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Figure. Distribution of Breast Density by Age Group
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Density categories based on the Breast Imaging Reporting and Data System.
Table 1. Characteristics of Women in the BCSC by Breast Density on Screening Mammograms
Table 2. Five-Year Cumulative Incidence of Invasive Breast Cancer Among Women in the BCSC by Breast Density, BMI, and Age Group
Table 3. Cox Proportional Hazards Regression Analysis for the Association of Breast Density With Invasive Breast Cancer by Age Group and BMI Among Women in the BCSC
Supplement 1.
eTable 1. Characteristics of Women Aged 65-74 Years
eTable 2. Characteristics of Women Aged 75 Years or Older
The Breast Cancer Surveillance Consortium
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Tice JA, Miglioretti DL, Li CS, Vachon CM, Gard CC, Kerlikowske K. Breast density and benign breast disease: risk assessment to identify women at high risk of breast cancer.  J Clin Oncol. 2015;33(28):3137-3143. doi:10.1200/JCO.2015.60.8869 PubMedGoogle ScholarCrossref
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Henderson LM, O'Meara ES, Braithwaite D, Onega T; Breast Cancer Surveillance Consortium. Performance of digital screening mammography among older women in the United States.  Cancer. 2015;121(9):1379-1386. doi:10.1002/cncr.29214PubMedGoogle Scholar
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Vachon CM, Kuni CC, Anderson K, Anderson VE, Sellers TA. Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States).  Cancer Causes Control. 2000;11(7):653-662. doi:10.1023/A:1008926607428 PubMedGoogle ScholarCrossref
Titus-Ernstoff L, Tosteson AN, Kasales C, et al. Breast cancer risk factors in relation to breast density (United States).  Cancer Causes Control. 2006;17(10):1281-1290. doi:10.1007/s10552-006-0071-1 PubMedGoogle ScholarCrossref
Richman I, Asch SM, Bendavid E, Bhattacharya J, Owens DK. Breast density notification legislation and breast cancer stage at diagnosis: early evidence from the SEER registry.  J Gen Intern Med. 2017;32(6):603-609. doi:10.1007/s11606-016-3904-y PubMedGoogle ScholarCrossref
Braithwaite D, Mandelblatt JS, Kerlikowske K. To screen or not to screen older women for breast cancer: a conundrum.  Future Oncol. 2013;9(6):763-766. doi:10.2217/fon.13.64 PubMedGoogle ScholarCrossref
Marcus PM, Freedman AN, Khoury MJ. Targeted cancer screening in average-risk individuals.  Am J Prev Med. 2015;49(5):765-771. doi:10.1016/j.amepre.2015.04.030 PubMedGoogle ScholarCrossref
US Preventive Services Task Force. Final recommendation statement: breast cancer: screening. January 11, 2016. Accessed September 16, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1
Ballard-Barbash R, Taplin SH, Yankaskas BC, et al; Breast Cancer Surveillance Consortium. Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database.  AJR Am J Roentgenol. 1997;169(4):1001-1008. doi:10.2214/ajr.169.4.9308451 PubMedGoogle ScholarCrossref
Breast Cancer Surveillance Consortium. Accessed December 18, 2020. https://www.bcsc-research.org/
DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A. Breast cancer statistics, 2015: convergence of incidence rates between Black and White women.  CA Cancer J Clin. 2016;66(1):31-42. doi:10.3322/caac.21320 PubMedGoogle ScholarCrossref
Lehman CD, Arao RF, Sprague BL, et al. National performance benchmarks for modern screening digital mammography: update from the Breast Cancer Surveillance Consortium.  Radiology. 2017;283(1):49-58. doi:10.1148/radiol.2016161174 PubMedGoogle ScholarCrossref
D'Orsi C, Sickles E, Mendelson E, et al. ACR BI-RADS® Atlas: Breast Imaging Reporting and Data System. 5th ed. American College of Radiology; 2013.
Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease.  N Engl J Med. 1985;312(3):146-151. doi:10.1056/NEJM198501173120303 PubMedGoogle ScholarCrossref
Page DL, Schuyler PA, Dupont WD, Jensen RA, Plummer WD Jr, Simpson JF. Atypical lobular hyperplasia as a unilateral predictor of breast cancer risk: a retrospective cohort study.  Lancet. 2003;361(9352):125-129. doi:10.1016/S0140-6736(03)12230-1 PubMedGoogle ScholarCrossref
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk.  J Am Stat Assoc. 1999; 94(446):496-509. doi:10.1080/01621459.1999.10474144 Google ScholarCrossref
Prentice RL, Gloeckler LA. Regression analysis of grouped survival data with application to breast cancer data.  Biometrics. 1978;34(1):57-67. doi:10.2307/2529588 PubMedGoogle ScholarCrossref
Singer JD, Willett JB. Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. Oxford University Press; 2003. doi:10.1093/acprof:oso/9780195152968.001.0001
Tice JA, Cummings SR, Ziv E, Kerlikowske K. Mammographic breast density and the Gail model for breast cancer risk prediction in a screening population.  Breast Cancer Res Treat. 2005;94(2):115-122. doi:10.1007/s10549-005-5152-4 PubMedGoogle ScholarCrossref
Tice JA, Bissell MCS, Miglioretti DL, et al. Validation of the Breast Cancer Surveillance Consortium model of breast cancer risk.  Breast Cancer Res Treat. 2019;175(2):519-523. doi:10.1007/s10549-019-05167-2 PubMedGoogle ScholarCrossref
Pushkin J. Women's imaging: breast density 2019—are you ready? Radiology Today. 2019;20(6):26.
Sherratt MJ, McConnell JC, Streuli CH. Raised mammographic density: causative mechanisms and biological consequences.  Breast Cancer Res. 2016;18(1):45. doi:10.1186/s13058-016-0701-9 PubMedGoogle ScholarCrossref
Moolgavkar SH, Day NE, Stevens RG. Two-stage model for carcinogenesis: epidemiology of breast cancer in females.  J Natl Cancer Inst. 1980;65(3):559-569.PubMedGoogle Scholar
Boyd N, Berman H, Zhu J, et al. The origins of breast cancer associated with mammographic density: a testable biological hypothesis.  Breast Cancer Res. 2018;20(1):17. doi:10.1186/s13058-018-0941-y PubMedGoogle ScholarCrossref
Simpson ER, Clyne C, Rubin G, et al. Aromatase—a brief overview.  Annu Rev Physiol. 2002;64:93-127. doi:10.1146/annurev.physiol.64.081601.142703 PubMedGoogle ScholarCrossref
McCormack VA, dos Santos Silva I. Breast density and parenchymal patterns as markers of breast cancer risk: a meta-analysis.  Cancer Epidemiol Biomarkers Prev. 2006;15(6):1159-1169. doi:10.1158/1055-9965.EPI-06-0034 PubMedGoogle ScholarCrossref
Vacek PM, Geller BM. A prospective study of breast cancer risk using routine mammographic breast density measurements.  Cancer Epidemiol Biomarkers Prev. 2004;13(5):715-722.PubMedGoogle Scholar
Lam PB, Vacek PM, Geller BM, Muss HB. The association of increased weight, body mass index, and tissue density with the risk of breast carcinoma in Vermont.  Cancer. 2000;89(2):369-375. doi:10.1002/1097-0142(20000715)89:2<369::AID-CNCR23>3.0.CO;2-J PubMedGoogle ScholarCrossref
Kerlikowske K, Ma L, Scott CG, et al. Combining quantitative and qualitative breast density measures to assess breast cancer risk.  Breast Cancer Res. 2017;19(1):97. doi:10.1186/s13058-017-0887-5 PubMedGoogle ScholarCrossref
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Ciatto S, Houssami N, Apruzzese A, et al. Categorizing breast mammographic density: intra- and interobserver reproducibility of BI-RADS density categories.  Breast. 2005;14(4):269-275. doi:10.1016/j.breast.2004.12.004 PubMedGoogle ScholarCrossref
Nicholson BT, LoRusso AP, Smolkin M, Bovbjerg VE, Petroni GR, Harvey JA. Accuracy of assigned BI-RADS breast density category definitions.  Acad Radiol. 2006;13(9):1143-1149. doi:10.1016/j.acra.2006.06.005 PubMedGoogle ScholarCrossref
Melnikow J, Fenton JJ, Whitlock EP, et al. Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Service Task Force. Ann Intern Med. 2016;164(4):268-278. doi:10.7326/M15-1789
Braithwaite D, Miglioretti DL, Zhu W, et al; Breast Cancer Surveillance Consortium. Family history and breast cancer risk among older women in the Breast Cancer Surveillance Consortium cohort.  JAMA Intern Med. 2018;178(4):494-501. doi:10.1001/jamainternmed.2017.8642 PubMedGoogle ScholarCrossref
Breast Density, Risk of Breast Cancer, and Screening Mammography in Women 75 Years and Older
Invited Commentary
Catherine M. Tuite, MD
Oncology Breast Cancer Women's Health Cancer Screening, Prevention, Control
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Advani SM, Zhu W, Demb J, et al. Association of Breast Density With Breast Cancer Risk Among Women Aged 65 Years or Older by Age Group and Body Mass Index. JAMA Netw Open. 2021;4(8):e2122810. doi:10.1001/jamanetworkopen.2021.22810
Ris (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley
Original Investigation
Association of Breast Density With Breast Cancer Risk Among Women Aged 65 Years or Older by Age Group and Body Mass Index
Shailesh M. Advani, MD, PhD1,2; Weiwei Zhu, MS3; Joshua Demb, PhD4; et al Brian L. Sprague, PhD5; Tracy Onega, PhD6; Louise M. Henderson, PhD7; Diana S. M. Buist, PhD3; Dongyu Zhang, MD, PhD8; John T. Schousboe, MD, PhD9; Louise C. Walter, MD10; Karla Kerlikowske, MD10,11; Diana L. Miglioretti, PhD3,12; Dejana Braithwaite, PhD, MSc2,13,14; for the Breast Cancer Surveillance Consortium
Author Affiliations Article Information
1Department of Oncology, Georgetown University, Washington, DC
2Terasaki Institute of Biomedical Innovation, Los Angeles, California
3Kaiser Permanente Washington Health Research Institute, Seattle, Washington
4Department of Medicine, University of California, San Diego
5Department of Surgery, Larner College of Medicine, University of Vermont, Burlington
6Department of Population Sciences, University of Utah, Salt Lake City
7Department of Radiology, University of North Carolina at Chapel Hill
8Department of Epidemiology, University of Florida, Gainesville
9Division of Research, Health Partners Institute, Bloomington, Minnesota
10Department of Medicine, University of California, San Francisco
11Department of Epidemiology and Biostatistics, University of California, San Francisco
12Department of Public Health Sciences, School of Medicine, University of California, Davis
13Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville
14Department of Epidemiology, University of Florida, Gainesville
JAMA Netw Open. 2021;4(8):e2122810. doi:10.1001/jamanetworkopen.2021.22810
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Question Is breast density associated with invasive breast cancer among women aged 65 years or older, and does body mass index (BMI) modify any associations between breast density and breast cancer risk?
Findings In this cohort study of 221 714 screening mammograms among 193 787 US women aged 65 years or older, heterogeneous or extreme breast density vs scattered fibroglandular density was associated with an increased risk of invasive breast cancer among women aged 65 to 74 years and among those aged 75 years or older with a BMI of 25 or higher. No interaction between BMI and breast density was found in either age group.
Meaning The findings suggest that breast density is associated with an increased risk of invasive breast cancer among women aged 65 years or older.
Importance Breast density is associated with breast cancer risk in women aged 40 to 65 years, but there is limited evidence of its association with risk of breast cancer among women aged 65 years or older.
Objective To compare the association between breast density and risk of invasive breast cancer among women aged 65 to 74 years vs women aged 75 years or older and to evaluate whether the association is modified by body mass index (BMI).
Design, Setting, and Participants This prospective cohort study used data from the Breast Cancer Surveillance Consortium from January 1, 1996, to December 31, 2012, for US women aged 65 years or older who underwent screening mammography. Data were analyzed from January 1, 2018, to December 31, 2020.
Exposures Breast Imaging Reporting and Data System breast density category, age, and BMI.
Main Outcomes and Measures The 5-year cumulative incidence of invasive breast cancer by level of breast density (almost entirely fat, scattered fibroglandular densities, or heterogeneous or extreme density) and age (65-74 vs ≥75 years) was calculated using weighted means. Cox proportional hazards models were fit to estimate the association of breast density with invasive breast cancer risk. The likelihood ratio test was used to test the interaction between BMI and breast density.
Results A total of 221 714 screening mammograms from 193 787 women were included in the study; a total of 38% of the study population was aged 75 years or older. Of the mammograms, most were from women aged 65 to 74 years (64.6%) and non-Hispanic White individuals (81.4%). The 5-year cumulative incidence of invasive breast cancer increased in association with increasing breast density among women aged 65 to 74 years (almost entirely fatty breasts: 11.3 per 1000 women [95% CI, 10.4-12.5 per 1000 women]; scattered fibroglandular densities: 17.2 per 1000 women [95% CI, 16.1-17.9 per 1000 women]; extremely or heterogeneously dense breasts: 23.7 per 1000 women [95% CI, 22.4-25.3 per 1000 women]) and among those aged 75 years or older (fatty breasts: 13.5 per 1000 women [95% CI, 11.6-15.5]; scattered fibroglandular densities: 18.4 per 1000 women [95% CI, 17.0-19.5 per 1000 women]; extremely or heterogeneously dense breasts: 22.5 per 1000 women [95% CI, 20.2-24.2 per 1000 women]). Extreme or heterogeneous breast density was associated with increased risk of breast cancer compared with scattered fibroglandular breast density in both age categories (65-74 years: hazard ratio [HR], 1.39 [95% CI, 1.28-1.50]; ≥75 years: HR, 1.23 [95% CI, 1.10-1.37]). Women with almost entirely fatty breasts had a decrease of approximately 30% (range, 27%-34%) in the risk of invasive breast cancer compared with women with scattered fibroglandular breast density (65-74 years: HR, 0.66 [95% CI, 0.58-0.75]; ≥75 years: HR, 0.73; 95% CI, 0.62-0.86). Associations between breast density and breast cancer risk were not significantly modified by BMI (for age 65-74 years: likelihood ratio test, 2.67; df, 2; P = .26; for age ≥75 years, 2.06; df, 2; P = .36).
