The development and testing of balanced communication material for a population-based breast cancer screening program

Organized breast cancer screening (BCS) programs rely on written communication materials for achieving participation and informing women about screening-related benefits and limits. In order to achieve informed decisions and to maximize reader acceptance, the Agency for Health Protection of the metropolitan area of Milan aimed at improving the communication materials of the local BCS program through a multiphase, mixed-method process. Multidisciplinary working groups drafted three sets of materials: postal letters, an informative leaflet, and a question-and-answer online set. Readability was assessed using the Italian language-tailored Gulpease index. Suitability and Comprehensibility were assessed using the SAM + CAM instrument. User perception was investigated through "think aloud"interviews in two consecutive purposive samples. Participants' intention to participate in the program was also assessed. After each phase was completed, materials were readapted, and previous phases were repeated, to maintain the pre-defined Gulpease and SAM + CAM targets. During the quality improvement process, the overall mean Gulpease and SAM + CAM scores increased from 65.5 (s. d. 10.4) to 67.7 (s. d. 8.2) and from 78 (s. d. 5.6) to 83 (s. d. 4.1), respectively. In light of the results of the first round of interviews, materials underwent rewriting and layout revision, which was generally appreciated during the second round, with a non-significant increase in the intention to participate in the program. However, negative emotions and miscomprehension concerning overdiagnosis were frequently reported, although less frequent in the second round, after rewording of the text. The mixed-method multistep process involving all the relevant key players allowed a balance among the multifaceted aspects of communication

Screening of women with aesthetic prostheses in dedicated sessions of a population-based breast cancer screening programme

Background: Women with aesthetic prostheses must be included in the target population of mammography screening programmes. Breast implants are radiopaque and partially obscure the breast tissue. This can be avoided with the use of the Eklund technique, which causes an increased radiation exposure. In this study, augmented women undergoing a dedicated protocol within a population-based screening programme were compared according to selected indicators with the standard screening population. Essential dosimetric parameters and their time trend were also assessed. Materials and methods: The study was conducted in a screening centre in Milan in the years 2009–2016. The screening protocol for women with breast implants included a double-read mammography with the Eklund views, ultrasound and clinical breast examination. Results: A total of 28,794 women were enrolled, including 588 (2%) women with breast implants and 28,206 (98%) undergoing the standard screening protocol. The invasive assessment rate was 9.0‰ for women with breast implants vs. 15‰ in the standard cohort. The surgical referral rate was 2.2% vs. 0.9%. The detection rate was similar in the two groups (4.0 and 4.5‰, respectively). There were significant differences in the average glandular dose according to the mammography equipment. The use of the Eklund views increased over time. Conclusions: Screening of augmented women according to a specific protocol in the contexts of population-based programmes is feasible. Observed differences in screening indicators relative to the standard screening population require further research. The increasing use of Eklund views probably results from quality assurance measures associated with screening programmes

Ammonia Borane Dehydrogenation Catalyzed by (κ⁴-EP<inf>3</inf>)Co(H) [EP<inf>3</inf> = E(CH<inf>2</inf>CH<inf>2</inf>PPh<inf>2</inf>)<inf>3</inf>; E = N, P] and H<inf>2</inf> Evolution from Their Interaction with NH Acids

© 2017 American Chemical Society.Two Co(I) hydrides containing the tripodal polyphosphine ligand EP3, (κ4-EP3)Co(H) [E(CH2CH2PPh2)3; E = N (1), P (2)], have been exploited as ammonia borane (NH3BH3, AB) dehydrogenation catalysts in THF solution at T = 55 °C. The reaction has been analyzed experimentally through multinuclear (11B, 31P{1H}, 1H) NMR and IR spectroscopy, kinetic rate measurements, and kinetic isotope effect (KIE) determination with deuterated AB isotopologues. Both complexes are active in AB dehydrogenation, albeit with different rates and efficiency. While 1 releases 2 equiv of H2 per equivalent of AB in ca. 48 h, with concomitant borazine formation as the final "spent fuel", 2 produces 1 equiv of H2 only per equivalent of AB in the same reaction time, along with long-chain poly(aminoboranes) as insoluble byproducts. A DFT modeling of the first AB dehydrogenation step has been performed, at the M06//6-311++G∗ level of theory. The combination of the kinetic and computational data reveals that a simultaneous B-H/N-H activation occurs in the presence of 1, after a preliminary AB coordination to the metal center. In 2, no substrate coordination takes place, and the process is better defined as a sequential BH3/NH3 insertion process on the initially formed [Co]-NH2BH3 amidoborane complex. Finally, the reaction of 1 and 2 with NH-acids [AB and Me2NHBH3 (DMAB)] has been followed via VT-FTIR spectroscopy (in the -80 to +50 °C temperature range), with the aim of gaining a deeper experimental understanding of the dihydrogen bonding interactions that are at the origin of the observed H2 evolution

C<inf>1</inf> and C<inf>s</inf> 2-pyridylethylanilido zirconium(iv), yttrium(iii) and lutetium(iii) complexes: synthesis, characterization and catalytic activity in the isoprene polymerization

