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"Appleton, Catherine"
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Single-breath-hold photoacoustic computed tomography of the breast
We have developed a single-breath-hold photoacoustic computed tomography (SBH-PACT) system to reveal detailed angiographic structures in human breasts. SBH-PACT features a deep penetration depth (4 cm in vivo) with high spatial and temporal resolutions (255 µm in-plane resolution and a 10 Hz 2D frame rate). By scanning the entire breast within a single breath hold (~15 s), a volumetric image can be acquired and subsequently reconstructed utilizing 3D back-projection with negligible breathing-induced motion artifacts. SBH-PACT clearly reveals tumors by observing higher blood vessel densities associated with tumors at high spatial resolution, showing early promise for high sensitivity in radiographically dense breasts. In addition to blood vessel imaging, the high imaging speed enables dynamic studies, such as photoacoustic elastography, which identifies tumors by showing less compliance. We imaged breast cancer patients with breast sizes ranging from B cup to DD cup, and skin pigmentations ranging from light to dark. SBH-PACT identified all the tumors without resorting to ionizing radiation or exogenous contrast, posing no health risks.
The current standard for breast cancer diagnostic is a mammogram; however, the sensitivity of mammography can be low in radiographically dense breasts. Here the authors develop a single-breath-hold photoacoustic computed tomography (SBH-PACT) system to reveal detailed angiographic structures in human breasts allowing the detection of higher blood vessel densities associated with tumors.
Journal Article
Life imprisonment : a global human rights analysis
Life imprisonment has replaced capital punishment as the most common sentence imposed for heinous crimes worldwide. As a consequence, it has become the leading issue in international criminal justice reform. In the first global survey of prisoners serving life terms, Dirk van Zyl Smit and Catherine Appleton argue for a human rights-based reappraisal of this exceptionally harsh punishment. The authors estimate that nearly half a million people face life behind bars, and the number is growing as jurisdictions both abolish death sentences and impose life sentences more freely for crimes that would never have attracted capital punishment. Life Imprisonment explores this trend through systematic data collection and legal analysis, persuasively illustrated by detailed maps, charts, tables, and comprehensive statistical appendices. The central question--can life sentences be just?--is straightforward, but the answer is complicated by the vast range of penal practices that fall under the umbrella of life imprisonment. Van Zyl Smit and Appleton contend that life imprisonment without possibility of parole can never be just. While they have some sympathy for the jurisprudence of the European Court of Human Rights, they conclude that life imprisonment, in many of the ways it is implemented worldwide, infringes on the requirements of justice. They also examine the outliers--states that have no life imprisonment--to highlight the possibility of abolishing life sentences entirely. Life Imprisonment is an incomparable resource for lawyers, lawmakers, criminologists, policy scholars, and penal-reform advocates concerned with balancing justice and public safety.-- Provided by publisher
Book
Prevalence and patterns of mental health disorders in long-term preventive detention: a 13-year national cohort study
Background
Research consistently demonstrates significantly higher rates of mental health disorders among incarcerated individuals compared to the general population. This paper examines the prevalence of mental health disorders among all individuals serving preventive detention in Norway between 2009 and 2022, and compares the prevalence of mental health disorders in this group with a comparison group of individuals convicted of serious violent and sexual offences, and with the total prison population.
Methods
We conducted a registry-based study to investigate the prevalence of psychiatric morbidity within this population in Norwegian prisons, using a subset of the data from the nPRIS-cohort including all people imprisoned in Norway between January 1st, 2000, and December 31st, 2022 (
n
= 112,877). The cohort, including 202 individuals serving preventive detention in the period 2009–2022, were linked to the Norwegian Patient Registry (NPR) and socio-economic data from Statistics Norway.
Results
The prevalence of mental health disorders was high across all three comparison groups. However, of the preventive detention population (
n
= 202) almost all (95.0%) had at least one mental health diagnosis during the study period. In addition, 73.8% of the preventive detention population had received a severe mental health disorder diagnosis during the observation period (compared to 23.7% for the comparison group and 28.3% for the total prison population). Approximately one third of the preventive detention population had a combination of three or more of the five most common diagnoses.
Conclusion
The preventive detention population in Norway is clearly a group with significant mental health treatment needs – even when compared to a prison population that is itself showing increasing prevalence of mental health disorders, indicating that they represent a particularly vulnerable population within the prison system.
