Does mammographic screening and a negative result affect attitudes towards future breast screening?

OBJECTIVES:To investigate the impact of an experience of a benign mammographic result on intention to seek medical help immediately in the case of breast abnormalities, and on intentions and thoughts about future participation in screening. SETTING:The Dutch Breast Cancer Screening Programme for women aged 50¿69. METHODS:Subjects were women who were invited for an initial breast examination: 223 women filled out a questionnaire about 10 days before and about 6 weeks after their initial breast examination. To be able to control for possible test effects, another group of 293 women filled out a questionnaire only after mammography. Changes in thoughts and intentions were examined. RESULTS:Most women were very satisfied with the course of their initial breast examination, although pain or discomfort was often mentioned. No clues to suggest false reassurance were found: more than 99% of the women would consider the possibility of breast cancer if they felt a lump in one of their breasts. In such a situation, most women intended to seek medical help within a week. These variables were not influenced by the experience of mammography with a benign result. In general, women were very positive about (repeat) participation, both before and after screening. After screening, the average woman perceived fewer costs in participating, and perceived her own ability to engage in future screening as higher. However, the experience of pain and anxiety during the initial screening did lead to reverse effects. Women who were less satisfied about their treatment by the staff were more likely to change their intentions to reparticipate in a negative way. CONCLUSIONS:As, in general, women became more positive about regular participation after they had attended breast cancer screening, efforts to improve first round attendance must be continued. At the same time, the screening organisations must continue to prioritise the high level of client friendliness throughout the screening. No evidence for detrimental effects of screening through false reassurance among participants was found

External Beam Treatment of Inoperable Non-Small Cell Carcinoma of the Lung

External beam radiation therapy for unresectable non-small cell carcinoma of the lung has produced significant survival in patients with disease limited to one hemithorax. New approaches to improve the results of radiation treatment of these patients include interstitial implantation, the use of hypoxic cell sensitizers, biologic response modifiers, as well as changes in the technique of radiation therapy. This includes the use of modern computerized tomographic scanning technology for better definition of tumor volume as well as the use of two fractions per day in the treatment of non-small cell carcinoma of the lung. Initial results of these studies are encouraging, with an increase in patient survival suggested

Reaching the hearts and minds of illiterate women in the Amhara highland of Ethiopia: Development and pre-testing of oral HIV/AIDS prevention messages

In the style of radio programmes, we developed three episodes of audio HIV prevention education for illiterate women in Ethiopia. We used social-oriented presentation formats, such as discussion between women on HIV prevention, and expert-oriented presentation formats, such as an interview with a male doctor. The aim of this study was to assess the relation between evaluation of presentation formats and overall liking of episodes, which is important for persuasive effects. Thirty women from rural Amhara listened to the episodes and, after listening, female data collectors interviewed the women on evaluation of presentation formats, overall liking of episodes, identification with the characters and convincingness. Evaluation of social-oriented presentation formats was strongly related to overall liking of episodes, but evaluation of expert-oriented presentation formats was not. This relation was mediated through convincingness and not through identification. We conclude that social-oriented presentation formats make messages more convincing and, consequently, improve overall liking and persuasive impact

Laboratory evidence of disseminated intravascular coagulation is associated with a fatal outcome in children with cerebral malaria despite an absence of clinically evident thrombosis or bleeding

Background A procoagulant state is implicated in cerebral malaria (CM ) pathogenesis, but whether disseminated intravascular coagulation (DIC ) is present or associated with a fatal outcome is unclear. Objectives To determine the frequency of overt DIC , according to ISTH criteria, in children with fatal and non‐fatal CM . Methods/patients Malawian children were recruited into a prospective cohort study in the following diagnostic groups: retinopathy‐positive CM (n = 140), retinopathy‐negative CM (n = 36), non‐malarial coma (n = 14), uncomplicated malaria (UM ), (n = 91), mild non‐malarial febrile illness (n = 85), and healthy controls (n = 36). Assays in the ISTH DIC criteria were performed, and three fibrin‐related markers, i.e. protein C, antithrombin, and soluble thrombomodulin, were measured. Results and conclusions Data enabling assignment of the presence or absence of ‘overt DIC ’ were available for 98 of 140 children with retinopathy‐positive CM . Overt DIC was present in 19 (19%), and was associated with a fatal outcome (odds ratio [OR] 3.068; 95% confidence interval [CI] 1.085–8.609; P = 0.035]. The levels of the three fibrin‐related markers and soluble thrombomodulin were higher in CM patients than in UM patients (all P < 0.001). The mean fibrin degradation product level was higher in fatal CM patients (71.3 μg mL−1 [95% CI 49.0–93.6]) than in non‐fatal CM patients (48.0 μg mL−1 [95% CI 37.7–58.2]; P = 0.032), but, in multivariate logistic regression, thrombomodulin was the only coagulation‐related marker that was independently associated with a fatal outcome (OR 1.084 for each ng mL−1 increase [95% CI 1.017–1.156]; P = 0.014). Despite these laboratory derangements, no child in the study had clinically evident bleeding or thrombosis. An overt DIC score and high thrombomodulin levels are associated with a fatal outcome in CM , but infrequently indicate a consumptive coagulopathy

Solitary coherent structures in viscoelastic shear flow: computation and mechanism

Starting from stationary bifurcations in Couette-Dean flow, we compute nontrivial stationary solutions in inertialess viscoelastic circular Couette flow. These solutions are strongly localized vortex pairs, exist at arbitrarily large wavelengths, and show hysteresis in the Weissenberg number, similar to experimentally observed ``diwhirl'' patterns. Based on the computed velocity and stress fields, we elucidate a heuristic, fully nonlinear mechanism for these flows. We propose that these localized, fully nonlinear structures comprise fundamental building blocks for complex spatiotemporal dynamics in the flow of elastic liquids.Comment: 5 pages text and 4 figures. Submitted to Physical Review Letter

About ergodicity in the family of limacon billiards

By continuation from the hyperbolic limit of the cardioid billiard we show that there is an abundance of bifurcations in the family of limacon billiards. The statistics of these bifurcation shows that the size of the stable intervals decreases with approximately the same rate as their number increases with the period. In particular, we give numerical evidence that arbitrarily close to the cardioid there are elliptic islands due to orbits created in saddle node bifurcations. This shows explicitly that if in this one parameter family of maps ergodicity occurs for more than one parameter the set of these parameter values has a complicated structure.Comment: 17 pages, 9 figure

Theoretical and Numerical Analysis of an Optimal Execution Problem with Uncertain Market Impact

This paper is a continuation of Ishitani and Kato (2015), in which we derived a continuous-time value function corresponding to an optimal execution problem with uncertain market impact as the limit of a discrete-time value function. Here, we investigate some properties of the derived value function. In particular, we show that the function is continuous and has the semigroup property, which is strongly related to the Hamilton-Jacobi-Bellman quasi-variational inequality. Moreover, we show that noise in market impact causes risk-neutral assessment to underestimate the impact cost. We also study typical examples under a log-linear/quadratic market impact function with Gamma-distributed noise.Comment: 24 pages, 14 figures. Continuation of the paper arXiv:1301.648