Conclusions and Relevance The findings suggest that breast density is associated with increased risk of invasive breast cancer among women aged 65 years or older. Breast density and life expectancy should be considered together when discussing the potential benefits vs harms of continued screening mammography in this population.
Breast density, a potential intermediate phenotype in the molecular pathway of breast cancer, is a measure of the amount of radiopaque fibroglandular tissue in the breast that consists of epithelial tissue and stroma as opposed to surrounding fat tissue that appears radiolucent on mammography.1,2 Evidence from the US Breast Cancer Surveillance Consortium (BCSC) estimates that approximately 27.6 million women (43.3%) aged 40 to 74 years in the US have dense breasts (heterogeneously or extremely dense), whereas the prevalence of dense breasts is only 28% among women aged 75 years or older.3,4 A systematic review1 comparing breast density among age groups concluded that breast density decreased in association with increasing age in both the premenopausal and postmenopausal period, with greater decreases observed in the postmenopausal period.
Rapid population aging in the US and worldwide underscores the need to examine factors associated with breast cancer in older women that can be assessed along with life expectancy to inform precision breast cancer screening.5,6 Although breast density is a factor associated with breast cancer among women aged 40 to 74 years,1,7-10 the association of breast density with breast cancer among women aged 75 or older is not well established.10 Epidemiological evidence suggests an association between breast density and breast cancer among women younger than 65 years3,8 and premenopausal women.11 The likelihood that a woman will have dense breasts based on the Breast Imaging Reporting and Data System (BI-RADS) decreases in association with increasing body mass index (BMI).4 Thus, evaluation of whether BMI modifies any association of breast density with breast cancer among older women is important.12,13 Current breast density notification laws in the US may create the expectation that supplemental screening will benefit women with dense breasts, but this has not been established for older women.14 Assessing the association of breast density with breast cancer in the context of advancing age and whether any associations are modified by BMI is crucial for understanding the biologic characteristics of breast cancer, estimating the risk of breast cancer later in life, and identifying population subgroups who might benefit from life expectancy–based screening.15
We used data from the population-based BCSC cohort to quantify the risk of invasive breast cancer according to BI-RADS breast density categories and compared the association between breast density and risk of invasive breast cancer among women aged 75 years or older vs 65 to 74 years. We also assessed whether associations were modified by BMI. The goal of this study was to identify population subgroups who may be at increased risk of breast cancer, especially because the US Preventive Service Task Force guidelines state that the current evidence is considered insufficient to recommend routine breast cancer screening for women aged 75 years or older.16,17
Inclusion and Exclusion Criteria
This cohort study used data from the National Cancer Institute–funded BCSC, a community-based, geographically and racially/ethnically diverse cohort study that broadly represents the population of women who receive screening mammography in the US.18,19 The BCSC registries collect information on demographics, risk factors, clinical history, pathologic features, and mammography indication and results.20 Breast cancer diagnoses and tumor characteristics are obtained by linking BCSC data to pathology services; regional Surveillance, Epidemiology, and End Results programs; and/or state tumor registries. Data are pooled at a central Statistical Coordinating Center (SCC). Each registry and the SCC received institutional review board approval for active or passive consenting processes or a waiver of consent to enroll participants, link data, and perform analytic studies. All procedures were compliant with the Health Insurance Portability and Accountability Act, and all registries and the SCC have received a Federal Certificate of Confidentiality and other protection for the identities of women, physicians, and facilities who are subjects of this research. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
We included 7 BCSC registries located in New Hampshire, North Carolina, the San Francisco Bay Area, western Washington, New Mexico, Colorado, and Vermont. The sample included 221 714 mammograms from 193 787 women aged 65 years or older that were performed between January 1, 1996, and December 31, 2012, and included the BCSC's comprehensive longitudinal collection of breast density as recorded by interpreting radiologists.21 For women with more than 1 mammogram during the study period, we selected the first mammogram performed within each of 2 age subdivisions: 65 to 74 years and 75 years or older. We excluded women with a breast cancer diagnosis before or within 3 months after their first eligible mammogram because we set out to examine incident breast cancer risk. Women were also excluded if they had breast implants or had undergone mastectomy or if their breast density or BMI was not available. Data were analyzed from January 1, 2018, to December 31, 2020.
Exposure and Outcomes of Interest
Breast density was the study's primary exposure and was classified by interpreting radiologists as part of their clinical interpretation of mammograms using the 4 American College of Radiology BI-RADS breast density categories22: a, almost entirely fat; b, scattered fibroglandular densities; c, heterogeneously dense; and d, extremely dense. We grouped the heterogeneously dense (27.8%) and extremely dense (3.7%) categories together (total, 31.5% of the mammograms) because extremely dense breasts are infrequent in older women.11 The main outcome variable was incident invasive breast cancer within 3 months to 10 years after the assessment of breast density.
Measurement of Covariates
Covariate information was obtained from self-report at the time of mammography and included age, first-degree family history of breast cancer, race/ethnicity, weight, height, current postmenopausal hormone therapy use at the time of mammography, and history of breast biopsy. Self-reported height and weight were used to calculate BMI (calculated as weight in kilograms divided by height in meters squared), which was categorized as less than 18.5, 18.5 to 24.9, 25.0 to 29.9, 30.0 to 34.9, or 35.0 or greater based on World Health Organization criteria.12 However, in subgroup analysis, we dichotomized BMI as less than 25 (normal weight) vs 25 or higher (overweight or obese) to avert small sample sizes. Race/ethnicity was grouped as non-Hispanic White, non-Hispanic Black, Asian or Pacific Islander, Hispanic, other (Native Hawaiian or Pacific Islander and American Indian or Alaskan Native), and mixed race/ethnicity. Age at the time of mammography was categorized based on US Preventive Service Task Force screening cutoffs17: women aged 65 to 74 years, for whom screening is recommended, and women aged 75 years or older, for whom there is no recommendation for or against screening. Use of hormone therapy at the time of mammography was classified dichotomously based on women's self-report. Prior diagnoses of benign breast disease were collected by BCSC registries from pathology reports and radiology systems. We grouped all diagnoses from each patient's pathology reports into 1 category based on the most invasive finding: nonproliferative, proliferative without atypia, proliferative with atypia, or lobular carcinoma in situ.23,24 We classified a biopsy as indicating an unknown diagnosis if a woman reported undergoing a prior biopsy but pathology results were not available.
By design, all women who had missing age and breast density data as well as those with missing values for specific covariates were excluded from all data analyses based on those variables. Using ascertained breast density as the unit of analysis, we evaluated the distribution of breast density by demographic and clinical factors that are associated with breast cancer risk in older women. We used separate models for women aged 75 years or older vs those aged 65 to 74 years. The Fine and Gray method25 was used to estimate the 5-year cumulative incidence of invasive breast cancer by breast density, BMI, and age group after accounting for mortality from causes other than breast cancer.26,27 The model was adjusted for the patients' BCSC registry and factors associated with breast cancer risk, including family history of breast cancer, race/ethnicity, hormone therapy use, and benign breast disease (Table 1). Results were based on marginal standardization with the predicted function summed to a weighted mean according to the observed covariate distribution in the study population. We used Cox proportional hazards regression analysis to model the time to diagnosis of invasive breast cancer according to breast density and age group, adjusted for the patient's BCSC registry and factors associated with breast cancer risk, including family history of breast cancer, race/ethnicity, hormone therapy use, benign breast disease, and BMI (Table 1). The follow-up time started 3 months after the first eligible mammogram. Women were censored at the time of death, diagnosis of ductal carcinoma in situ, mastectomy, end of complete cancer capture, or 10 years after study entry, whichever happened first. To assess whether BMI modified the association of breast density with breast cancer risk among older women, we fitted separate models among women aged 65 to 74 years and those aged 75 years or older to test the interaction between BMI (<25 vs ≥25) and breast density using the likelihood ratio test. Two-sided statistical tests with P < .05 were considered statistically significant. Statistical analyses were conducted using R, version 3.4.3 (R Project for Statistical Computing).
Characteristics of the Study Population
A total of 221 714 screening mammograms from 193 787 women were included in the study; 38% of the study population was aged 75 years or older. During a mean follow-up of 6.3 years, 5069 invasive breast cancers were diagnosed. Of the included mammograms, most were from women aged 65 to 74 years (64.6%) and 35.4% were from women aged 75 years or older (Table 1). Most mammograms were from non-Hispanic White women (81.4%), followed by Hispanic women (9.0%), women who were Asian or Pacific Islanders (6.4%), and Black, non-Hispanic women (1.9%). With regard to breast density, among women aged 65 to 74 years, 16.5% had BI-RADS a, 51.4% had BI-RADS b, and 32.1% had BI-RADS c or d. Among women aged 75 years or older, 17.5% had BI-RADS a, 52.0% had BI-RADS b, and 30.5% had BI-RADS c or d (Figure). Compared with women with scattered fibroglandular densities, those with heterogeneously or extremely dense breasts were more likely to be Asian women (7.7% vs 5.5%), less likely to have benign breast disease (73.2% vs 79.5%), more likely to have a normal BMI (53.5% vs 39.0%), and more likely to currently use postmenopausal hormone therapy (30.2% vs 20.5%). Characteristics of the study population are shown in eTables 1 and 2 in Supplement 1.
Five-Year Cumulative Incidence of Invasive Breast Cancer by Breast Density, Age Group, and BMI
In general, we observed higher rates of breast cancer associated with increasing BI-RADS density by BMI categories in both age groups (Table 2). Among women aged 65 to 74 years, the 5-year cumulative incidence of invasive breast cancer increased in association with increasing breast density: 11.3 per 1000 women (95% CI, 10.4-12.5 per 1000 women) in the group whose breasts were almost entirely fat, 17.2 per 1000 women (95% CI, 16.1-17.9 per 1000 women) in the group with scattered fibroglandular density, and 23.7 per 1000 women (95% CI, 22.4-25.3 per 1000 women) in the group with heterogeneously or extremely dense breasts. Among women aged 75 years or older, the cumulative incidence also increased in association with increasing breast density: 13.5 per 1000 women (95% CI, 11.6-15.5 per 1000 women) in the group with fatty breasts, 18.4 per 1000 women (95% CI, 17.0-19.5 per 1000 women) in the group with scattered fibroglandular density, and 22.5 per 1000 women (95% CI, 20.2-24.2 per 1000 women) in the group with heterogeneously or extremely dense breasts.
