br Acknowledgements br Introduction Within the past century human

Acknowledgements

Introduction
Within the past century, human began to dominate their ecosystems in an unprecedented manner through urbanization (Vitousek et al., 1997; Curran et al., 2002; Wei et al., 2015). Such domination not only exerts heavy pressure on the remaining natural resources (Atmis et al., 2007), but also changes the relationships between human and the natural world (Miller, 1997; Miller, 2005; Maller et al., 2005; Nisbit and Zelenski, 2011; The Royal Society, 2012). The most typical example is the remnant natural forests within a rapidly growing region. Following the urban outgrowth into the surrounding rural landscapes, forests which were once in large scale, located in remote, and possessed pristine biodiversity, have now been fragmented, degraded, and become part of the urban infrastructure that sharing the same border with the residential and commercial areas. Instead of being valued for their FLAG tag Peptide importance, these remnants are getting more appreciated in terms of their existence to counter-balance the low quality urban environment (high volume of traffic, air pollution, excess of built-up areas, etc.). Due to the gradual increase of environmental awareness among mass population, as well as the realization of the adverse impacts of the human technology to the living system, people\’s expectations to the natural environment have been shifted to a greater desire that starting to complement their lifestyle with elements of nature (Foo and Kidokoro, 2011; Farahwaheeda et al., 2009). As such, small natures within the urban settings are somehow as important as big reserves in the sense that reconnecting people to the nature (Shafer, 1995; Pyle, 2003; Turner et al., 2004; Nisbit and Zelenski, 2011; Groenewegen et al., 2012; Beil and Hanes, 2013).
The importance of experiencing nature, particularly among urban dwellers, has always been the topic of study under the medical, psychological, and recreation discipline. An easily accessible neighborhood nature offers urban dwellers a comfortable outdoor setting for public leisure, physical activities, social interaction, and spiritual inspiration. The experience with nature not only can improve cardiovascular and immune function, reducing physical responses to stress, promoting relaxation, and reducing the negative impact of illness through conducting physical exercises (Maller et al., 2002; de Vries et al., 2011; Groenewegen et al., 2012), but also can strengthen interpersonal bonds and foster other beneficial social factors (civic participation, trust, social relationship, etc.) through facilitating various levels of physical activity (Baur and Tynon, 2010; Hartig et al., 2011). All these benefits are delivered by simply providing common greenery that encourages outdoor recreation and face to face social contact. Besides, time spent in nature can change one\’s feeling, such as reducing anxiety, evoking positive feelings (freedom, unity with nature, happiness, etc.), and offering emotional experiences through the provision of a place for relaxation and escaping from the stressful rhythm of the city (Chiesura, 2004; Groenewegen et al., 2012; Bratman et al., 2015). Such restorative benefits may seem minor, but should not be underestimated as its function on mental refreshment is of crucial to the modern cities’ livability.
While natural experiences have been proven to be efficient in fulfilling many physical, mental, and social functions, different degree of naturalness may affect people\’s experiential connection to the nature, and eventually leading to the different ways the nature contributes to these functions. It is because natural environment is not a homogenous category. Some natures do outperform others by having a number of physical attributes associated with varying affective experiences, such as liking, attractiveness and preference (Kaplan and Herbert, 1987; Balling and Falk, 1982; Zheng et al., 2011). As such, the conceptions of naturalness are not dichotomous, which only differentiate between natural and unnatural environments (Wohlwill, 1983). Instead, Nuclear lamina can be assessed on a scale or hierarchy, such as ‘totally natural’, ‘civilized nature’, ‘semi-natural’ or ‘non-natural’ (Mausner, 1996). Thus, it is expected that the degree of naturalness to vary along with the nature\’s ecological and botanical dimensions, as well the type and intensity of development where specific human artifacts are involved (Purcell and Lamb, 1998; Grahn and Stigsdotter, 2003).

