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Screening for breast cancer with mammography. Update in: Cochrane Database Syst Rev. The theoretic basis for the intervention is sound. It is presumed that therapeutic intervention at a point when cancer is visible on a mammogram but not yet palpable in the breast will, for a small number, result in earlier, ultimately life-saving, therapy.
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The statistical result is slightly different when one accepts all trial data rather than restricting data to appropriately randomized studies. If accurate, this would represent a NNT of approximately 2000. This is an important, though uncommonly discussed, issue in the translation of evidence from cancer screening trials. Harms due to breast cancer screening are discussed at length in the Cochrane review, and in more recent analyses.
2,3 These include false positives that result in surgical procedures, and emotional distress due to false positives. Moreover the studies are dated, and there have been significant improvements in breast cancer therapy since these trials. Therefore these data are highly imperfect. Importantly, overall mortality may not be affected by mammography because breast cancer deaths are only a small fraction of overall deaths. This would make it very difficult to affect overall mortality by targeting an uncommon cause of death like breast cancer. It is important to note that screening mammography saves some number of individual lives in the sense that there are almost certain to be women whose breast cancer is amenable to curative treatment at the time it is identified by mammography, but not amenable to cure at the time it is identified by physician examination or self-examination.
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Two recent data reviews deserve further mention. The United Kingdom commissioned an independent review after dissenting voices swelled, for the purpose of better informing shared decision making and educational materials about the harms and benefits of screening. A circumspect, and patient-centered, response to the UK review provides a brief, smart data analysis suggesting that screening mammography is taking significantly more lives than it is saving. As a final note, it is important to be aware that the primary reason for the failure of screening mammography is the ongoing inability to determine which cancer cells in which humans represent a true threat to the host. If this could be determined successfully then any screening test like mammography would be a success. Screening for breast and prostate cancer: moving toward transparency. Rethinking breast and prostate cancer screening.
Effect of Screening Mammography on Breast-Cancer Mortality in Norway. Effect of three decades of screening mammography on breast-cancer incidence. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Black WC, Haggstrom DA, Welch HG.
All-cause mortality in randomized trials of cancer screening. Harms from breast cancer screening outweigh benefits if death caused by treatment is included. The Title Bar The title bar is color-coded with our overall recommendation. Red: Benefits do not outweigh risks. Black: Obvious harms, no clear benefits.
If you have suggestions, requests, or questions about a particular NNT review, please send us a message and we’ll try to address it as soon as possible. Development of this technology was spurred on by the deaths of dozens of fish that occurred during the retrofit of the San Francisco-Oakland Bay Bridge. National Geographic reported that after 300-foot pilings were driven into the ocean dead fish appeared on the surface nearby, with tests afterwards showing that huge pressure waves from the drilling had compressed the air in the swim bladder, which then rapidly expanded, bursting the bladder and causing fatal kidney damage. To lessen the impact of its activities, the firm behind the project, Caltrans, decided to deploy bubble curtains, which greatly lessened fish fatalities. Californian marine biologist Bud Abbott, a consultant on the project, told National Geographic how the devices weaken sound waves.
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When a pressure wave hits an air bubble, it will compress the bubble, then it will expand again, so energy is lost. Sound travels faster through water than air. It slows down as it hits the air bubble. The devices won’t just save the lives of marine animals, but also make life for them much less confusing and stressful. Many marine mammals find food and mates using sound pulses, which undersea noises interfere with. While researchers from the New England Aquarium in Boston have shown that noises from ships’ propellers actually increase stress-hormone levels in whales.
One company under scrutiny over its noisy underwater activities is Shell, with the U. Arctic seismic surveys would bring sounds of over 160 decibels to a 74-square-mile area. This is a level researchers believe could dramatically affect marine life. By comparison, sounds of 130 decibels would be painful to humans. However, Shell says that it is taking this issue seriously and is developing its own bubble curtain devices. We are focusing on the use of air bubbles and their impact on sound waves as a means of reducing the sound transmitted from stationary sources.
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Will this epic pilgrimage allow them to begin the new life they so desperately seek? War Wounds That Time Alone Can’t Heal. Almost Sunrise” is truly special and must be seen. Documentary follows Iraq War vets across country. Almost Sunrise” is a standout film, showing cinema’s potential to effect social change. Veterans Walk 2,700 Miles to Help Their Own.