In the group of women aged 65 to 74 years with overweight or obesity, the 5-year cumulative incidence of invasive breast cancer was 12.3 per 1000 women (95% CI, 11.3-15.1 per 1000 women) among those with fatty breasts and 23.9 per 1000 women (95% CI, 23.2-29.2 per 1000 women) among those with heterogeneously or extremely dense breasts. In the group of women aged 65 to 74 years with a BMI less than 25, the cumulative incidence was 8.2 per 1000 women (95% CI, 6.3-13.4 per 1000 women) among those with fatty breasts and 20.6 per 1000 women (95% CI, 18.2-22.9 per 1000 women) among those with heterogeneously or extremely dense breasts.
In the group of women aged 75 or older with overweight or obesity (BMI ≥25), the 5-year cumulative incidence of invasive breast cancer was 15.0 per 1000 women (95% CI, 11.9-17.3 per 1000 women) among those with fatty breasts and 27.2 per 1000 women (95% CI, 22.1-30.8 per 1000 women) among those with heterogeneously or extremely dense breasts. In the group of women aged 75 years or older with a BMI less than 25, the cumulative incidence was 13.5 per 1000 women (95% CI, 10.6-16.4 per 1000 women) among those with fatty breasts and 18.3 per 1000 women (95% CI, 15.9-21.4 per 1000 women) among those with heterogeneously or extremely dense breasts.
Association of Breast Density, Age Group, and BMI With Risk of Invasive Breast Cancer
Compared with scattered fibroglandular breast densities, heterogeneous or extreme breast density was associated with an increased risk of breast cancer among women aged 65 to 74 years regardless of BMI (overall: hazard ratio [HR], 1.39 [95% CI, 1.28-1.50]; BMI ≥25: HR, 1.39 [95% CI, 1.25-1.54]; BMI <25: HR, 1.35 [95% CI, 1.20-1.54]) (Table 3). Similarly, among women aged 75 years or older, heterogeneous or extreme breast density was associated with an increased risk of breast cancer regardless of BMI (overall: HR, 1.23 [95% CI, 1.10-1.37]; BMI ≥25: HR, 1.29 [95% CI, 1.10-1.49]; BMI <25: HR, 1.15 [95% CI, 0.98-1.36]) (P = .14 for interaction for age × density).
Among women aged 65 to 74 years, those with almost entirely fatty breasts had a decreased risk of invasive breast cancer compared with women with scattered fibroglandular breast densities regardless of BMI (overall: HR, 0.66 [95% CI, 0.58-0.75]; BMI ≥25: HR, 0.71 [95% CI, 0.61-0.81]; BMI <25: HR, 0.53 [95% CI, 0.40-0.72]). Similar associations were observed in the group of women aged 75 years or older overall (HR, 0.73; 95% CI, 0.62-0.86) and among those with a BMI of 25 or higher (HR, 0.70; 95% CI, 0.57-0.86), but there was no association among those with a BMI less than 25 (HR, 0.82; 95% CI, 0.62-1.09). There was no significant interaction between BMI and breast density among women aged 65 to 74 years (likelihood ratio test, 2.67; df, 2; P = .26) and those 75 years or older (likelihood ratio test, 2.06; df, 2; P = .36).
In this cohort study of the association between BI-RADS breast density categories and the risk of invasive breast cancer by BMI level and age among women aged 65 years or older, we found that breast density was associated with increased breast cancer risk among women aged 65 to 74 years regardless of BMI and among those aged 75 or older with a BMI of 25 or higher. The findings are consistent with those reported in a previous study3 of women aged 40 to 74 years that revealed associations between age and most of the breast cancer risk factors investigated, with the association between age and BI-RADS breast density declining as age increased. Although breast density is important in risk assessment and could be evaluated in older women, some risk prediction models do not provide risk estimates for women aged 75 or older.28,29 Given that greater breast density as categorized by the BI-RADS remains a factor associated with breast cancer even in older women,2,3 information about breast density together with life expectancy may benefit clinical decision-making regarding whether screening after 75 years of age should be continued.
In March 2019, the US Food and Drug Administration recommended changes to the Mammography Quality Standards Act to make it mandatory to report breast density information to both patients and their physicians.30 However, how women and their physicians should use this information to inform screening recommendations is unclear, particularly for older women. This study adds to the literature by showing that despite a decrease in breast density associated with increasing age, density continued to be associated with a modest increase in breast cancer risk among women aged 65 to 74 years and those aged 75 years or older. This study also showed that the association between BI-RADS breast density categories and breast cancer was statistically significant after adjustment for BMI and other factors. Additional research is needed to elucidate the mechanisms underlying the observed associations between breast density and risk of breast cancer.31,32 For example, a potential mechanism is hypercellularity and increased breast epithelium in dense breasts that may lead to increased rates of somatic mutations.33 In addition, dense breasts contain a large amount of stroma with aromatase activity, which has been associated with an increased release of estrogen that may lead to carcinogenesis.34 Further studies are needed to elucidate these mechanisms among older women.
Although this study showed a significant association between breast density and increased breast cancer risk among older women, the estimates in our study were lower than the estimates reported in a meta-analysis by McCormack and dos Santos Silva35 based on quantitative measures of density percentages. In 2 studies,36,37 the pooled relative risk of breast cancer was increased in women with greater breast density (ie, pooled odds ratio for heterogeneously dense breasts, 2.81 [95% CI, 2.13-3.71]; odds ratio for extremely dense breasts, 4.08 [95% CI, 2.96-5.63]).35 Although Lam et al37 found that the risk of breast cancer increased in association with increased breast density and vice versa after adjusting for a patient's BMI, the study included a small group of women aged 75 years or older, and the estimates did not take into account factors associated with breast cancer. Similarly, in a study of 61 844 women, of whom 4137 (6.7%) were aged 75 years or older, Vacek et al36 observed an increased breast cancer risk in association with increasing breast density but did not stratify results based on age. We extended the results from these studies by quantifying the association between BI-RADS breast density categories and breast cancer risk in a population-based cohort of older women who underwent screening mammography in US community practice.
As newer and more advanced breast density assessment techniques are developed,38 evaluation of the diffusion of such innovations among older women with an aim of developing individualized screening strategies will be important, particularly among women aged 75 years or older, for whom guidelines regarding screening mammography remain unclear. With the aging of the population in the US and worldwide, it is becoming increasingly important to implement life expectancy–based screening strategies15,39 that consider breast cancer risk so that older women who are likely to benefit can continue to undergo screening and risk of harms such as overdiagnosis and overtreatment can be reduced among those unlikely to benefit.
This study has strengths. We used, to our knowledge, the largest population-based sample of socioeconomically diverse older women undergoing screening mammography in US community practice. In addition, the study was conducted with prospective cohort design and included complete breast cancer follow-up. We were also able to account for the several confounding factors, including family history of breast cancer, race/ethnicity, postmenopausal hormone therapy use, BMI, and benign breast disease. Furthermore, we examined the association of breast density with breast cancer separately by age group, which included a large proportion of women aged 75 years or older.
This study also has limitations. It relied on BI-RADS breast density measurements reported by interpretive radiologists as part of clinical practice at multiple radiology facilities.40,41 Of note, interobserver agreement on the BI-RADS categories is moderate.42 Although the lack of quantitative measures of breast density in this study may be considered a limitation, a strength of the BI-RADS measurement categories is their clinical relevance; the categorical assessment of BI-RADS density is the measure provided clinically on all mammograms performed in the US. The BI-RADS measurements have evolved over time, with the 2013 (5th) edition being the most recent. Although this study's population included women from 1996 to 2012, we used the latest BI-RADS measurements to evaluate the association of breast density with breast cancer risk. As the methods for measuring breast density evolve, future studies should continue to evaluate associations between breast cancer risk and breast density, especially among older women. Another limitation of this study was the use of self-reported height and weight; a considerable amount of these data was missing, mostly because some BCSC facilities did not collect this information during some or all years.
In this cohort study, we observed an association between increased density as categorized by the BI-RADS and an increased risk of invasive breast cancer, but low breast density (ie, fatty breasts) was associated with a decreased risk of invasive breast cancer across age groups. The positive associations found in this study between breast density and breast cancer among women aged 75 years or older suggest that breast density and life expectancy should be considered together when discussing the potential benefits and harms of continued screening mammography in this population.43
Accepted for Publication: June 16, 2021.
Published: August 26, 2021. doi:10.1001/jamanetworkopen.2021.22810
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Advani SM et al. JAMA Network Open.
Corresponding Author: Dejana Braithwaite, PhD, MSc, Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, University of Florida, Clinical and Translational Sciences Building, Ste 145, 2004 Mowry Rd, Gainesville, FL 32610 (dbraithwaite@ufl.edu).
Author Contributions: Drs Miglioretti and Braithwaite share senior authorship. Ms Zhu and Dr Miglioretti had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kerlikowske, Miglioretti, Braithwaite.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Advani, Braithwaite.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Zhu, Miglioretti.
Obtained funding: Braithwaite.
Administrative, technical, or material support: Advani, Onega, Buist, Kerlikowske.
Supervision: Miglioretti, Braithwaite.
Conflict of Interest Disclosures: Ms Zhu reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Sprague reported receiving grants from the National Cancer Institute (NCI), NIH and the Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. Dr Onega reported receiving grants from the NIH during the conduct of the study. Dr Henderson reported receiving grants from the NCI, NIH during the conduct of the study. Dr Buist reported receiving grants from Kaiser Permanente Washington and the NCI, NIH during the conduct of the study. Dr Kerlikowske reported receiving grants from the NCI, NIH and PCORI during the conduct of the study and serving as a nonpaid consultant for GRAIL. Dr Miglioretti reported receiving grants from the NCI, NIH during the conduct of the study. Dr Braithwaite reported receiving grants from the NCI, NIH during the conduct of the study. No other disclosures were reported.
Funding/Support: This study was supported by grant 1R01CA207361 from the NCI, NIH (Dr Braithwaite) and grants P01CA154292, U54CA163303, and R01CA149365 from the Breast Cancer Surveillance Consortium (Drs Miglioretti and Kerlikowske) with funding from the NCI. Cancer and vital status data collection was supported in part by several state public health departments and cancer registries.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Group Members: The members of the Breast Cancer Surveillance Consortium are listed in Supplement 2.
Disclaimer: The statements, findings, and conclusions in this report are solely those of the authors and do not necessarily represent the views of the NCI or the NIH.
Additional Contributions: We thank the participating women, mammography facilities, and radiologists for the data they have provided to the Breast Cancer Surveillance Consortium.
Additional Information: Cancer and vital status data collection was supported in part by several state public health departments and cancer registries.
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Birds by Toikka are individually handmade, mouth blown glass art objects. A new bird has joined the collection annually since 1972. Like their counterparts in nature, each unique bird has its own personality. Kuulas is one of the most popular in the extensive bird collection.