ace inhibitors The first organization to lead the

The first organization to lead the development of CGs in Israel was veteran environmental organization, Society for Protection of Nature in Israel (SPNI) that used CG as a tool to introduce environmental values into the low income neighborhoods, preserve urban nature and develop sense of responsibility among local communities (Levi, personal communication, 21 August 2011). In 2008 Joint Israel, leading Jewish humanitarian assistance organization, started to promote CGs in low income neighborhoods in several cities as a tool for social empowerment (Kamaisky, personal communication, 22 August 2011). According to Kamaisky, the director of ace inhibitors gardens program in Joint, For his organization, CG is a tool to engage with such communities as Ethiopian immigrants, who are often among the most marginalized Israeli populations (Kamaisky, personal communication, 22 August 2011). Previously predominantly rural, this immigrant community is at high risk for developing nutrition-related chronic diseases arguably due to new food environments characterized by heavily marketed unhealthy foods, reinforcement deficit of traditional healthy diets as well as low socioeconomic status (Regev-Tobias et al., 2012). In addition to existing organizations promoting CGs, Organization of Activists for Community Gardens was established in 2008 to provide Israeli gardeners a networking platform, forum for sharing knowledge and a database of existing CGs as well as relevant resources and suppliers (The Organization of activists for Community gardens in Israel, 2013).
Governments and municipalities in Europe and USA seem to support CGs in times of crises such as World Wars and economical depressions and to show less support and at times openly contest gardens when other land uses such as infrastructure and new developments turn out to be more profitable (Lawson, 2005; Rosol, 2010; McKay, 2011). In USA, 1976 state bill allowed to claim unused land for CGs and federal programs such as USDA Cooperative Extension Urban Garden Program were established (1976) to allocate funds for CGs. Such steps led to great rise in number of CGs and their expansion all through USA (Lawson, 2005). Yet, institutional support tends to be unstable. USDA Cooperative Extension Urban Garden Program ceased in the 1990s and only 5.8% CGs surveyed by ACGA at the turn of the century had ownership over the land or a land trust and the future of the CGs was unstable (American Community Garden Association, 1998). The centrality of tenure is well demonstrated by the case of NYC. Municipality of NY leased the land for to its some 1906 gardens, but in the 1990 with renewed feasibility of private investment, the city moved to auction off many of these sites for sake of urban regeneration (Eizenberg, 2012). Land use is a contested and highly competitive arena in contemporary urban space, thus garden initiatives require legal structures and property right solutions (Barthel et al., 2013). For instance in 1921, Stockholm allotment gardeners responded to the threat of city authorities to remove their gardens for the sake of development, by establishing the Allotment Union, umbrella origination, that to this day represents the interest of gardens before the city authorities regarding lease holds, fees and property rights (Barthel et al., 2010).

Methods
Four community gardens were chosen for the qualitative research phase in order to understand why Israelis engage in community gardens and what benefits do they perceive to derive form their participation. We examined the survey results in order to allocate sites for field work that represented diversity in time of existence, location of the sites, objectives for establishment of gardens and variability in members and users. Before approaching the chosen CGs interviews were conducted with coordinators in order to learn about the history of CG and member composition (Table 1).
Three of the gardens selected for further research are located in three of the Israel’s largest cities: Jerusalem, Tel Aviv and Beer Sheba, while a fourth garden is located in Gedera – a rapidly developing small town, characterized by a heterogeneous population. Three gardens vary greatly in the economic status of users, ranging from high – medium income level of users to very low income levels. In two of the gardens the population is homogenous in terms of origin, education, occupation and income and age groups. The gardens also vary in size, duration of existence objectives for establishment (Table 1).