© The Royal Society of Chemistry and the Centre National de la Recherche Scientifique.Neutral group-IV and rare-earth complexes stabilized by novel Cs and C1-symmetric 2-pyridylethylanilido ligands have been prepared and fully characterized before being scrutinized as catalyst precursors in the isoprene (IP) polymerization. In all the isolated complexes, these ligands coordinate to the metal centers in their monoanionic bidentate form. Tetra-amido ZrIV-complexes from this series (11 and 12) have shown only negligible catalytic activity in the IP polymerization, giving polydienes in traces, irrespective of the activator(s) and reaction conditions used. On the other hand, ternary systems made of a bis-alkyl rare-earth metal complex (13-16), an organoborate and a 10-fold excess of an aluminum-alkyl [pre-catalyst/Al-alkyl/borate = 1 : 10 : 1] are found to initiate the living IP polymerization with complete monomer conversion within a few minutes. The process selectivity has been investigated from different perspectives, analyzing its dependence from the rare-earth metal ion of choice (YIIIvs. LuIII), the ligand type (C1vs. Cs) and the activator(s). Polyisoprenes (PIPs) with a prevalent cis-1,4-motif (up to 67.0%) or mainly featured by vinyl pendant arms in their microstructure (up to 75.7%-3,4-motif) are obtained

The IGF2 methylation score for adrenocortical cancer:an ENSAT validation study

Adrenocortical carcinoma (ACC) is diagnosed using the histopathological Weiss score (WS), but remains clinically elusive unless it has metastasized or grows locally invasive. Previously, we proposed the objective IGF2 methylation score as diagnostic tool for ACC. This multicenter European cohort study validates these findings. Patient and tumor characteristics were obtained from adrenocortical tumor patients. DNA was isolated from frozen specimens, where after DMR2, CTCF3, and H19 were py rosequenced. The predictive value of the methylation score for malignancy, defined by the WS or metastasis development, was assessed using receiver operating characteristic curves and logistic and Cox regression analyses. Seventy-six ACC patients and 118 patients with adrenocortical adenomas were included from seven centers. The methylation score and tumor size were independently associated with the pathological ACC diagnosis (OR 3.756 95% CI 2.224-6.343; OR 1.467 95% CI 1.202-1.792, respectively; Hosmer-Lemeshow test P = 0.903), with an area under the curve (AUC) of 0.957 (95% CI 0. 930-0.984). The methylation score alone resulted in an AUC of 0.910 (95% CI 0.8 66-0.952). Cox regression analysis revealed that the methylation score, WS and tumor size predicted development of metastases in univariate analysis. In multivariate analysis, only the WS predicted development of metastasis (OR 1.682 95% CI 1.285-2.202; P <0.001). In conclusion, we validated the high diagnostic accuracy of the IGF2 methylation score for diagnosing ACC in a multicenter European cohort study. Considering the known limitations of the WS, the objective IGF2 methylation score could potentially provide extra guidance on decisions on postoperative strategies in adrenocortical tumor patients

Amine Boranes Dehydrogenation Mediated by an Unsymmetrical Iridium Pincer Hydride: (PCN) vs (PCP) Improved Catalytic Performance

© 2018 American Chemical Society. The IrIII hydride (tBuPCN)IrHCl (1) containing the tridendate unsymmetrical pincer ligand tBuPCN- {tBuPCN(H) = 1-[3-[(di-tert-butylphosphino)methyl]phenyl]-1H-pyrazole} has been exploited as ammonia borane (NH3BH3, AB) and amine boranes dehydrogenation catalyst in THF solution at ambient temperature. 1 releases one H2 equivalent per AB equivalent, with concomitant cyclic poly(aminoboranes) formation [B-(cyclotriborazanyl)-amine-borane (BCTB) and cyclotriborazane (CTB)] as the final "spent fuel". 1 has been found to have superior catalytic activity than its symmetrical analogue (tBuPCP)IrHCl, with recorded TOF values of 580 h-1 (AB in THF) and 401 h-1 (DMAB in toluene) at ambient temperature. The reaction has been analyzed experimentally through multinuclear [11B, 31P{1H}, 1H] NMR and IR spectroscopy, kinetic rate measurements, and kinetic isotope effect determination with deuterated AB isotopologues. The hydride/borohydride intermediate (tBuPCN)IrH(η2-BH4) (2) is the catalyst resting state formed during the dehydrogenation process; it is detected by a variableerature multinuclear NMR of the reaction course (in the 190-323 K range). A DFT modeling of the reaction mechanism using DMAB as substrate has been performed with the geometry optimization in toluene at the M06 level of theory. The combination of the kinetic and computational data reveals that a simultaneous B-H/N-H activation occurs in the presence of 1, after the preliminary amine borane coordination to the metal center

Cannabis in medicine: a national educational needs assessment among Canadian physicians

BACKGROUND: There is increasing global awareness and interest in the use of cannabis for therapeutic purposes (CTP). It is clear that health care professionals need to be involved in these decisions, but often lack the education needed to engage in informed discussions with patients. This study was conducted to determine the educational needs of Canadian physicians regarding CTP. METHODS: A national needs assessment survey was developed based on previous survey tools. The survey was approved by the Research Ethics Board of the McGill University Health Centre Research Institute and was provided online using LimeSurvey®. Several national physician organizations and medical education organizations informed their members of the survey. The target audience was Canadian physicians. We sought to identify and rank using 5-point Likert scales the most common factors involved in decision making about using CTP in the following categories: knowledge, experience, attitudes, and barriers. Preferred educational approaches and physician demographics were collected. Gap analysis was conducted to determine the magnitude and importance of differences between perceived and desired knowledge on all decision factors. RESULTS: Four hundred and twenty six responses were received, and physician responses were distributed across Canada consistent with national physician distribution. The most desired knowledge concerned “potential risks of using CTP” and “safety, warning signs and precautions for patients using CTP”. The largest gap between perceived current and desired knowledge levels was “dosing” and “the development of treatment plans”. CONCLUSIONS: We have identified several key educational needs among Canadian physicians regarding CTP. These data can be used to develop resources and educational programs to support clinicians in this area, as well as to guide further research to inform these gaps