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The Jasmine Throne by Tasha Suri Is Complicated, Unapologetic, Powerful, Glorious
Liz Bourke
Tue Jun 8, 2021 3:30pm 3 comments 5 Favorites [+]
The Jasmine Throne is the opening volume of a new epic fantasy trilogy by Tasha Suri. I'm not sure I know how to express my feelings about it. I enjoyed Suri's "Books of Ambha" duology, Empire of Sand and Realm of Ash, and admired them as well-constructed epic fantasy with a strong romantic component, but they never made me feel like this—gobsmacked, a little awestruck, violently satisfied, painfully engaged.
Perhaps I do know how to express my feelings after all.
Parijatdvipa is an empire of city-states. One of those city-states, Ahiranya—conquered and brought unwillingly into the empire—is where, for the most part, The Jasmine Throne sets itself. Ahiranya is not in outright revolt against the empire, but there are layers of resistance to its subjugation. With poetry and performance as well as violence: in the inner chambers of the Parijati regent as well as in the streets.
Malini is sister to the emperor, a cruel, zealous man who holds his position because his elder brother chose to become a priest rather than take up the throne. She refused to die when he bid her, and in consequence he has had her imprisoned in the Hirana in Ahiranya: a temple that was once home to powerful magic and those who could use it, but which, now, ever since the temple children and temple elders burned, is little more than a haunted ruin. Watched over by guards, drugged into docility, she will be allowed leave only when she is willing to choose to mount her own pyre. But Malini—forceful, unbending, willing to use every tool she can lay hands on to survive her brother and see him fall—is deeply unwilling to lie down and die.
Priya is a servant in Ahiranya, attached to the household of the regent's wife. Malini's imprisonment sees her sent to attend the princess's chambers, making the dangerous climb to the top of the Hirana nightly. Her anonymous servitude protects her, because she hides a secret that might see her killed: she's one of the last surviving temple children, one of the few to have passed through the deathless waters. But the Hirana itself is waking Priya's long-buried memories, as well as her power. And when Malini accidentally witnesses Priya's capabilities—in a fight with an intruder who holds secrets from Priya's past—the two find themselves yoked together in a reluctance and at times combative alliance that slowly evolves into mutual empathy and—not without setbacks—something like a partnership.
While Malini and Priya are at the centre of The Jasmine Throne—the push-pull of their relationship, their circumstances, their trust and their complicated, unapologetic, powerful selves—this isn't a book that's narrowly focused on two people. Bhumika, the Ahiranyi wife of the Parijati regent, is one of the other major characters: once Priya's temple sister, she's now directing her own form of resistance to Parijati domination. So too is Rao, an Alori prince, and one of Malini's partisans, who has come to Ahiranya to try to get Malini free—or at least find more allies.
Running through the heart of The Jasmine Throne, like sap through a tree, is its concern with power and power's costs. With the nature of empire, and its consequences for the subjected. With what is done to you and what you do to others: the choices that you make and the choices you are denied. What you are willing to become and what you are willing to give up, what you are willing to destroy and what you are willing to protect—what you will give up almost anything to protect. And along with this concern with power goes a concern with trust, with love—in all its painful, complicated glory—and with family.
And undergirding its concern with human power, The Jasmine Throne owns a striking sense of the numinous. There's magic in Suri's world: a bigger, slippery thing than any one person can understand, bleeding in at the edges and out through the cracks: a world wider and stranger than anyone can know.
This is a powerful and intense opening to an epic trilogy. Glorious. Honestly, I don't think I have enough superlatives for it. Lush, evocative, richly characterised, emotionally dense, with a scope that at first seems intimate and turns out to be much, much larger. Suri's skill—never minor—here seems to have taken a step or three up: there are few epic fantasies I have enjoyed, or admired, as greatly.
It made me feel so very much, and I'll be a while sitting with these feelings. But damn, it's an amazing book.
The Jasmine Throne is available from Orbit.
Liz Bourke is a cranky queer person who reads books. She holds a Ph.D in Classics from Trinity College, Dublin. Her first book, Sleeping With Monsters, a collection of reviews and criticism, was published in 2017 by Aqueduct Press. It was a finalist for the 2018 Locus Awards and was nominated for a 2018 Hugo Award in Best Related Work. She was a finalist for the inaugural 2020 Ignyte Critic Award, and has also been a finalist for the BSFA nonfiction award. Find her on Twitter. She supports the work of the Irish Refugee Council, the Transgender Equality Network Ireland, and the Abortion Rights Campaign.
book reviewsbooksEpic FantasyOrbit BooksqueersapphicTasha SuriThe Jasmine Throne
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Elizabeth on Demon Possession—IN SPACE! Lewis's Perelandra as Exorcism Narrative 1 hour ago