There is a lack of research into

There is a lack of research into the educational aspects of forest gardens. One reason for this might be that most urban forest gardens, have only been established in recent years. There are reasons to assume that forest gardens in urban areas respond to a variety of emotional, aesthetic, nutritional and recreational needs, for instance through opportunities for citizens to collect and enjoy edible plants. Participation in creating and maintaining forest gardens provides potential opportunities to emotionally and intellectually experience, practice and process knowledge about the interconnectedness and interactions between species, which in turn might increase the children’s capabilities to handle complexities; this is important when making decisions about land use, particularly with regard to the conservation and development of akt inhibitor services. ‘Ecosystem services’, as a perspective on ecological processes, is highlighted in the Biology curriculum in grades 4–9 in Sweden (Swedish National Agency of Education, 2011), intended to provide students with insights into ecological processes. The ecosystem service approach to nature implies a unidirectional view about the purpose and value of organisms other than humans, insofar as the concept is described as follows:
‘Ecosystem services’ is a generic term for functions in nature that in different ways are beneficial to humans. Ecosystem services include products such as water, food and raw materials, and processes such as pollination of plants, water purification and circulation of nutrients.” (The Swedish National Agency of Education, 2011, p. 21, our translation from Swedish).
Evidence suggesting that experiential contact with nature is necessary for child development has been presented by several authors (Sebba, 1991; Faber Taylor et al., 1998; Basile, 2000). While Faber Taylor and Kuo (2006) saw methodological weaknesses in most of these studies they concluded that “given the pattern of findings pointing in the same direction […] it is more parsimonious to accept the fact that nature can promote healthy child development”. Using the biophilia hypothesis (Wilson, 1984), nine types of basic “biocultural” values that people hold about the natural world and which are likely to have been adaptive during human evolution were described by Kellert (1997, 2002, 2009). Kellert’s typology, the result of many years of research into people\’s attitudes and values concerning nature, includes scientific, symbolic, aesthetic, utilitarian, moralistic, humanistic, dominionistic, negativistic and naturalistic values, each describing a particular “affinity” that humans have with nature. The values develop during childhood and represent “the creation of values, beliefs and moral perspectives”, referred to as evaluative development (Kellert, 2002, p. 120). This is of interest in our study, as experiential contact with the natural environment, especially for children aged 6–10 years old, has been suggested to be necessary for the development of different values, and consequently for normal maturation during childhood (Kellert, 2009).
Notably for 10–16-year-olds, the ecosystem services-perspective, which reflects the utilitarian values in Kellert’s typology, is the only explicit perspective on nature expressed in the curriculum for Biology. For younger students, 6–9-year-olds, the curriculum does not explicitly point out any particular perspectives on nature that should frame learning about and in nature. However, implicitly there is a strong emphasis on what Kellert classified as scientific and symbolic values, such as naming and classifying (The Swedish National Agency of Education, 2011).
The concept of biophilia and Kellert’s values of nature has recieved empirical support and form the basis of a considerable body of research (Gullone, 2000). In an investigation of educator\’s perceptions about the benefits for children of contact with nature, Maller (2009) used biophilia as a basis for a model of how activities involving hands-on-contact with nature influences children’s mental, emotional and social health. Davis et al. (2006) applied Kellert’s typology to findings in two outdoor learning case studies aimed at children three to 11 years old and found that Kellert’s values relate to the pillars of learning formulated in UNESCOs report for learning in the 21st century (Delors, 1996). More recently, Richardson et al. (2015) used Kellert\’s typology to analyses of results in a study investigating what aspects of urban landscapes can be valued as a route for people to connect to nature. Kahn (2003, p. 131) found ”remarkably similar environmental moral reasoning” among children across diverse cultures and concluded that one explanation for this “is that that there are universal and invariant aspects of nature itself that give rise to and bound children’s environmental constructions”. For a critical discussion the biophilia hypothesis in relation to structural-developmental theory, see Kahn (1997).

diazoxide Our results further indicate that

Our results further indicate that placing vegetation strategically in heat-exposed areas increases its mitigating effects and lowers the need for additional green cover. While a maximum tree crown cover of 34% would reduce the PET by 13%, just a 22% tree cover would achieve a PET reduction of 10% if hotspots were prioritized. Similar findings were obtained for green facades. A possible explanation could be that a nonlinear relationship exists between green cover and PET reduction. This would be a different result than in other studies like e.g. Middel et al. (2015), who showed a linear reduction in the air temperature for increasing shares of tree crown cover in hot and arid climates by applying ENVI-met V3.1. Reasons for the diverging results could be that Middel et al. (2015) used air temperature and not PET and distributed the additional trees evenly within the case area. In V3.1 as used by Middel et al. (2015) vegetation could not yet be displayed as individual object, hence calculating transpiration processes differently (Bruse and Environmental Modelling Group, 2015; Simon, 2016). Moreover, the higher building density and thus, higher heat storage capacity and more shaded areas by buildings, in the present study could impact the cooling potential differently than in an open lowrise residential area in the study of Middel et al. (2015). To explore this first finding in more details, further research with a different approach of greening scenarios would be needed, which has not been the scope of this study.
Compared to alternative diazoxide options, i.e., technical measures, UGI is multifunctional. In addition to heat mitigating effects, UGI can also adapt to climate change by regulating surface runoff after heavy rain events that are likely to occur more often in the future as e.g. Armson et al. (2013) and Vanuytrecht et al. (2014) could show. Moreover, UGI can be beneficial for addressing climate change mitigation, air quality, biodiversity, and social and health effects (Chen et al., 2014a; Coombes et al., 2010; Davies et al., 2011; Demuzere et al., 2014; Hansen et al., 2016; Klemm et al., 2015; Strohbach et al., 2013; Tratalos et al., 2007). For example, green roofs do not perform well as a measure for heat mitigation. They neither provide shading nor are located close to the focus of analysis at 1.4m height. Consequentially, their resulting cooling impact at the street level remains close to zero. Nevertheless, green roofs can have positive influences via building energy performance and retention of storm water (Berardi et al., 2014; Ng et al., 2012; Wang et al., 2014).
Despite the benefits of UGI, its implementation faces many challenges, including involving various stakeholders, overcoming institutional and technical barriers, resolving conflicts of using high-demand open space and subsoil, and the lack of strategic information for its realisation (Connop et al., 2016; Matthews et al., 2015; Naumann et al., 2011; Norton et al., 2015; Wamsler, 2015). Therefore, this study does not suggest that the modelled scenarios can be translated directly into practice but rather that they can serve as an assessment of the adaptation potential of UGI in specific settings.
The presented results are valid for a perimeter block urban fabric located in humid continental climates. A transfer of results to other urban areas of the same fabric type and local climate zone can be achieved by simplifying the building geometry in the spatial setup of the case area. The chosen modelling approach worked well to quantify the differences between different UGI scenarios now and in the future using the ENVI-met model. To represent a likely future situation, the balanced IPCC scenario A1B for the time horizon 2030–2060 was chosen. This scenario projects a future of strong economic growth and a mixed use of fossil and renewable energies (Nakicenovic et al., 2000). Therefore, the climate change impacts on thermal comfort conditions shown in this study could be worse for more pessimistic scenarios (e.g., A2).