Journal Article
Hope of release? Life imprisonment in Lithuania
In 2017, in the case of Matijošaitis and Others v. Lithuania, the European Court of Human Rights ruled that imposing life imprisonment without hope of release violated Article 3 of the European Convention on Human Rights, both in law and in practice. This landmark decision prohibited irreducible life sentences in Lithuania, prompting significant legislative amendments in 2019. These changes allowed individuals serving life sentences to request a commutation to a fixed term of imprisonment ranging from five to 10 years, provided they had served a minimum of 20 years and met specific criteria assessed by the courts. This article sheds light on these significant changes to Lithuania’s life sentence system and evaluates whether the new commutation procedure offers a realistic hope of release. The analysis draws on legal and documentary sources, as well as empirical evidence from 45 court decisions on commutation requests, and eight research interviews with individuals serving life sentences. The findings reveal a disparity between the progressive, rehabilitative intent of the legislative changes, and the actual experiences of those serving life sentences in Lithuania.
Journal Article
Facilitating gynecological examination and long acting reversible contraception for women with substance use disorder: a prospective cohort study
Background
Women with substance use disorder (SUD) face a higher risk of sexual assault, abuse, cervical premalignant lesions, and unplanned pregnancy compared to the general female population. To meet the specific needs of this vulnerable group, we established a comprehensive gynecological service. The study aimed to describe the characteristics of women with SUD who accessed these services. Furthermore, we evaluated their cervical cytology and sexually transmitted infections (STIs) test results, preferred contraceptive methods, and the overall acceptability of the service.
Methods
We enrolled 48 women undergoing outpatient or inpatient treatment for SUD in the South-Trøndelag region of Norway in the study. Each women received a comprehensive gynecological anamnesis, including a history of sexual assault, followed by a gynecological examination at the outpatient clinic of the Department of Obstetrics and Gynecology. The examination included ThinPrep Tests and microbiological swabs. They were also offered contraception options, with an emphasis on Long Acting Reversible Contraceptives (LARC), at no cost. Participants provided feedback on the service immediately after their consultation and again six months later.
Results
Nearly two-thirds (63%) of the women with a mean age 31.8, reported a history of sexual assault. One in three (33%) had cervical cytology or human pappilomavirus (HPV) test results necessitating treatment or follow-up, though no cases of sexually transmitted infections were found. Two thirds (66%) of eligible women chose LARC as their contraceptive method. Among the 23 women reached for a follow-up phone call six months later, all expressed high level of satisfaction with the service and indicated they would recommend it to other women in similar situations.
Conclusions
An integrated, specialized gynecological service that provides cervical testing and contraceptive counselling can effectively reach women receiving outpatient or inpatient treatment for SUD, who typically fail to follow-up routine women’s health screening programmes. If implemented, this approach has the potential to reduce unplanned pregnancies and improve early detection of cervical pathology in this vulnerable population.
Journal Article
Plasma carotenoids and the risk of premalignant breast disease in women aged 50 and younger: a nested case–control study
Purpose
To examine the association of plasma carotenoids, micronutrients in fruits, and vegetables, with risk of premalignant breast disease (PBD) in younger women.
Methods
Blood samples were collected at the Siteman Cancer Center between 2008 and 2012 from 3537 women aged 50 or younger with no history of cancer or PBD. The analysis included 147 participants diagnosed with benign breast disease or breast carcinoma in situ during a 27-month follow-up and 293 controls. Cases and controls were matched on age, race/ethnicity, and date of and fasting status at blood draw. Plasma carotenoids were quantified. We used logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and linear regression to assess racial differences in plasma carotenoids.
Results
The risk reduction between the highest and lowest tertiles varied by carotenoid, with β-cryptoxanthin having the greatest reduction (OR 0.62; 95% CI, 0.62–1.09;
P
trend
= 0.056) and total carotenoids the least (OR 0.83; 95% CI, 0.48–1.44;
P
trend
= 0.12). We observed an inverse association between plasma carotenoids and risk of PBD in obese women (BMI ≥ 30 kg/m
2
; 61 cases and 115 controls) but not lean women (BMI < 25 kg/m
2
; 54 cases and 79 controls), although the interaction was not statistically significant. Compared to white women, black women had lower levels of α and β-carotene and higher levels of β-cryptoxanthin and lutein/zeaxanthin.