redpajama_set_name: RedPajamaCommonCrawl


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SN 2001eb – supernowa typu Ia odkryta 29 sierpnia 2001 roku w galaktyce NGC 1589. W momencie odkrycia miała maksymalną jasność 16,30.

Przypisy

Supernowe zaobserwowane w 2001 roku
Gwiazdozbiór Byka

redpajama_set_name: RedPajamaWikipedia


A Valentine's Day donation has been made in your honour to help care for rescued chimps at the Jane Goodall Institute's Tchimpounga sanctuary in the Republic of Congo. Chimps arrive at Tchimpounga alone and afraid. The love they receive from their caregivers restores their strength and confidence – it gives them a second chance. The gift of love is the best gift of all.
Cards may only be sent to one recipient at a time.


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Traditionally, the Bob Hope USO at LAX partners with local hotels to feed troops finishing basic training. This year, those troops were redirected to San Diego because of the smoke from the Woolsey Fire. But the feast did not go to waste. The Thanksgiving Dinner was delivered to the first Responders fighting the Woolsey Fire at the Lost Hills Sheriff's station in Agoura. Local airport hotels, including the Hilton Los Angeles Airport, the Hyatt Regency, Sheraton Gateway, the Westin, the Marriott, the Crowne Plaza, the Renaissance, Four Points by Sheraton, and the Gateway L.A., came together to support those who spent their Thanksgiving fighting raging fires in Ventura County. "For many years, our community has come together to give Marines a holiday they can remember," said Gateway Executive Director Laurie Hughes. "This year, it was our honor to bring Thanksgiving to those who could not be with their families because they were battling the wildfires."
Newer Post Gateway Elects 2019 Board of Directors
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Ein Spinnakerbaum oder kurz Spibaum (gelegentlich auch als Whiskerbaum bezeichnet) ist eine Spiere aus Aluminium, Holz oder kohlenstofffaserverstärktem Kunststoff (CFK), die dazu dient, den Spinnaker nach Luv auszubaumen (gegen den Wind offenzuhalten).
Zu diesem Zweck wird eine Seite des Spinnakerbaums am Mast befestigt, die andere in den Achterholer (auch: Luvschot) eingeklinkt und das luvseitige Schothorn des Spinnakers an den Baum gezogen.

Um das Segel zu trimmen kann der Spinnakerbaum durch Verwendung eines Toppnanten nach oben oder eines Niederholers nach unten verkippt und mit dem Achterholer nach achtern gezogen werden. Außerdem gibt es auf vielen Booten die Möglichkeit den Befestigungspunkt für den Spibaum am Mast mit Hilfe eines Schlittens zu verstellen.

Man unterscheidet zwei Arten von Spinnakerbäumen
 Symmetrische: Beide Enden des Baumes sind mit den gleichen Endbeschlägen versehen und diese sind in der Regel durch eine Auslöseleine, mit der sich beide Endbeschläge öffnen lassen, direkt verbunden. Solche Spibäume finden in erster Linie auf kleinen Booten und Fahrtenyachten Verwendung. Als Befestigungspunkt am Mast dient ein waagrechter Ring oder Halbring. Ein Vorteil dieser Konstruktion ist, dass bei einer Halse mit Spinnaker, der Spinnakerbaum einfach auf die andere Seite durchgesteckt werden kann. (Er muss nicht auf dem Vorschiff gedreht werden.) Dieses Vorgehen wird als End-To-End-Manöver bezeichnet.
 Asymmetrische: Eine Seite trägt einen Endbeschlag zum Einklinken der Luvschot, die andere ist konisch und wird in einen Glockenbeschlag (ein beweglicher Becher) am Mast gesteckt. Asymmetrische Spibäume findet man auf großen Yachten, speziell bei Regattabooten, wenn End-To-End-Manöver wegen der auftretenden Kräfte ohnehin schwierig, beziehungsweise unsicher sind.

