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Increasing BRCA1 and BRCA2 (collectively termed herein as BRCA) gene testing is required to improve cancer management and prevent BRCA-related cancers. To evaluate mainstream genetic testing using cancer-based criteria in patients with cancer. A quality improvement study and cost-effectiveness analysis of different BRCA testing selection criteria and access procedures to evaluate feasibility, acceptability, and mutation detection performance was conducted at the Royal Marsden National Health Service Foundation Trust as part of the Mainstreaming Cancer Genetics (MCG) Programme. Participants included 1184 patients with cancer who were undergoing genetic testing between September 1, 2013, and February 28, 2017. Mutation rates, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were the primary outcomes. Of the 1184 patients (1158 women [97.8%]) meeting simple cancer-based criteria, 117 had a BRCA mutation (9.9%). The mutation rate was similar in retrospective United Kingdom (10.2% [235 of 2294]) and prospective Malaysian (9.7% [103 of 1061]) breast cancer studies. If traditional family history criteria had been used, more than 50% of the mutation-positive individuals would have been missed. Of the 117 mutation-positive individuals, 115 people (98.3%) attended their genetics appointment and cascade to relatives is underway in all appropriate families (85 of 85). Combining with the equivalent ovarian cancer study provides 5 simple cancer-based criteria for BRCA testing with a 10% mutation rate: (1) ovarian cancer; (2) breast cancer diagnosed when patients are 45 years or younger; (3) 2 primary breast cancers, both diagnosed when patients are 60 years or younger; (4) triple-negative breast cancer; and (5) male breast cancer. A sixth criterion-breast cancer plus a parent, sibling, or child with any of the other criteria-can be added to address family history. Criteria 1 through 5 are considered the MCG criteria, and criteria 1 through 6 are considered the MCGplus criteria. Testing using MCG or MCGplus criteria is cost-effective with cost-effectiveness ratios of $1330 per discounted QALYs and $1225 per discounted QALYs, respectively, and appears to lead to cancer and mortality reductions (MCG: 804 cancers, 161 deaths; MCGplus: 1020 cancers, 204 deaths per year over 50 years). Use of MCG or MCGplus criteria might allow detection of all BRCA mutations in patients with breast cancer in the United Kingdom through testing one-third of patients. Feedback questionnaires from 259 patients and 23 cancer team members (12 oncologists, 8 surgeons, and 3 nurse specialists) showed acceptability of the process with 100% of patients pleased they had genetic testing and 100% of cancer team members confident to approve patients for genetic testing. Use of MCGplus criteria also appeared to be time and resource efficient, requiring 95% fewer genetic consultations than the traditional process. This study suggests that mainstream testing using simple, cancer-based criteria might be able to efficiently deliver consistent, cost-effective, patient-centered BRCA testing.

Coupled multiproxy indicators (pollen, stable isotopes and charcoal) reconstructed from annually laminated lake sediments from Nar Gölü in Cappadocia (central Turkey) complemented by documentary and archaeological evidence provide a detailed record of environmental changes and their causes from late Antiquity (AD 300) to the present day. Stable isotope data indicate marked shifts in the variability in summer drought intensity and winter—spring rainfall, but these did not coincide in time with changes in vegetation and land use shown by pollen data. Rather, human impacts appear to have been the main driver of landscape ecological changes in Cappadocia over the last two millennia. Pollen and charcoal data indicate four principal land-use phases: (i) an early Byzantine agrarian landscape characterized by cereals and tree crops, and marking the later part of the so-called Beyşehir Occupation phase; (ii) a period of landscape abandonment and the establishment of secondary woodland from AD 670 to 950 coinciding with the Arab invasions of Anatolia and marking the transition from late Antiquity to the middle Byzantine period; (iii) the re-establishment of cereal-based agriculture and pastoralism from c. AD 950, with this cultural landscape being maintained through the Byzantine `Golden Age', the Seljuk and Ottoman Empires; and (iv) agricultural intensification during the late Ottoman era and the Turkish Republic (AD 1830 to present). Charcoal fluxes indicate that prior to the twentieth century, landscape burning was most frequent at times of diminished human impact when fuel biomass increased. Pollen and historical data show remarkably close agreement in terms of the timing of landscape change, and the former suggest that rural cultural traditions were able to survive largely intact through short-lived periods of socio-political dislocation such as the sixth century Justinian plague and the thirteenth century Mongol invasions.