Conclusions
We observed suggestive inverse associations between plasma carotenoids and risk of PBD in younger women, consistent with inverse associations reported for invasive breast cancer. Carotenoids may play a role early in breast cancer development.
Journal Article
A prospective cohort study to analyze the interaction of tumor-to-breast volume in breast conservation therapy versus mastectomy with reconstruction
Purpose
We explored the impact of the relative volume of a tumor versus the entire breast on outcomes in patients undergoing breast conservation therapy (BCT) versus mastectomy and reconstruction (M + R). We hypothesized that there would be a threshold tumor:breast ratio (TBR) below which patient-reported outcomes (PRO) would favor BCT and above which would favor M + R.
Methods
We conducted a prospective cohort study of patients with ductal carcinoma in situ (DCIS) or invasive breast cancers undergoing BCT or M + R. A prerequisite for inclusion, analysis of tumor and breast volumes was conducted from three-dimensional magnetic resonance imaging reconstructions to calculate the TBR. Three-dimensional photography was utilized to calculate pre- and postoperative volumes and assess symmetry. Oncologic, surgical, and patient-reported outcome data were obtained from relevant BREAST-Q modules administered pre- and postoperatively.
Results
The BCT cohort had significantly smaller tumor volumes (
p
= 0.001) and lower TBRs (
p
= 0.001) than patients undergoing M + R overall. The M + R group, however, comprised a broader range of TBRs, characterized at lower values by patients opting for contralateral prophylactic mastectomy. Postoperative satisfaction with breasts, psychosocial, and sexual well-being scores were significantly higher in the BCT cohort, while physical well-being significantly favored the M + R cohort 480.2 ± 286.3 and 453.1 ± 392.7 days later, respectively.
Conclusions
Relative to BCT, M + R was used to manage a broad range of TBRs. The relative importance of oncologic and surgical risk reduction, symmetry, and number of procedures can vary considerably and may limit the utility of TBR as a guide for deciding between BCT and M + R.
Clinical Trial Statement
This study was registered with clinicaltrials.gov as “A Prospective Trial to Assess Tumor:Breast Ratio and Patient Satisfaction Following Lumpectomy Versus Mastectomy With Reconstruction”, Identifier: NCT02216136.
Journal Article
The Pros and Cons of Life Without Parole
The question of how societies should respond to their most serious crimes if not with the death penalty is 'perhaps the oldest of all the issues raised by the two-century struggle in western civilization to end the death penalty' (Bedau, 1990: 481). In this article we draw attention to the rapid and extraordinary increase in the use of 'life imprisonment without parole' in the United States. We aim to critically assess the main arguments put forward by supporters of whole life imprisonment as a punishment provided by law to replace the death penalty and argue against life-long detention as the ultimate sanction.
Journal Article
Which Imaging Modality Is Superior for Prediction of Response to Neoadjuvant Chemotherapy in Patients with Triple Negative Breast Cancer?
Background and Objectives. Triple negative breast cancer (TNBC) has been shown to be generally chemosensitive. We sought to investigate the utility of mammography (MMG), ultrasonography (US), and breast magnetic resonance imaging (MRI) in predicting residual disease following neoadjuvant chemotherapy for TNBC. Methods. We identified 148 patients with 151 Stage I–III TNBC treated with neoadjuvant chemotherapy. Residual tumor size was estimated by MMG, US, and/or MRI prior to surgical intervention and compared to the subsequent pathologic residual tumor size. Data were compared using chi-squared test. Results. Of 151 tumors, 44 (29%) did not have imaging performed prior to surgical treatment. Thirty-eight (25%) tumors underwent a pathologic complete response (pCR), while 113 (75%) had residual invasive disease. The imaging modality was accurate to within 1 cm of the final pathologic residual disease in 74 (69%) cases and within 2 cm in 94 (88%) cases. Groups were similar with regards to patient age, race, tumor size and grade, and clinical stage (P>0.05). Accuracy to within 1 cm was the highest for US (83%) and the lowest for MMG (56%) (P<0.05). Conclusions. Breast US and MRI were more accurate than MMG in predicting residual tumor size following neoadjuvant chemotherapy in patients with TNBC. None of the imaging modalities were predictive of a pCR.
Journal Article