive in-school therapeutic mentoring with social work interns increase the socioemotional, cognitive, noncognitive, and academic skills and engagement of underserved middle-school students? This evaluation for the school year 2022–2023 is based on the program of 200 students and 30 mentors, with quantitative mentee, mentor, teacher, and caregiver surveys and qualitative interview data. The program and evaluation methodology are described, with results and conclusions. Students showed significant improvement in all domains; mentors reported student increases in confidence, perseverance, problem-solving, and communication; and teachers and caregivers reported students' increased academic engagement. The Arthur Project program can become a national middle-school mentoring model to address widespread student inequalities. [ABSTRACT FROM AUTHOR]