Is Step Down Assessment of screen‐detected lesions as safe as workup at a Metropolitan Assessment Centre?

Objective: BreastScreen WA offers population mammographic screening via fixed clinics in the metropolitan area and mobile clinics that visit country areas every two years. If an abnormality is suspected following mobile clinic screening, women undergo Step Down Assessment; diagnostic further views are performed at the mobile clinic and if a possibly significant abnormality persists, country women are referred to a Perth Metropolitan Breast Assessment Centre. The purpose of this retrospective cohort study was to determine if Step Down Assessment in country Western Australia offered the same diagnostic effectiveness as screening and assessment in the metropolitan area. Methods: The study included all screening episodes at BreastScreen WA between 1999 and 2008. Screening episodes from metropolitan and mobile clinics were compared according to the primary outcomes of cancer detection rates, recall and further investigations, cancer size, return to screen rates and interval cancers. Results: Cancer detection rate per 1,000 screening episodes was lower for the country program than the metropolitan program (3.07 (2.84–3.31) versus 7.04 (6.82–7.27)). The false negative (interval cancer) rate was lower for Step Down Assessment than for the metropolitan program. The size of cancers detected was similar for both screening services. Return to screen rates were comparable between both groups. Conclusion: The results indicate that the current service model is providing appropriate diagnostic effectiveness, as well as comparable client satisfaction, for country and metropolitan women.     

Dual Vulnerability of Being Both a Teen and an Immigrant Parent: Illustrations from an Italian Context

Italy has experienced a recent surge in immigration, which has led to an increase in the country’s birth rate. Many immigrant mothers are adolescent parents. 30 adolescent mothers (17 recent immigrants and 13 adolescents of Italian descent) completed measures of adolescent self-development and motherhood, perceived availability and satisfaction with social support, and emotional and behavioral characteristic of their children. Findings suggest that immigrant teen mothers show more difficulties related to parenting than do Italian born teen mothers. In particular, immigrant teen mothers report lower levels of social support satisfaction and availability, higher levels of parent–child dysfunction, and experience motherhood and child behavior as more problematic. The findings highlight and confirm the need for well-designed, specific supportive services for adolescent immigrant mothers.     

Migration and Maternity: Insights of Context,Health Policy,and Research Evidence on Experiences and Outcomes From a Three Country Preliminary Study Across Germany,Canada, and the United Kingdom

A group from Germany, Canada, and the United Kingdom undertook country-specific scoping reviews and stakeholder consultations before joining to holistically compare migration and maternity in all three countries. We examined four interlinking dimensions to understand how international migrant/minority maternal health might be improved upon using transnational research: (a) wider sociopolitical context, (b) health policy arena, (c) constellation, outcomes, and experiences of maternity services, and (d) existing research contexts. There was clear evidence that the constellation and delivery of services may undermine good experiences and outcomes. Interventions to improve access and quality of care remain small scale, short term, and lacking in rigorous evaluation.     

Performance measures of 7– to 15-year-old children on the auditory verbal learning test

This study provides Auditory Verbal Learning Test (AVLT) data for 10 boys and 10 girls in each offour age groups, 7-to 8-years, 9-to 10-years, 11-to 12-years and 14-to 15-years. Gender was not a significant factor in any of the measures in this study. Superior performance by older children was found for acquisition, retention, word span, and retrieval efficiency. Age did not affect acquisition rate, the shape of the serial position curve, memory for the source of items, or the proportion of items recalled after a 20-min delay. The stability of these measures across the wide age range of normal children is indicative of their potential diagnostic significance.     

Comparison of two functional independence scales with a participation measure in post-stroke rehabilitation

The objectives of the study were to compare the association and responsiveness of the functional autonomy measurement system (SMAF) and functional independence measure (FIM) as outcome measures addressing functional independence in stroke patients involved in an intensive rehabilitation program and to compare their relationships with a social participation measure after rehabilitation period. One hundred and thirty-two people who had a stroke were evaluated with the SMAF and FIM during the rehabilitation period (T1: admission; T2: discharge; n=132) and twice after discharge (T3=2 weeks; n=118; T4=6 months later; n=102). At T3 and T4, a participation measure, the assessment of life habits (LIFE-H), was added. The main findings are: (1) the total scores on the SMAF and FIM are strongly correlated together (r=0.93 to 0.95; p<0.001); 2) the responsiveness of both functional independence scales is similar even though the SMAF total score is more responsive to change than the FIM total score (standardized response mean: 1.20 vs. 0.97; p<0.01); (3) the SMAF and FIM are related similarly to the daily activities domain of the participation scale; and finally (4) the social roles domain of the participation scale is less related to the SMAF and MIF than the daily activities domain; however, the SMAF score is more related to the social roles domain than the MIF. Our results support the need to use supplementary measures, such as participation measure, that cover not only physical function but also the other domains of participation, such as interpersonal relationships and leisure, that can be disrupted following a stroke.     

Ultra-high vacuum scanning tunneling microscopy and theoretical studies of 1-halohexane monolayers on graphite

A simple model system for the 2D self-assembly of functionalized organic molecules on surfaces was examined in a concerted experimental and theoretical effort. Monolayers of 1-halohexanes were formed through vapor deposition onto graphite surfaces in ultrahigh vacuum. Low-temperature scanning tunneling microscopy allowed the molecular conformation, orientation, and monolayer crystallographic parameters to be determined. Essentially identical noncommensurate monolayer structures were found for all 1-halohexanes, with differences in image contrast ascribed mainly to electronic factors. Energy minimizations and molecular dynamics simulations reproduced structural parameters of 1-bromohexane monolayers quantitatively. An analysis of interactions driving the self-assembly process revealed the crucial role played by small but anisotropic electrostatic forces associated with the halogen substituent. While alkyl chain dispersion interactions drive the formation of a close-packed adsorbate monolayer, electrostatic headgroup forces are found to compete successfully in the control of both the angle between lamella and backbone axes and the angle between surface and backbone planes. This competition is consistent with energetic tradeoffs apparent in adsorption energies measured in earlier temperature-programmed desorption studies. In accordance with the higher degree of disorder observed in scanning tunneling microscopy images of 1-fluorohexane, theoretical simulations show that electrostatic forces associated with the fluorine substituent are sufficiently strong to upset the delicate balance of interactions required for the formation of an ordered monolayer. The detailed dissection of the driving forces for self-assembly of these simple model systems is expected to aid in the understanding of the more complex self-assembly processes taking place in the presence of solvent.     

Substitute Consent for Research Involving the Elderly: A Comparison Between Quebec and France

The authors first describe the rules enacted in Quebec and France to protect adults with decisional impairment who may be approached by investigators to participate in research protocols. They then present two consecutive postal surveys conducted among Quebec and French researchers in aging and designed to (1) assess their knowledge of the legal provisions implemented to protect decisionally incapable adults, (2) elicit their opinions regarding the person best suited to provide substitute consent for research participation, and (3) document their conduct related to obtaining consent for prospective subjects with impaired decisional capacity. Knowledge of the legislation governing substitute consent was poor, even more so among French than Quebec researchers (p < 0.001). In both samples, the majority of respondents felt that the substitute decision-maker does not have to be legally appointed when the study poses little risk to the participant. Practice data revealed a certain discrepancy between the conduct of researchers in aging and the legal provisions regarding consent for research purposes that prevail in their jurisdictions. These findings underscore the need to better educate clinical investigators about existing measures to protect prospective subjects who lack decisional capacity. They also provide some support for allowing close relatives to consent to research participation on behalf of older adults who are unable to consent by themselves and have not been appointed a legal representative.