• Title/Summary/Keyword: problem-posing

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Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer

  • Janie M. Lee;Laura E. Ichikawa;Karen J. Wernli;Erin J. A. Bowles;Jennifer M. Specht;Karla Kerlikowske;Diana L. Miglioretti;Kathryn P. Lowry;Anna N. A. Tosteson;Natasha K. Stout;Nehmat Houssami;Tracy Onega;Diana S. M. Buist
    • Korean Journal of Radiology
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    • v.24 no.8
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    • pp.729-738
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    • 2023
  • Objective: When multiple surveillance mammograms are performed within an annual interval, the current guidance for oneyear follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses. Materials and Methods: We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up). Results: Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%. Conclusion: Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.

A Study about the Direction and Responsibility of the National Intelligence Agency to the Cyber Security Issues (사이버 안보에 대한 국가정보기구의 책무와 방향성에 대한 고찰)

  • Han, Hee-Won
    • Korean Security Journal
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    • no.39
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    • pp.319-353
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    • 2014
  • Cyber-based technologies are now ubiquitous around the glob and are emerging as an "instrument of power" in societies, and are becoming more available to a country's opponents, who may use it to attack, degrade, and disrupt communications and the flow of information. The globe-spanning range of cyberspace and no national borders will challenge legal systems and complicate a nation's ability to deter threats and respond to contingencies. Through cyberspace, competitive powers will target industry, academia, government, as well as the military in the air, land, maritime, and space domains of our nations. Enemies in cyberspace will include both states and non-states and will range from the unsophisticated amateur to highly trained professional hackers. In much the same way that airpower transformed the battlefield of World War II, cyberspace has fractured the physical barriers that shield a nation from attacks on its commerce and communication. Cyberthreats to the infrastructure and other assets are a growing concern to policymakers. In 2013 Cyberwarfare was, for the first time, considered a larger threat than Al Qaeda or terrorism, by many U.S. intelligence officials. The new United States military strategy makes explicit that a cyberattack is casus belli just as a traditional act of war. The Economist describes cyberspace as "the fifth domain of warfare and writes that China, Russia, Israel and North Korea. Iran are boasting of having the world's second-largest cyber-army. Entities posing a significant threat to the cybersecurity of critical infrastructure assets include cyberterrorists, cyberspies, cyberthieves, cyberwarriors, and cyberhacktivists. These malefactors may access cyber-based technologies in order to deny service, steal or manipulate data, or use a device to launch an attack against itself or another piece of equipment. However because the Internet offers near-total anonymity, it is difficult to discern the identity, the motives, and the location of an intruder. The scope and enormity of the threats are not just focused to private industry but also to the country's heavily networked critical infrastructure. There are many ongoing efforts in government and industry that focus on making computers, the Internet, and related technologies more secure. As the national intelligence institution's effort, cyber counter-intelligence is measures to identify, penetrate, or neutralize foreign operations that use cyber means as the primary tradecraft methodology, as well as foreign intelligence service collection efforts that use traditional methods to gauge cyber capabilities and intentions. However one of the hardest issues in cyber counterintelligence is the problem of "Attribution". Unlike conventional warfare, figuring out who is behind an attack can be very difficult, even though the Defense Secretary Leon Panetta has claimed that the United States has the capability to trace attacks back to their sources and hold the attackers "accountable". Considering all these cyber security problems, this paper examines closely cyber security issues through the lessons from that of U.S experience. For that purpose I review the arising cyber security issues considering changing global security environments in the 21st century and their implications to the reshaping the government system. For that purpose this study mainly deals with and emphasis the cyber security issues as one of the growing national security threats. This article also reviews what our intelligence and security Agencies should do among the transforming cyber space. At any rate, despite of all hot debates about the various legality and human rights issues derived from the cyber space and intelligence service activity, the national security should be secured. Therefore, this paper suggests that one of the most important and immediate step is to understanding the legal ideology of national security and national intelligence.

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