Traditionally POS attributes have been described using

Traditionally, POS attributes have been described using tools relying on direct observation, i.e., on-site visits (Brownson et al., 2009). However, direct observations can be expensive and time-consuming. Alternatively, remote observation using desktop auditing methods has the potential of being less labour-intensive and time consuming (Edwards et al., 2013; Taylor et al., 2011). The Public Open Space Desktop Park Auditing Tool (POSDAT) is an Australian desktop assessment tool developed and validated for use in Perth, Western Australia. POSDAT utilises a hybrid method of data sources, combining Geographic Information Systems (GIS) software and websites to audit parks remotely. Compared with on-site auditing of park attributes, Edwards et al. (2013) found a 22% ochratoxin a in the auditing time using the POSDAT methods.
POSDAT draws on a variety of satellite and aerial imagery sources from Google Earth (Google Inc., 2011); high resolution orthoimagery (Western Australian Land Information Authority, 2010); Google Street View (Google Inc, 2011); street map data, e.g., ‘StreetSmart’ (Western Australian Land Information Authority, 2009); the National Public Toilet Registry: https://toiletmap.gov.au/, and local government websites. While many of these sources are available Australia wide, the high resolution orthoimagery and StreetSmart data used by POSDAT are specific to Western Australia; these sources may not be widely available across the rest of Australia (Edwards et al., 2013). Furthermore, it has not been established whether POSDAT can be applied to rural settings where POS attributes and types are likely to be different from urban environments.

Methods
We used the definition of POS outlined by Edwards et al. (2013: 23), as ‘spaces reserved for the provision of green space and natural environments, accessible to the general public free of charge’. The study was conducted in Victoria, Australia. The method has been described in detail elsewhere (Edwards et al., 2013). In short, the POSDAT method is based on a comprehensive protocol that ensures contingency in the web-based auditing by use of clear definitions for each audit item, illustrations and step-by-step instructions. The POSDAT protocol (Edwards et al., 2011) and training manual (Edwards and Hooper, 2011) can be found online at: http://www.sph.uwa.edu.au/research/cbeh/projects/posdat. A number of spatial datasets were compiled to test the POSDAT in Victoria and are described in Table 1. Alongside GIS, Google Maps/Street View, the National Public Toilet Registry and local government pages were used to identify park attributes ochratoxin a in the POS’. All GIS spatial data were sourced from 2012 and the timing of the Google imagery captured varied from 2008–2014. The POSDAT audits were conducted in September–December 2014 by a trained auditor.