This study examined the prevalence of suicidal behaviors among 1, 638 Northern Plains American Indians ages 15–57. Age and gender patterns were investigated as was comorbidity with psychiatric and substance use disorders. Data from a population‐based survey indicated that suicidal behaviors were more frequently reported among females than males and among younger respondents than older respondents. In addition, suicidal behaviors were associated with depressive disorders, PTSD, substance abuse/dependence, and violent ideation/aggression. Results underscore the importance of effective and acceptable alcohol, drug, and mental health services in reducing the rates of suicidal behaviors in American Indian communities.

This second edition of an acclaimed book for nurse educators provides a practical, step-by-step guide to designing and developing simulation scenarios and integrating them into the nursing curriculum.

J. F. LAZENBY. The First Punic War: A Military History. London: UCL Press, 1996. Pp. xi, 205. £12.95, paper. Reviewed by Richard E. Mitchell BRENT D. SHAW. Rulers, Nomads, and Christians in Roman North Africa. Alder-shot: Variorum, 1995; dist. Brookfield, Vt.: Ashgate Publishing. Pp. xii, 338. $89.95 (US). Reviewed by C. R. Whitakker GEOFF KING. Mapping Reality: An Exploration of Cultural Cartographies. New York: St Martin's Press, 1996. Pp. vii, 216. $39.95(ZUS), cloth; $17.95 (US), paper. Reviewed by Norman J.W. Thrower PATRICIA SEED. Ceremonies of Possession in Europe's Conquest of the New World, 1492-1640. New York: Cambridge University Press, 1996. Pp. viii, 197. $49.95 (US), cloth; $14.95 (US), paper. Reviewed by Gwindler Williams PAUL DOUGLAS LOCKHART. Denmark in the Thirty Years War, 1618-1648: King Christian IV and the Decline of the Oldenburg State. Selingsgrove: Susquehanna University Press, 1996. Pp. 347. $42.50 (US). Reviewed by John Theibault PETER H. WILSON. War, State, and Society in Wiirttemberg, 1677-1793. New York: Cambridge University Press, 1995. Pp. xvii, 294. $27.95 (US), paper. Reviewed by Franz A. J. Szabo JOHN DUNMORE, ed. The Journal of Jean-François de Galaup de la Pérouse, 1785-1788. Volume I. London: Hakluyt Society, 1994. Pp. ccxl, 232. £35.00; Volume II: 1995. Pp. vi, 613. £35.00. Reviewed by Alan Frost ARTHUR L. STINCHCOMBE. Sugar Island Slavery in the Age of Enlightenment: The Political Economy of the Caribbean World. Princeton: Princeton University Press, 1995. Pp. xvii, 361. $45.00 (US). Reviewed by David Eltis BRIAN BOND. The Pursuit of Victory: From Napoleon to Saddam Hussein. New York: Oxford University Press, 1996. Pp. vi, 240. $49.50 (CDN). Reviewed by Dennis E. Showalter JUDITH EWELL. Venezuela and the United States: From Monroe's Hemisphere to Petroleum's Empire. Athens: University of Georgia Press, 1996. Pp. x, 267. $50.00 (US), cloth; $20.00 (US), paper. Reviewed by Thomas Schoonover S. C. M. PAINE. Imperial Rivals: China, Russia, and Their Disputed Frontier. Armonk and London: M. E. Sharpe, 1996. Pp. xxi, 417. $70.00 (US). Reviewed by John A. White OLAF ROSE. Carl von Clausewitz. Wirkungsgeschichte seines Werkes in Rußiland und der Sowjetunion 1836-1991. Munich: R. Oldenbourg Verlag, 1995. Pp. vi, 275. DM78. Reviewed by Daniel Moran WINFRIED BAUMGART, ed. Englische Akten zur Geschichte des Krimkriegs. Band 3. 