X-Ray Diffraction of Ramp-Compressed Silicon to 390 GPa.

Silicon (Si) exhibits a rich collection of phase transitions under ambient-temperature isothermal and shock compression. This report describes in situ diffraction measurements of ramp-compressed Si between 40 and 389 GPa. Angle-dispersive x-ray scattering reveals that Si assumes an hexagonal close-packed (hcp) structure between 40 and 93 GPa and, at higher pressure, a face-centered cubic structure that persists to at least 389 GPa, the highest pressure for which the crystal structure of Si has been investigated. The range of hcp stability extends to higher pressures and temperatures than predicted by theory.

Equation of State of CO_{2} Shock Compressed to 1 TPa.

Equation-of-state (pressure, density, temperature, internal energy) and reflectivity measurements on shock-compressed CO_{2} at and above the insulating-to-conducting transition reveal new insight into the chemistry of simple molecular systems in the warm-dense-matter regime. CO_{2} samples were precompressed in diamond-anvil cells to tune the initial densities from 1.35 g/cm^{3} (liquid) to 1.74 g/cm^{3} (solid) at room temperature and were then shock compressed up to 1 TPa and 93 000 K. Variation in initial density was leveraged to infer thermodynamic derivatives including specific heat and Gruneisen coefficient, exposing a complex bonded and moderately ionized state at the most extreme conditions studied.

Common, important, and unmet needs of cancer outpatients.

PURPOSE: To maximize patient well-being, health and social care should, whenever possible, address individual patient needs. The present study aims firstly, to identify prevalent, salient and unmet needs amongst cancer outpatients, and secondly, to explore socio-demographic and clinical influences on expressed need. METHODS: One-hundred and ten outpatients registered at a UK cancer treatment centre completed a self-report questionnaire measuring the presence, salience and degree to which 80 need items were met. Six broad cancer sites were represented: urology, colorectal, breast, gynaecology, haematology, and head and neck. RESULTS: The mean number of needs reported was 27. The top five needs concerned the treatment, care and health information patients receive from healthcare professionals, all of which were rated as well met. Least met needs included receiving genetic information, information about lifestyle changes, help with worries about spread or recurrence, and parking near treatment centres. Salient needs showed greater variation across the sample and were often unmet, for example the need for genetic information, and the need for information about symptoms/indicators of recurrence. Gender (female), age (younger), having an informal caregiver, and cancer site all affected aspects of need; whereas time since diagnosis and type of treatment did not. CONCLUSIONS: Acknowledging these influences on patient need could help guide patient-centred support services with potential gains to patient satisfaction and well-being.

Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk.

Although the effectiveness of mammography for women under the age of 50 years with a family history of breast cancer (FHBC) has not yet been proven, annual screening is being offered to these women to manage breast cancer risk. This study investigates women's awareness and interpretation of their familial risk and knowledge and views about mammographic screening. A total of 2231 women from 21 familial/breast/genetics centres who were assessed as moderate risk (17-30% lifetime risk) or high risk (>30% lifetime risk) completed a questionnaire before their mammographic screening appointment. Most women (70%) believed they were likely, very likely or definitely going to develop breast cancer in their lifetime. Almost all women (97%) understood that the purpose of mammographic screening was to allow the early detection of breast cancer. However, 20% believed that a normal mammogram result meant there was definitely no breast cancer present, and only 4% understood that screening has not been proven to save lives in women under the age of 50 years. Women held positive views on mammography but did not appear to be well informed about the potential disadvantages. These findings suggest that further attention should be paid to improving information provision to women with an FHBC being offered routine screening.

Predictors of breast cancer-related distress following mammography screening in younger women on a family history breast screening programme.

OBJECTIVE: This longitudinal study investigated pre-screening factors that predicted breast cancer-specific distress among 1286 women who were undergoing annual mammography screening as part of a UK programme for younger women (i.e., under 50) with a family history of breast cancer. METHODS: Women completed questionnaires one month prior to screening, and one and six months after receiving screening results. Factors measured were breast cancer worry, perceived risk, cognitive appraisals, coping, dispositional optimism, and background variables relating to screening history and family history. RESULTS: Pre-screening cancer worry was the most important predictor of subsequent worry, explaining 56/61% and 54/57% of the variance at one and six months follow-up, respectively. Other salient pre-screening predictors included high perceived risk of breast cancer, appraisals of high relevance and threat associated with the family history, and low perceived ability to cope emotionally. Women who had previously been part of the screening programme and those with a relative who had recently died from breast cancer were also vulnerable to longer-term distress. A false positive screening result, pessimistic personality, and coping efforts relating to religion and substance use predicted outcomes of screening at one month follow-up, but were not predictive in the longer-term. CONCLUSION: Early intervention to ameliorate high levels of cancer-related distress and negative appraisals would benefit some women as they progress through the familial breast screening programme.

Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study.

Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of developing breast cancer because of their family history of the disease. Little is understood about the impact of screening on the emotional well-being of women with a family history of breast cancer. This qualitative study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35-50, diagnosed with breast cancer while on an annual mammographic screening programme. Women described the strong sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the positive yet diverse attitudes towards mammographic screening in this group of women with a family history of breast cancer.

Factors associated with breast cancer-specific distress in younger women participating in a family history mammography screening programme.