Results
Table 2 outlines the POSDAT items retained and the reasons for recommended removal of five items. Using POSDAT, 41 items were auditable and of these, 39 had high intra-rater reliability (i.e. percent agreement ≥0.8).
The time taken to assess POS was 11min when using POSDAT in Perth (Edwards et al., 2013). This implied a time and cost saving worth 3min in comparison to the in-person-audit tool POST (excluding travelling time and cost to the POS when performing direct observation). In the present study, sodium-potassium pump took 10min on average for the desktop auditor to assess POS.
The timeliness of the Google Street View imagery varied; some of the Street View imagery, predominantly in urban settings, was from 2014, whereas in regional areas it tended to be older (e.g. 2008). Thus, although the original POSDAT has been successfully applied to POS assessment in the large regional city (Geraldton, WA) (Edwards et al., 2015), we found auditing in areas further away from large regional urban settings was challenging due to older and lower quality images from Google Street View (see Appendix A for examples). Furthermore, in a few cases, roads surrounding the regional POS had not been photographed by the Google car resulting in three POS’ not being auditable.

br Two dimensional Speckle Tracking Echocardiography In an initial

Two-dimensional Speckle Tracking Echocardiography
In an initial experimental study, leukotriene receptor antagonists 2-D STE was able to recognize the early damage caused by anthracyclines (Migrino et al. 2008). Subsequently, this technique was applied by many authors in clinical investigations with favorable results. Studies can be grouped according to the four main features addressed: (i) identification of cardiotoxicity in patients previously treated with oncologic therapies; (ii) serial evaluations for prospective early recognition of cardiotoxicity; (iii) prediction of late cardiotoxicity development; and (iv) evaluation of cardioprotection strategies.

3-D Speckle Tracking Echocardiography
There are a few studies in the cardio-oncology field on the use of 3-D-STE. Yu et al. (2013a) evaluated 53 anthracycline-treated survivors of childhood cancers (mean age: 18.6 ± 5.1 y) and 38 controls. Three-dimensional STE was performed to assess LV 3-D global and segmental strain, time-to-peak segmental strain, LV torsion and EF. A LV systolic dyssynchrony index (SDI) was calculated as the percentage of the standard deviation of time-to-peak strain of 16 ventricular segments divided by the length of one leukotriene receptor antagonists (i.e., the time between two R-waves). A global performance index (GPI) was calculated as (global 3-D strain × torsion)/SDI. Compared with controls, patients had significantly reduced LV global 3-D strain (p < 0.001), torsion (p < 0.001) and GPI (p < 0.001) and greater SDI (p < 0.001). A GPI cutoff of 10.6°/cm had a sensitivity of 84.9% and a specificity of 81.6% in differentiating patients from controls. The advantage of the LV GPI obtained by 3-D-STE is that it incorporates LV 3-D strain, dyssynchrony and torsion for the sensitive detection of altered LV mechanics in childhood cancer survivors. Although this approach merits further validation, at present it appears to be relatively complex and difficult to implement in routine clinical practice. Miyoshi et al. (2014) studied 50 patients with preserved LV-EF (all ≥55%) after receiving anthracycline chemotherapy and 20 matched normal volunteers. With 3-D-STE, 3-D radial, circumferential and longitudinal myocardial function was quantified as a peak global strain curve from 16 LV segments; also, LV endocardial area change ratio (area strain) was quantified as peak global area strain curve (3-D-GAS) to determine LV endocardial function. Only 3-D-GAS and peak 3-D global circumferential strains of the anthracycline group were significantly worse than those of the control group (−43.3 ± 3.1% vs. −45.8 ± 4.3%, p = 0.008, and −31.6 ± 3.5% vs. −34.4 ± 4.2%, p = 0.004, respectively), whereas global LV systolic function and diastolic function were similar. It was noteworthy that multivariate analysis revealed that only 3-D-GAS (p = 0.025) was independently associated with cumulative doxorubicin dose. The authors concluded that 3-D-STE area strain is useful for early detection of minor LV endocardial dysfunction associated with the use of anthracyclines. However, whether this approach is clinically useful for predicting global LV dysfunction remains to be demonstrated. Intra- and inter-observer variability for strain and strain rate measurements by 3-D-STE is reported in Table 3.
Velocity Vector Imaging
Only few data are available on the evaluation of cardiotoxicity with VVI. Park et al. (2009) reported, in a small group 14 asymptomatic patients who had been treated with anthracyclines and had normal LV-EF, that anthracycline therapy, even at a low dose (<300 mg/m2), can induce changes in the regional peak systolic strain and strain rate obtained with VVI (especially at the septal level) before global dysfunction. These authors also calculated the intra-observer variability, as the mean difference [95% confidence interval], for peak systolic strain (0.99% [−2.32, 1.76]), peak systolic strain rate (0.13/s [−0.29, 0.24]) and diastolic strain rate (0.18/s [−0.40, 0.32]).