3. Dezember 1854 bisg. September 1855. Munich: R. Oldenbourg Verlag, 1994. Pp. 960. DM 378. Reviewed by Ann Pottinger Saab LOUIS THIERCELIN. Travels in Oceania: Memoirs of a Whaling Ship's Doctor, 1866, trans. Christiane Mortelier. Dunedin: University of Otago Press, 1995; dist. Portland, Oreg.: ISBS. Pp. 350. $34.95 (US), paper. Reviewed by Colin Newbury ROBERT T. HARRISON. Gladstone's Imperialism in Egypt: Techniques of Domination. Westport: Greenwood Press, 1995. Pp. 184. $55.00 (US). Reviewed by Marvin Scwartz S. BERNARD THOMAS. Season of High Adventure: Edgar Snow in China. Berkeley: University of California Press, 1996. Pp. xviii, 416. $34.95 (US); Reviewed by A. Hamish Ion LAWRENCE D. KESSLER. The Jiangyin Mission Station: An American Missionary Community in China, 1895-1951. Chapel Hill and London: University of North Carolina Press, 1996. Pp. xiv, 212. $24.95 (US). Reviewed by A. Hamish Ion VAHAKN N. DADRIAN. The History of the Armenian Genocide: Ethnic Conflict from the Balkans to Anatolia to the Caucasus. Providence: Berghahn Books, 1995. Pp. xxviii, 452. $39.95 (US); Reviewed by Dennis R. Papazian MANOUG JOSEPH SOMAKIAN. Empires in Conflict: Armenia and the Great Powers, i895-1920. London: I. B. Tauris, 1995; dist. New York: St Martin's Press. Pp. xi, 276. $35.00 (US). Reviewed by Dennis R. Papazian DAVID LONG. Towards a New Liberal Internationalism: The International Theory of J. A. Hobson. New York: Cambridge University Press, 1996. Pp. xi, 273. $54.95 (US). Reviewed by Peter Cain J. P. HARRIS. Men, Ideas, and Tanks: British Military Thought and Armoured Forces, 1903-1939. Manchester: Manchester University Press, 1996; dist. New York: St Martin's Press. Pp. viii, 342. $24.95 (US). Reviewed by Brian Holden Reid STANLEY G. PAYNE. A History of Fascism, 1914-1945. Madison: University of Wisconsin Press, 1996. Pp. xiv, 613. $39.95 (US). Reviewed by H. A. Turner ASHER SUSSER and ARYEH SHMUELEVITZ, eds. The Hashemites in the Modern Aral World: Essays in Honour of the Late Professor Uriel Dann. London: Frank Cass 1995; dist. Pordand, Oreg.: ISBS. Pp. xv, 246. $39.50 (US). Reviewed by Howard J. Dooley G. H. BENNETT. British Foreign Policy during the Curzon Period, 1919-1924. New York: St Martin's Press, 1995. Pp. xi, 243. $65.00 (US); Reviewed by Keith Neilson DAVID S. FOGLESONG. America's Secret War against Bolshevism: US Intervention in the Russian Civil War, 1717-1720. Chapel Hill and London: University of North Carolina Press, 1995. Pp. x, 386. $45.00 (US). Reviewed by Keith Neilson GUNTER BERGHAUS, ed. Fascism and Theatre: Comparative Studies on the Aesthetics and Politics of Performance in Europe, 1925-1945. Providence: Berghahn Books, 1996. Pp. vi, 315. $24.50 (US), paper. Reviewed by Stanley G. Payne GORDON W. MORRELL. Britain Confronts the Stalin Revolution: Anglo-Soviet Relations and the Metro-Vickers Crisis. Waterloo: Wilfrid Laurier University Press, 1995. Pp. ix, 204. $34-95 (CDN). Reviewed by Teddy J. Uldricks DIETMAR ROTHERMUND. The Global Impact of the Great Depression. London and New York: Roudedge, 1996. Pp. xi, 180. £11.99, paper. Reviewed by Barry Eichengreen CLYDE SANGER. Malcolm MacDonald: Bringing an End to Empire. Montreal and Kingston: McGill-Queen's University Press, 1995. Pp. xxi, 498. $49.95 (CDN). Reviewed by John W. Cell STEPHEN G. FRITZ. Frontsoldaten: The German Soldier in World War II. Lexington: University Press of Kentucky, 1995. Pp. x, 299. $29.95 (US). Reviewed by Armin E. Mruck JÜRGEN HEIDEHNG and CHRISTOF MAUCH, eds. American Intelligence and the German Resistance to Hitler: A Documentary History. Boulder: Westview Press, 1996. Pp. xxii, 457. $35.00 (US). Reviewed by David Clay Large MATTHEW JONES. Britain, the United Sates, and the Mediterranean War, 1942-44 New York: St Martin's Press, 1996. Pp. x, 293. $65.00 (US). Reviewed by Warren F. Kimball G. E. MAGUIRE. Anglo-American Policy towards the Free French. New York: St Martin's Press, 1995. Pp. x, 