This multi-centre study examined factors associated with breast cancer-specific distress in 2321 women under 50 who are on a mammographic screening programme on account of their family history. Women were recruited from 21 UK centres, and completed a questionnaire one month before their screening appointment. The transactional theory of stress, appraisal, and coping provided the theoretical framework for the study. Factors measured included screening history, family history, perceived risk, cognitive appraisals, coping, optimism, and cancer worry. The findings indicate that the majority of women appraise their family history as being relevant and somewhat threatening to personal well-being, but something they can deal with emotionally. Acceptance was the most commonly used coping strategy. Hierarchical regression analysis identified that the factors most significantly associated with distress were an appraisal of high relevance and threat, increased risk perception, low dispositional optimism, and the use of both avoidant and task-orientated coping strategies. Women with children and those with relatives who have died from breast cancer were also more distressed. To conclude, most women appraised their situation positively but there is a potential profile of risk factors which may help clinicians identify those women who need extra psychological support as they progress through screening.

Three lay mental models of disease inheritance.

Genetics are coming to play an increasing role in biomedical understanding of common diseases. The implication of such findings is that at-risk individuals may be offered predictive genetic tests. How do individuals make decisions about predictive tests and what information do they need to make informed choices? Richards [Richards, M.P.M., 1993. The new genetics: some issues for social scientists. Sociology of Health and Illness 15, 567-586] has argued the first step in understanding and helping people to make these decisions is to investigate lay beliefs of genetics. This study examined mental models of inheritance in a sample of 72 lay people. Through analysis of open-ended questionnaires we found three mental models which loosely corresponded to three phases of historical development in the science of genetics. These we labelled the Constitutional, Mendelian and Molecular Models. Predictions for individuals holding each model are made for the comprehension of genetic information in a testing situation.

Lay representations of genetic disease, and predictive testing.

As research in human genetics advances, genes for familial forms of cancer and heart disease will continue to be identified. The implication of such findings is that at-risk individuals will be offered a predictive genetic test. How do individuals make such decisions and what information do they need to make informed choices? Richards (1993) has argued that the first step in understanding and helping people to make these decisions is to investigate lay beliefs of genetics. This study examined illness representations of genetic disease, and predictive testing in a sample of 20 educated lay people. Through content analysis of open-ended interviews, we discovered that individuals have limited knowledge of late-onset genetic disorders and predictive testing. Most of the sample identified genetic diseases that manifest in childhood, and were more familiar with prenatal testing. They did not mention any treatment options for genetic disorders, which may indicate that lay people are more deterministic about diseases with a genetic component. Finally, they consistently raised concerns about the ethics of genetic testing and research. The implications of our findings for the provision of information in a genetic testing situation are discussed.

Changes in women's emotions as a function of emotion valence, self-determined category of premenstrual distress, and day in the menstrual cycle.

A confirmatory study where 20 women completed Plutchik and Kellerman's Emotions Profile Index in a daily prospective rating of emotions supported previous findings of mood fluctuations across the menstrual cycle. Positive moods peaked at or about the time of ovulation and negative ones at or about the time of menstruation. However, significant interactions indicated that a pronounced shift in mood was only characteristic of women who rated themselves as "sufferers" of premenstrual discomfort and not of those who rated themselves as experiencing very mild discomfort.

Hungary: a health system in transition.

Hungary has an area of 93,030 square kilometers (35,900 square miles), the size of the state of Indiana in the United States. It is landlocked by the Czech Republic and the Slovak Republic to the north, Austria to the west, Yugoslavia to the south, and Romania and the Soviet Union to the east. Although the health care system is based on the Soviet system, there have been dramatic changes since 1991, when the soviet Union and its Eastern European partners discarded their communist structures and the Soviet empire was disbanded. In this report, the current Hungarian health care system and the political structure in which it is housed will be described in terms of a key set of characteristics and their subparts. The purpose of this approach is to facilitate comparison of the Hungarian system with other national health care systems. An expanded version of this article will appear in an upcoming second edition of the College's book, International Health Care: A Framework for Comparing National Health Care Systems, by Drs. Mendoza and Henderson.

Constitutional guarantees to health care in Spain.

This analysis of the Spanish health care system is one in a series of such studies undertaken by the author, following a grid of factors that influence the delivery and financing of health care. The purpose of the national analyses is to facilitate a comparison of the United States' and other health care systems in terms of anticipated reform of the U.S. system. Analyses of the U.S. and nine other national systems are included in a book that has just been published by the College. Spain and nine additional countries will be studied in a book due for publication later this year. A final book with ten additional national analyses will appear in 1996.

Comparison of three rapid diagnostic techniques for detection of respiratory syncytial virus from nasal wash specimens.

We report results of three rapid tests for respiratory syncytial virus antigen detection. An immunofluorescence assay using commercial antibody and two commercial enzyme immunoassays (Ortho Diagnostics, Inc., Raritan, N.J., and Abbott Laboratories, North Chicago, Ill.) were applied to 199 nasal wash specimens. The Abbott enzyme immunoassay was the most sensitive technique, with a sensitivity of 93.8%. The specificities of the three techniques were comparable and greater than 95%. The availability of reliable rapid diagnostic techniques will allow for better care of infants with severe respiratory syncytial virus infection.

Pneumonectomy through an empyema.

In the 10 year period from May, 1973, to May, 1983, a total of 251 pneumonectomies were undertaken. Total unilateral bronchiectasis, the consequence of previous tuberculosis, occurred in 67.3% of cases and was the major indication for pneumonectomy. Of the 251 pneumonectomies, 14.7% were done through an empyema. The management of patients undergoing this procedure is discussed. There were two operative deaths among the 37 patients. Postpneumonectomy empyema developed in 16 patients (45.7%), and five of these patients required thoracoplasty, five left the hospital with an open drain or sinus, and in six the empyema was sterilized.