Literatur
 Bent Aarre, Matthias Beilken: Spinnakersegeln. 10. Auflage, Delius Klasing, Bielefeld 2003

Segelschiffbau


I have been working in DevOps environment for the past 4 years and it is one of the very interesting concepts and there is no end to its learning. Every day I look forward to learning something new.
A few weeks back, after my work, as I was returning home from my workplace. I got into the cab that was allocated to me by the transport admins. I was waiting for the cab to move when another girl got inside the cab gasping. We smiled at each other and exchanged greetings. We talked about our work and project when somehow the topic of DevOps popped up. She said she was very eager to learn this new technology DevOps as it's very demanding in the market now. Her friend had told her to install DevOps in her system and start learning about it. That's when I stopped her and asked installed DevOps? She said yeah, her friend is working in this DevOps and had asked her to install it. That is when I told her that the DevOps that I know you don't have to install, DevOps is not a technology in itself but is a methodology similar to Agile.
Why did we need DevOps? A very popular saying goes like this "Necessity is the mother of invention". We being humans always want things to be better and faster. That's where the need for DevOps came into the picture. Before DevOps, the developers and operation team did not work in collaboration. The developers had to sometimes wait for months or years for his changes to get deployed into production and then it was an overhead for the developers to work on any bug that came up in the production environment because the code deployed was ages old. Operation guys had a tough time as they could not directly communicate with the developers, they would have a hard time telling the developers that their code didn't work properly in the production environment while the developers claimed that it worked fine on their local machine. Sometimes the blame game would go on for weeks before it could get resolved.
Now it didn't make any sense either that the changes that you are making are getting deployed in production after months. That's where DevOps comes into the picture. DevOps is the collaboration between the developers and the operations team. Hence the word DevOps. They work together, and there is no blame game over here. Everything is owned by everyone. There are many tools that are available in the market that makes this possible like CI Tools.
4. This code is tested for any bugs and issues and then released into the production environment.
Above mentioned steps is a simpler version of what actually happens though in reality there are many technical steps that are taken. But to begin with, these are the basic steps that we need to understand. All these happen in cycles. There is continuous development, build and deployment.
Because of continuous integration, quality code reaches the market in a better and faster manner. So in short DevOps is a collaboration of developers and operation guys with the help of tools that are available in the market.


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HIV/AIDS: What Parents Need to Know.
This fact sheet provides facts for parents about HIV/AIDS and provides parents with age-appropriate tips for talking about sexuality, drug use, and how they relate to HIV/AIDS.Note: PDF version available.
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Facts on Kids in South Dakota: Early Head Start in South Dakota.
This fact sheet focuses on the implementation of the Early Head Start program in South Dakota. It begins by explaining the history of the Early Head Start program, the establishment of 8 Early Head Starts in South Dakota, and the goal of Early Head Start programs to prepare children to be ready for school. It is reported that in 2013-2014 a total of 868 families participated in Head Start, 18% of the parents had less than a high school diploma, and 53% were single parent families. Data on parental employment, racial characteristics of children enrolled in Early Head Start, pregnant women in…
Facts on Kids in South Dakota: Head Start in South Dakota.
This fact sheet focuses on the implementation of the Head Start program in South Dakota. It begins by explaining the establishment of the South Dakota Head Start State Collaboration, the history of Head Start, and the beliefs and goals of Head Start related to school readiness. Head Start program options are reviewed, as well as an early learning framework and the racial characteristics of children enrolled in Head Start in South Dakota in 2012/2013. It is reported that in 2013-2014 a total of 3,990 families participated in Head Start, 22% of the parents had less than a high school diploma,…
Facts on Kids in South Dakota: About the Juvenile Justice System.
This fact sheet highlights the establishment of the Juvenile Detention Alternatives Initiative (JDAI), an evidence-based, cost effective approach to treating juvenile offenders. It begins by explaining the development of the juvenile justice system in the United States and then describes the JDAI and its key strategies. Data is shared that indicates when Minnehaha and Pennington counties implemented JDAI there was a decrease in juvenile detention numbers. The disproportionate number of incarcerated youth of color is noted and statistics are reported that indicate minority youths, primarily…
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Such as "Washington DC" or "20002"


WASHINGTON--(BUSINESS WIRE)--Dec 4, 2018--If you are looking to lose weight and get healthy in the new year, you will have no trouble sticking to your resolution with the help of Neal Barnard, M.D.'s new book, . Vegan diets have been shown to reverse heart disease and diabetes and to cause impressive weight loss without calorie-counting.
Dr. Barnard's research, funded by the U.S. government, established the power of vegan diets for diabetes, and he is often called on by news programs and celebrities for nutrition advice.
Many are looking to adopt a more healthful diet but may have questions, like: How do I plan a vegan meal? Is protein an issue? Which are the best choices at restaurants or if I'm traveling? Dr. Barnard has the answers to these questions and more. The Vegan Starter Kit also includes information on healthy eating in childhood, pregnancy, and other stages of life, and a complete set of basic meals, holiday feasts, snacks, among many other tips.
"Dr. Barnard makes a compelling case as to why all of us should 'test drive' a vegan diet. His guidebook is straightforward and simple to follow...as easy to digest as a plant-based lifestyle. All in all, a delicious read," says journalist and television personality Meredith Vieira.
"We've known Neal Barnard for years as a leader in the plant-based revolution. His new book makes it so easy to start your plant-based journey that we're recommending The Vegan Starter Kit to everyone we meet who's 'vegan curious' or just interested in good health, better energy levels, and a longer, more vibrant life," say Suzy Amis Cameron and James Cameron.
Going vegan is expected to be one of the biggest health trends in 2019. Vegan diets rose in popularity by 600 percent between 2014 and 2017, while Google searches for the term vegan recently reached an all-time high. Consumer demand for plant-based products, meat alternatives, and nondairy milks is also growing.
For those looking for more resources to get started on a vegan diet, Dr. Barnard is also featured in the 21-Day Vegan Kickstart, a free online program and app, available on iTunes and Google Play, featuring 21 days of recipes, meal plans, cooking tips, and nutrition information.
For an interview with Dr. Barnard, please contact Laura Anderson at 202-527-7396 or landerson@PCRM.org.


text:
Q: Stop redirecting subdomain to main domain How can I stop my subdomain from redirecting to my main domain,
here's my code so that http://mydomain.com always add the www
RewriteCond %{HTTP_HOST} .
RewriteCond %{HTTP_HOST} !^www\.mysite\.com [NC]
RewriteRule (.*) http://www.mysite.com/$1 [R=301,L]

I've created a sub domain (sub.mysite.com) that is in a sub sub folder of my main site, and when I type sub.mysite.com it redirects to www.mysite.com/sub/sub/
thanks for your help

A: You have to specify your sub folder which is related to your subdomain.
Edit your code to:
RewriteCond %{HTTP_HOST} ^subdomain\.domain\.com
RewriteRule ^(.*)$ http://domain.com/sub/sub/$1 [R=301]

A: Just add an exclusion for that subdomain (like you've done with www):
RewriteCond %{HTTP_HOST} .
RewriteCond %{HTTP_HOST} !^www\.mysite\.com [NC]
RewriteCond %{HTTP_HOST} !^subdomain\.mysite\.com [NC]
RewriteRule (.*) http://www.mysite.com/$1 [R=301,L]

redpajama_set_name: RedPajamaStackExchange


text:
Q: How to exclude unnecessary requests from JMeter log file in NonGUI mode I am running JMeter 4.0 r1823414.
In my test suite, I have the following structure:

When I run this TestPlan in non gui mode with the following command:
.\jmeter -t $testplan -l $testlog -e -o $reportFolder
I get a CSV file with all debug steps and requests (Authentication for example).
I am interested only in Query requests.
How can I exclude all requests from the CSV file and leave only Query requests in there?

A: I figured out what I did wrong.
by providing -l with a file path, I created a listener for the whole test session:

12.2 non-GUI (batch) test runs
  When running in non-GUI mode, the -l flag can be used to create a top-level listener for the test run. This is in addition to any Listeners defined in the test plan. The configuration of this listener is controlled by entries in the file jmeter.properties as described in the previous section.

If I run jmeter -n -t $testplan i get just the logs from the listeners I have specified

A: This is exact match for Filter Results Tool jmeter plugin

It should also filter queries that are not calls to the application but debug samplers or intermediate calculation samplers as beanshell samplers.