210. $59.95 (US). Reviewed by Robert J. Young MOSHE GAT. Britain and Italy, 1943-1949: The Decline of British Influence. Brighton: Sussex Academic Press, 1996. Pp. ix, 230. $59.95 (US). Reviewed by Alan Cassels KENNETH P. WERRELL. Blankets of Fire: US Bombers over Japan during Work War II. Washington and London: Smithsonian Institution Press, 1996. Pp. xvi, 350. $39.95 (US). Reviewed by Conrad C. Crane GLEN JEANSONNE. Women of the Far Right: The Mothers' Movement and World War II. Chicago and London: University of Chicago Press, 1996. Pp. xix, 264. $29.95 (US). Reviewed by Harriet Hyman Alonso MICHAELJ. HOGAN, ed. Hiroshima in History and Memory. New York: Cambridge University Press, 1996. Pp. xiv, 238. $54.95 (US). Reviewed by R. J. B. Bosworth FREDERICK B. PIKE. FDR'S Good Neighbor Policy: Sixty Tears of Generally Gentle Chaos. Austin: University of Texas Press, 1995. Pp. xxvi,394. $34.95 (US). Reviewed by Stephen J. Randall NORMAN M. NAIMARK. The Russians in Germany: A History of the Soviet Zone 0 Occupation, 1945-1949. Cambridge, Mass, and London: Harvard University Press 1995. Pp. xv, 586. $35.00 (US). Reviewed by John Erikson DOMINIQUE-D. JUNOD. The Imperiled Red Cross and the Palestine-Eretz-Yisrael Conflict, 1945-1952. London and New York: Kegan Paul International, 1996; dist. New York: Columbia University Press. Pp. xvi, 344. $76.50 (US). Reviewed by David P. Forsythe ERIC ROMAN. Hungary and the Victor Powers, 1945-1950. New York: St Martin's Press, 1996. Pp. x,342. $49-95 (US). Reviewed by Bennett Kovrig GUNTHER MAI. Der Alliierte Kontrollrat in Deutschland 1945-1948. Alliierte Einheit - deutsche Teilung? Munich: R. Oldenbourg Verlag, 1995. Pp. xiii, 536. DM 198. Reviewed by G¨nter Bischof FRANCIS H. HELLER and JOHN R. GILLINGHAM. The United States and the Integration of Europe: Legacies of the Postwar Era. New York: St Martin's Press, 1996. Pp. 410. $49.95 (US). Reviewed by Alan S. Milward DAVID MAYERS. The Ambassadors and America's Soviet Policy. New York: Oxforc University Press, 1995. Pp. viii, 335. $51.95 (CDN). Reviewed by Keith Eagles M. SRINIVAS CHARY. The Eagle and the Peacock: US Foreign Policy toward India since Independence. Westport: Greenwood Press, 1995. Pp. xii, 194. $57.50 (US). Reviewed by Anita Inder Singh STEVEN HUGH LEE. Outposts of Empire: Korea, Vietnam, and the Origins of th Cold War in Asia, 1945-1954. Montreal and Kingston: McGill-Queen's University Press, 1995. Pp. xiv, 295. $39-95 (CDN), cloth; $19.95 (CDN), paper. Reviewed by R. B. Smith SHU GUANG ZHANG. Mao's Military Romanticism: China and the Korean War, 1950-1953. Lawrence: University Press of Kansas, 1995. Pp. xiii,338. $45.00 (US). Reviewed by Michael H. Hunt BURTON I. KAUFMAN. The Arab Middle East and the United States: Inter-Arab Rivalry and Superpower Diplomacy. New York: Twayne Publishers, 1996. Pp. xvii, 291. $26.95 (US); Reviewed by Douglas Little BONNIE F. SAUNDERS. The United States and Arab Nationalism: The Syrian Case, 1953-1960. Westport: Praeger, 1996. Pp. x, 115. $49.95 (US). Reviewed by Douglas Little CHEN JIAN. China's Road to the Korean War: The Making of the Sino-American Confrontation. New York: Columbia University Press, 1995. Pp. xii, 339. $42.00 (US); Reviewed by Kenneth G. Hamburger DENNIS E. SHOWALTER and JOHN G. ALBERT, eds. An American Dilemma: Vietnam, 1964-1973. Chicago: Imprint Publications, 1993. Pp. ix, 203. $22.95 (vs). paper. Reviewed by Kenneth G. Hamburger TONY CHAFER and BRIAN JENKINS, eds. France: From the Cold War to the New World Order. London: Macmillan, 1996. Pp. xi, 245. £40.00. Reviewed by Samir Saul SAKI DOCKRILL. Eisenhower's Mew-Loo