Modeling the Adenoma and Serrated Pathway to Colorectal CAncer (ASCCA)

Several colorectal cancer (CRC) screening models have been developed describing the progression of adenomas to CRC. Currently, there is increasing evidence that serrated lesions can also develop into CRC. It is not clear whether screening tests have the same test characteristics for serrated lesions as for adenomas, but lower sensitivities have been suggested. Models that ignore this type of colorectal lesions may provide overly optimistic predictions of the screen‐induced reduction in CRC incidence. To address this issue, we have developed the Adenoma and Serrated pathway to Colorectal CAncer (ASCCA) model that includes the adenoma‐carcinoma pathway and the serrated pathway to CRC as well as characteristics of colorectal lesions. The model structure and the calibration procedure are described in detail. Calibration resulted in 19 parameter sets for the adenoma‐carcinoma pathway and 13 for the serrated pathway that match the age‐ and sex‐specific adenoma and serrated lesion prevalence in the COlonoscopy versus COlonography Screening (COCOS) trial, Dutch CRC incidence and mortality rates, and a number of other intermediate outcomes concerning characteristics of colorectal lesions. As an example, we simulated outcomes for a biennial fecal immunochemical test screening program and a hypothetical one‐time colonoscopy screening program. Inclusion of the serrated pathway influenced the predicted effectiveness of screening when serrated lesions are associated with lower screening test sensitivity or when they are not removed. To our knowledge, this is the first model that explicitly includes the serrated pathway and characteristics of colorectal lesions. It is suitable for the evaluation of the (cost)effectiveness of potential screening strategies for CRC.     

What Cruising Infants Understand about Support for Locomotion

“Cruising” infants can only walk using external support to augment their balance. We examined cruisers' understanding of support for upright locomotion under four conditions: cruising over a wooden handrail at chest height, a large gap in the handrail, a wobbly unstable handrail, and an ill‐positioned low handrail. Infants distinguished among the support properties of the handrails with differential attempts to cruise and handrail‐specific forms of haptic exploration and gait modifications. They consistently attempted the wood handrail, rarely attempted the gap, and occasionally attempted the low and wobbly handrails. On the wood and gap handrails, attempt rates matched the probability of cruising successfully, but on the low and wobbly handrails, attempt rates under‐ and overestimated the probability of success, respectively. Haptic exploration was most frequent and varied on the wobbly handrail, and gait modifications—including previously undocumented “knee cruising”—were most frequent and effective on the low handrail. Results are discussed in terms of developmental changes in the meaning of support.     

(Re)constructing Family Images: Stepmotherhood Before Biological Motherhood

Strong cultural values and ideals attached to women in families deem the role of stepmother as inferior to that of biological mother. Although biological motherhood is celebrated, stepmotherhood is stigmatized, and women who wish to become mothers but become stepmothers prior to having biological children may grieve the loss of images surrounding normative ideals of creating a family. Using a feminist family science approach, the purpose of this grounded theory study was to explore the experiences of women without children in their transition to stepmotherhood. Interviews with 23 stepmothers (aged 26–47) revealed that women engaged in an internal process of creating and then adjusting personal images of family life to accommodate their new family circumstances. The process of (re)constructing family images had implications for later adjustment to stepmotherhood. Notions of the motherhood hierarchy emerged to depict the unique experiences of women who became stepmothers prior to having biological children.     

Time Off: The Social Experience of Time on Vacation

This article explores the phenomenological and socially constructed experience of time during the finite period of the vacation. Temporal routine is considered as a form of social control from which vacations and similar breaks for time off offer opportunities for agency and release. In-depth interviews, participant observation, and a narrative analysis of vacation blogs are used to analyze norms in orientation to time while one is away from select constraints of everyday life. Approaches to time while on vacation are found to fall into two ideal types: those who may ??ignore?? time and find release from schedules and routine, and those who must closely attend to its passage. Influences of duration, frequency and pace are also central in moderating experience.