In your case you search for Query:
 jmeter\lib\ext\FilterResults.bat --output-file filteredout.csv --input-file inputfile.jtl --include-label-regex true --include-labels "Query.*"

A: If you want to exclude from CSV , then go for Filter Results Tool as per @ser7294900 answer.
But if you only want to exclude in HTML report then :

*

*First apply Naming Convention on your Transaction Controllers by right clicking on them and selecting "Apply Naming Convention"

 - Second, use menu Help > "Export Transactions for report" and replace  this in user.properties


Many books and people on this forum talk about direct mail campaigns to potential sellers. Currently, I've been driving throughout the town and city looking for apartment buildings seemingly in some disarray, jot down the address, then go on the website for the county and look up the records to find the name of the owner, or, if an LLC, google the LLC to find the owners, and see if I can find an address that way. This is incredibly onerous. Are there other methods people are using that are more effective?
I remember seeing a forum post about obtaining lists...who do I talk to to pay for lists of multifamily properties to directly mail them? Is it the township, and if so, which department usually can help with that? Title companies?
I can see how Driving for Dollars would be worth it if a deal lands, but for someone interested in finding deals out of state, this approach doesn't seem to work as well (unless people are driving on googlemaps to find potential deals? But even those photos are a couple years old).
@Barry Je so what you describe as 'incredibly onerous' many people have found to be 'very profitable' so not sure what to tell you. You are either wiling to do the work or to pay someone else to do it. I will say I have used Listsource and I think it is pretty effective.
Do you have access to CoStar?? You can get GREAT list and contact info.
I just checked the review on Listsourse, and by reading those, I personally would not use them due to both very "helpfool" customer service and obsolete contact list.
@Jeff Kehl congrats on your success and wish you many more. I have been playing around with listsource but it's a very open site. A lot of information presented and with your experience would know that every dollar counts so you want to make sure your pulling from the site exactly what your looking for. I ask if you'll be willing to teach me your methods on how it's worked for you?
@Emmanuel Lopez it depends what you're looking for. They offer a ton of data so you have to first figure out what you're looking for.
For instance, my goal might be to to buy small multi-family at a discount from the market. So I would limit to multi-family properties built 20+ years ago and a few other variables.
On the other hand if I'm looking for flip houses I want singe family houses of a specific type in very specific areas.
@jef Thank you for that. Now when looking for instance on the multi families do you also filter your searches by houses with EQUITY.
Also after you get the list what type of direct mail do you use?
Driving for dollars is great. But it's really not feasible unless you're going to fly in and drive or have someone you can trust to do it for you.
List Source is pretty solid. They tend to have a 5-10% margin of error in the accuracy of their data. I'd highly recommend running them through the NCOA database to limit the RTS and wasted marketing budget. If you need help with any of it drop me a PM. I buy a LOT of lists.
I've had success with the county. With properties held in LLCs and other types of entities, you'll still have to do some digging or hire someone to do it for you. Plenty of good help out there if you know where to look for them - good luck!


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text:
Q: how to raise event from dynamically created usercontrol How do I raise an event from a user control that was created dynamically?
Here's the code that I'm trying where Bind is a public EventHandler
protected indDemographics IndDemographics;
protected UserControl uc;
override protected void OnInit(EventArgs e)
{
    uc = (UserControl)LoadControl("indDemographics.ascx");
    IndDemographics.Bind += new EventHandler(test_handler);
    base.OnInit(e);
}

I get a null object for IndDemographics.  Can anyone point me to a complete code sample?
Thanks in advance...

A: First off, you'll need to make sure that you have the event defined in your usercontrol's code.
for example:
public class MyUserControl
  Inherits UserControl

  Public Event Bind(sender as object, e as EventArgs)

  public sub SomeFunction()
     RaiseEvent Bind(me, new EventArgS())
  End Sub
End Class

After this, then you can bind to the Event. Now,for your other issue, are you loading this control dynamically or is it declared on your ASPX side?  If it's on your ASPX side, then you don't need the LoadControl, as declaring an object as Runat=Server on the ASPX side instantiates an instance of said class.
If not, then you'll need to make sure you're using the Virtual Path for the location of the ASCX file. (in your example, you'd use "~/indDemographics.ascx" if the ASCX was at the root of the website). At this point you'd need to add it to the page (or a placeholder or some other container object).
Regardless, of which way you instantiate an instance of the UserControl, you then associate the Event Handler to the Event of the instance of the class. For example:
Dim btn As New Button;
AddHandler btn.Click, AddressOf MyButtonClickEventHandler

Now, for the reason that you're getting a NULL reference in the example code.
When you use the LoadControl reference, then the instance of your object is in the UC variable. In the example, you declare two objects, UC as a type of UserControl and indDemographics as a type of indDemographics.
When you use the LoadControl, you're instantiating an instance of indDemographics and assigning it to UC. When you try to assign the event handler to the IndDemographics variable, it has never actually been instantiated.
Ultimately, your code should look more along these lines:
protected indDemographics IndDemographics;
override protected void OnInit(EventArgs e)
{
    indDemographics = LoadControl("~/indDemographics.ascx");
    IndDemographics.Bind += new EventHandler(test_handler);
    base.OnInit(e);
}

A: I see it (IndDemographics) declared but never actually created, so I'd expect it to be null with just this code.

A: Thanks to Stephen for getting me on the right track. Here's the final working code in C#:
protected indDemographics IndDemo;
override protected void OnInit(EventArgs e)
{
    Control c = LoadControl("~/indDemographics.ascx");
    IndDemo = (indDemographics) c;
    IndDemo.Bind += new EventHandler(test_handler);
    place1.Controls.Add(IndDemo);
    base.OnInit(e);
}

It's important to cast the generic control into the indDemographics class. After that everything else works fine.