In addition to the assessment by the initial

In addition to the assessment by the initial examiner, BI-RADS classification (ACR, 2003) of static B-mode images and Tsukuba scoring (Itoh et al. 2006) of static RTE images were repeated by three independent, experienced reviewers who fdps were blinded to the clinical findings, as well as mammographic and histopathologic results. After at least 2 months, all images were re-assessed in random order by all three reviewers.

Results
Analysis of inter- and intra-observer agreement in US BI-RADS classification and TS included 613 elastograms of 164 breast lesions in 156 patients. Patients ranged from 18 to 89 y of age with a mean of 50.3 y. Patients with benign lesions were significantly younger than patients with malignant lesions. Core needle biopsy was performed on all 164 breast lesions. Histologic evaluation revealed 38.4% (n = 63) malignant and 61.6% (101) benign lesions. Among the benign lesions, 40.6% (n = 41) were fibroadenomas, 34.7% (n = 35) fibrocystic changes, 15.8% (n = 16) ductal hyperplasias and 8.9% (n = 9) other benign lesions. Among the malignancies, 77.8% (n = 49) were invasive ductal cancers, 12.7% (n = 8) invasive lobular cancers and 9.5% (n = 6) other types of breast cancer. The mean maximal diameter of the lesions was 17.7 mm (4.6–67.9 mm), and the mean lesion volume was 2.55 mL (0.05–30.1 mL). Benign and malignant lesions did not significantly differ in size (Table 2).
Initial BI-RADS classification by the examiner of all 164 lesions yielded 51.8% (n = 85) in BI-RADS 3, 26.8% (n = 44) in BI-RADS 4 and 21.3% (n = 35) in BI-RADS 5. The cancer rates for each BI-RADS classification are listed in Table 2. Benign lesions were significantly more often classified as BI-RADS 3 than malignant lesions, whereas malignant lesions were significantly more often classified as BI-RADS 4 or 5 than benign lesions (p < 0.001). The elastograms were scored according to the Tsukuba elasticity score developed by Itoh and Ueno (Itoh et al. 2006). The 5-point scoring system is based on visual assessment of the degree and distribution of strain in the breast lesion and surrounding tissue (Fig. 1). TS 1 and 2 lesions are considered benign, TS 3 lesions probably benign and TS 4 and 5 lesions malignant. One to five elastograms of each lesion (n = 613) were recorded and scored. In the real-time assessment by the examiner, 9.5% (n = 58) of elastograms were assessed as TS 1, 60.8% (n = 373) as TS 2, 10.9% (n = 67) as TS 3, 4.6% (n = 28) as TS 4 and 14.2% (n = 87) as TS 5. The cancer rates for different TSs are listed in Table 2. Among the elastograms of benign lesions, 71.2% (n = 354) had a TS between 1 and 3, whereas 81.7% (n = 94) of images of malignant lesions had a TS of 4 or 5. The assignment of benign lesions to TS 1–3 versus 4 and 5 and prothallus of malignant lesions to 4 and 5 versus 1–3 are statistically significant (p < 0.001). To assess inter-observer reproducibility of US BI-RADS classification and TSs, static B-mode images and elastograms were independently evaluated in random order by three reviewers who were blinded to all clinical data, in addition to the primary examiner. Weighted κ values for inter-observer agreement are summarized in Table 3. For inter-observer agreement of US BI-RADS classification between the examiner and each of the three reviewers, κ values between 0.585 and 0.738 were calculated, which correspond to a moderate to substantial agreement. κ values between reviewers ranged from 0.559 to 0.701, also representing moderate to substantial inter-observer agreement. The κ values for inter-observer agreement of TSs ranged from 0.608 to 0.693 (examiner vs. reviewer) and from 0.750 to 0.779 (inter-reviewer). Theses κ values represent substantial inter-observer agreement. To determine the intra-observer reliability of US BI-RADS classification and elasticity scoring for each reviewer, the κ values were calculated based on two sequential reviews of B-mode images and elastograms that were carried out in random order with an interval of 2 months between reviews (Table 3). The κ values for US BI-RADS ranged from 0.847 to 0.872, and those for TS, from 0.879 to 0.914, reflecting almost perfect intra-observer agreement for both image evaluations.