A remarkable transformation, rarely depicted on screen. Our Moving Mountains Campaign mission is empowering veterans, presenting hopeful solutions for Moral Injury and the suicide crisis. Educating on Moral Injury Spark a national conversation about “Moral Injury” and it’s relationship to the veterans suicide crisis. Promoting wellness Increase awareness and access to evidence – based, holistic tools for healing for veterans and their families. Connecting Communities Build active community support for veteran reintegration, break the stereotypes, and bridge the military civilian divide. Changing Legislation Support legislation to improve the VA’s ability to promote holistic practices within the system.
Almost Sunrise with a Voice Award in recognition of the film and impact campaign’s ongoing contribution to the mental health community. Powerful live events can be organized at college campuses, organizations, faith-based groups, corporations and institutions. Pledge to support Almost Sunrise in the movement to promote and expand complementary and alternative wellness programs for veterans and their families. Interested in bringing Almost Sunrise to your community, conference or campus? Share your details here and we’ll be in touch right away! A few years ago, as part of a video project I’d volunteered for, I had the opportunity to interview veterans and hear about their lives and struggles. Twenty-two veterans kill themselves every day.
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It stopped me dead in my tracks. That was a pivotal moment for me in this journey to make this film. The connection we shared through these exchanges was of an intensity that would knock me off my feet. It often felt as if time itself had stopped. There’s tremendous work yet to be done to help properly care for our returning warriors and all servicemen and women.
My sincere hope is that, in the midst of this urgent crisis, the film will stir people to consider the significance of including holistic practices, such as proven ancient breath techniques and meditation, in the overall approach to our veterans’ wellness. One vet whom I had encountered had reluctantly, skeptically tried a powerful breathing exercise. After a period of time, he was able to come off of his regimen of numbing meds. He says it was like waking up for the first time in 40 years. The making of the film has created a tremendous opening for me. I can more deeply appreciate and, hopefully, as a consequence, more deeply convey an understanding: that in embracing the struggles of these men and women, and their families—these very human pillars who endeavor to keep the home together—we are not only helping to lift whole communities, but, in essence, we are lifting ourselves.
A rare, hopeful look at the life of a veteran, beyond his demons. 2,700 mile trek on foot across America. Will this epic pilgrimage be enough to release them from their self-destructive impulses and give them the chance to begin life anew? While the film exposes some of the brutality of war, it doesn’t dwell there. It’s ultimately a story of hope and potential solutions.
Most importantly, the film reveals the promise of holistic practices for healing. When Tom signs up for a special breathing workshop for veterans, he must confront his deepest spiritual identity. Almost Sunrise allows us to connect with a universal human aspiration for happiness and through Tom and Anthony’s genuine search for it, be reminded of our common soaring possibilities. The film also acts as an urgent call for communities to better understand these deep-seated psychic wounds, and for the government to acknowledge and finally treat moral pain by using methods other than pills.
Almost Sunrise deftly and movingly demonstrates the promise of holistic healing practices is on the horizon in a way that we cannot afford to ignore. Katinka Hooyer, PhD, also a character in Almost Sunrise. I would bet anything, that if we had the wherewithal to do this kind of research we’d find that moral injury underlies veteran homelessness and suicide. The actions that war requires, whether committed or witnessed, often violate the core cultural beliefs Veterans learned from their families and communities. Moral injuries surface when a Veteran begins to reflect on the memories of war, judging their own behavior or that of their friends or leaders. The memories that define a moral injury are about sorrow, shame, and deception, not so much fear or anger.
Fear and anger are more representative of PTSD. The consequences of violating one’s moral code, even if the act was necessary and unavoidable in that moment, can be very destructive. In these instances, self-judgment is at the core of moral injury. The killing of children and women, not being there for a battle buddy who lost their life or the incapacity to help injured civilians are common sources of moral pain that Veterans talk about. Witnessing leaders and respected peers violate core values is a different form of moral conflict. Feelings of betrayal are at the root of these types of moral injury. Examples include being raped by fellow service members or witnessing the inhumane treatment of prisoners.