text:
Iraq in 2017
Thread: Iraq in 2017
Jedburgh
From ICG: Iraq and the Kurds: The Brewing Battle Over Kirkuk
In drafting Article 140 of the constitution, Kurdish leaders believed they were gaining guaranteed acquisition of Kirkuk. However, because of the way the constitution was achieved – through a rushed process culminating in a political deal between the Kurds and a single Shiite party, SCIRI, to the exclusion of many other parties, communities and minorities, as well as civil society organisations and public opinion more broadly – it reflects imposition of a Kurdish template for Kirkuk rather than a consensus agreement. As a result, a Kirkuk referendum may not happen, certainly not by the December 2007 deadline, and Kurdish aspirations may well flounder.
For the Kurds, this deadline thus threatens to become a self-laid trap. Having raised expectations and convinced their people to defer their Kirkuk ambitions by a couple of years, Kurdish leaders must now deliver by the end of 2007 or meet their wrath. As a Kurdish official put it, "we concentrated so much on Kirkuk, we would lose face if we now lowered our position. This is the problem".
This is a problem, however, not only for the Kurdish leadership, but for all Iraqis, as the Kurds' failure to secure Kirkuk by lawful, constitutional procedure may drive them to reckless adventurism with the risk of violence, civil war and possibly (direct or indirect) foreign intervention...
zenpundit
Former USG official ( I think State or NSC) Peter W. Galbraith has a new book out arguing, essentially, for a partition of Iraq.
The End of Iraq
Galbraith is best known from the chapters on the Kurdish genocide in Samantha Power's book A Problem From Hell: America in the Age of Genocide
Originally Posted by zenpundit
Other articles discussing that option have been posted on SWC here and here
Cordesman of CSIS has also just published another short commentary, Losing the War in Iraq?
ICG, 19 Apr 07: Iraq and the Kurds: Resolving the Kirkuk Crisis
....The U.S. needs to recognise the risk of an explosion in Kirkuk and press the Kurds, the Baghdad government and Turkey alike to adjust policies and facilitate a peaceful settlement.
The studied bystander mode assumed by Washington, the Kurds' sole ally, has not been helpful. Preoccupied with their attempt to save Iraq by implementing a new security plan in Baghdad, the Bush administration has left the looming Kirkuk crisis to the side. This neglect can cost the U.S. severely. If the referendum is held later this year over the objections of the other communities, the civil war is very likely to spread to Kirkuk and the Kurdish region, until now Iraq's only area of quiet and progress. If the referendum is postponed without a viable facesaving alternative for the Kurds, their leaders may withdraw from the Maliki cabinet and thus precipitate a governmental crisis in Baghdad just when the security plan is, in theory, supposed to yield its political returns....
Note that Galbraith writes from a very pro-Kurdish vantage point, for understandable reasons. I think he also serves as a sort of advisor for one or both of the Kurdish parties.
SWJED
Security May Trump Ethnicity in Kirkuk
Security May Trump Ethnicity in Kirkuk - Borzou Daragahi, Los Angeles Times.
A staunch Arab nationalist, Ismail Hadidi once dreaded the possibility that his ethnically diverse city would be swallowed up by the neighboring semiautonomous Kurdish region and cut off from the Baghdad government.
But the provincial councilman is also a practical man. And when he compares the chaos and violence in the Iraqi capital with the prosperity and peace next door in the three-province Kurdistan Regional Government area, teaming up with the Kurds doesn't seem like such a bad idea. He's even considering buying some property in the Kurdish enclave.
"The people of Kirkuk were afraid of this," said Hadidi, a Sunni Arab tribal leader. "But given the situation, I believe most people will move toward being part of Kurdistan, because what the people want above all is security."
Uncertainty clouds Iraq's future, but not so much here. The Kurdish region's exploding economic and political power has begun to shape northern Iraq's reality...
ICG, 28 Oct 08: Oil for Soil: Toward a Grand Bargain on Iraq and the Kurds
......Difficult negotiations over a provincial elections law in July-September 2008 were only the latest indication of the centrality of the Kirkuk question. A minority in Iraq, the Kurds have deployed all available legal and institutional mechanisms to facilitate their quest for Kirkuk. Still, they have failed to overcome the odds. The result has been a growing political standoff that is immediately destabilising – witness developments in and around Khanaqin in August-September – and, perhaps even more dangerously, challenges the foundations of the post-2003 order. The territorial dispute stems from a deeper Arab-Kurdish conflict that has its origins in the state's creation almost a century ago and has yet to be settled, whether through accommodation or by force. At its core it is a struggle between rival nationalisms with conflicting territorial claims to border areas, which the two groups claim based on historical demographic presence rather than on established boundaries, which never existed. Today, the goal should be a negotiated, consensus-based accommodation enshrined in the constitution, ratified in a referendum and guaranteed by the international community.
Deadlocked negotiations over the hydrocarbons and related laws, the architecture of federalism and the constitution review, together with growing tensions in disputed territories such as Khanaqin, suggest that these negotiations ought to shift from their focus on single issues to a grand bargain. A comprehensive approach will demand painful compromises from key stakeholders – principally Arabs and Kurds – who will be unable to provide their constituencies all they had promised them. It also will require overcoming deeply entrenched fears and mistrust.....
Erbil, Kurdistan, Iraq
My understanding is Galbraith is a paid lobbyist for the KRG. He writes well though and as someone with experience in Kurdistan, I find he is very accurate in his assessment of the situation.
WINEP, 14 Jan 09: Kirkuk: A Test for the International Community
On January 31, most Iraqis will go to the polls and express their political preferences in provincial elections, but four of Iraq's provinces -- the three governorates within the Kurdish Regional Government (KRG) and Kirkuk province -- will not hold elections. Kirkuk's noninclusion is a symbol of its unresolved status, and its elections are on hold until the Council of Representatives in Baghdad passes a special election law. There is little impetus, however, for the different ethnic factions to compromise on such a law unless the international community strongly supports the process.....
ICG, 28 Mar 11: Iraq and the Kurds: Confronting Withdrawal Fears
....Given great uncertainty over how security conditions will develop along the trigger line in the coming year, progress in political negotiations over the disputed territories' status has become more imperative than ever. While neither Baghdad nor Erbil appears to have an interest in armed confrontation, and both sides seem intent for the moment to capitalise on the mutual goodwill that arose from formation of the new coalition government, the disputed territories conflict is so fundamental to Baghdad-Erbil relations that a single incident could trigger a dangerous escalation. The unilateral deployment of Kurdish asaesh in Kirkuk city in November 2010 and of peshmergas / zerevanis into Kirkuk governorate in February 2011 were two such incidents. Violence has been avoided so far, in large measure because of the Baghdad-Erbil-U.S. security arrangement, but these moves stoked local anger as well as unease over the Kurds' long-term plans; they could still give rise to violent response and will vastly complicate negotiations for a deal, especially if the Kurds' military forces are not withdrawn to the Kurdistan region....
USIP, 28 Mar 11: Preventing Arab-Kurd Conflict in Iraq after the Withdrawal of U.S. Forces
Since the fall of the former regime, in 2003, there has been continuous concern that fighting might break out between the Arabs and the Kurds over Kirkuk and the boundary of the Kurdistan Regional Government.
In response to requests to help manage tensions between the different security forces, General Odierno, then Commanding General of United States Forces-Iraq, developed a Joint Security Architecture, bringing together Iraqi Security Forces, Kurdish forces, and US forces to work against their common enemy, the al-Qaeda.
US forces are due to start pulling out of their conflict prevention role along the 'trigger line' that divides the Kurds and the Arabs in the disputed territories, by the summer of 2011. Unless new conflict prevention mechanisms are put in place, there is a real risk that tensions could boil over as people tire of waiting for a political resolution.
Last edited by Jedburgh; 03-29-2011 at 07:06 PM.
SWJ Blog
Fewer Fighters in Iraq/Syria as IS Focuses on 'Third Capital'
Entry Excerpt:
Read the full post and make any comments at the SWJ Blog.
This forum is a feed only and is closed to user comments.
Peshmerga Commander Talks on Group's Anti-IS Strategy & Kurdish Peshmerga Fighters Wa
Peshmerga Commander Talks on Group's Anti-IS Strategy & Kurdish Peshmerga Fighters Waiting for Mosul Battle Plan
Islamic State's 'Battle Ready' Fighters Hit New Low
Created for 2017. The 2016 thread had 219 posts and 45.8k views:http://council.smallwarsjournal.com/...ad.php?t=23327
Thanks to Joel Wing for his updates and a few others who have posted here.
Last edited by davidbfpo; 12-31-2016 at 07:41 PM.
JWing
New post in new thread. Mosul campaign day 75, 2nd day of official restart of operations. Very little movement and all the fighting is over areas already freed or entered in east Mosul.
Happy New Year! Day 76 of Mosul Campaign.
Day 77 of Mosul Campaign review.
Did my year end total for casualties reported in Iraq in 2016. Came out to 24,079 dead and 39,166. Because of govt censorship of its losses the real figures are much higher.
Day 78 Mosul campaign.
Worth reading: 'Baghdad Doesn't Want You to Know How Many of Its Soldiers Are Dying' and for the unit at the front in Mosul:
The problem is, the constant fighting is bleeding dry the Golden Division. A Pentagon source told Politico that Iraqi Special Operations Forces "are suffering upwards of 50-percent casualties. The division could become combat ineffective in a little over a month, and perhaps even sooner".
Link:https://warisboring.com/baghdad-does...63c#.tez7oh96o
Quick Navigation Middle East Top
Iraq and the Arab States on Its Borders
By Jedburgh in forum Catch-All, OIF
Toward Sustainable Security in Iraq and the Endgame
By Rob Thornton in forum US Policy, Interest, and Endgame
US Senator's Iraq Trip Comments: WSJ 15 June 07
By TROUFION in forum US Policy, Interest, and Endgame
Victory in Iraq
By SWJED in forum US Policy, Interest, and Endgame
DNI's Fabius Maximus: Iraq and the Future
By SWJED in forum Catch-All, OIF
iran, iraq, isis, jihad, russia, usa


text:
The News - 2 month ago
IHC gives more time to appoint ECP members
ISLAMABAD: The Islamabad High Court (IHC) Thursday gave more time for the appointment of Members of Election Commission of Pakistan (ECP).PML-N Member National Assembly (MNA) Murtaza Javed Abbasi and Dr Nisar Cheema had challenged the appointment of ECP members on the seats of Sindh and Balochistan in Islamabad High Court, which led to the suspension of the appointment of new members.During hearing, IHC Chief Justice Athar Minallah remarked that the role of Senate chairman and the Speaker of the National Assembly (NA) is praiseworthy. The legislation is with Parliament but the judiciary is being included in the parliamentary affairs.Justice Athar further remarked that the issue need to be solved through Parliament. He said that the issue could be resolved within one week.The secretary requested the court to give 10 days for resolving the matter of ECP appointments. To this, MNA Mohsin Shahnawaz Ranjha agreed to give 10 days for appointment of ECP members.Ranjha argued that the premier is not serious to resolve of issues, as he is ready to sit with the opposition for consultations.To this, Justice Athar Minallah remarked that Chief Election Commissioner (CEC) is a constitutional position. Opposition and ruling side should be on the same page in national interests. It is recommended to amend character instead of amending the Constitution.The court later adjourned the hearing till December 17.Appointment of ECP members raised after the retirement of ECP members Abdul Ghaffar Soomro from Sindh and Justice (R) Shakeel Baloch from Balochistan in January and, as per law their replacements were to be made within 45 days.A consultation between the prime minister and the leader of the opposition in the National Assembly is required for the appointment of the ECP members.
Dr. Baig Inaugurates GTex Expo 2020
appoint
WAPDA issues report on rivers inflows, outflows
Fearless Delhi women protesters inspire national movement
فالس فلیگ آپریشن اور ٹارچر سنگھ
عراق میں امریکی فوج کے انخلاء کی حمایت میں ملین مارچ


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