177,314 research outputs found
Preventative therapy for breast cancer: a clinical experience
No full textBACKGROUND: Breast Cancer incidence in the UK is estimated to rise to 71,000 per year by 2035. Preventative strategies could significantly reduce this. Preventative therapy reduces women's risk of oestrogen receptor positive breast cancer, but uptake remains low. Having established a preventative therapy clinic as part of a wider breast cancer prevention project, we explored qualitative data to inform future preventative efforts. METHOD: Women aged 30 to 60 who had benign diagnoses at a symptomatic breast clinic or were under mammographic surveillance in the moderate risk family history clinic were invited to participate in the study. Those who expressed an interest and completed an initial questionnaire had their breast cancer risk calculated using the IBIS risk calculator. Those at increased risk were invited to a consultation about preventative therapy. RESULTS: 182 women were identified as increased risk (≥ 17% lifetime or ≥ 3% 10-year risk NICE guidelines: Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer, 20131) of whom 91 women (50%) would not have been identified by family history criteria alone. 96% attended a risk/prevention consultation and all eligible women accepted screening mammography but only 14 (8%) women requested a preventative therapy prescription during the duration of the study. Reluctance to take medication and inconvenient time of life were common reasons for declining preventative therapy. Despite this, the majority were grateful for breast cancer risk and prevention information. CONCLUSIONS: Women at increased risk of breast cancer accept additional screening but are reluctant to take preventative therapy. This suggests that stratified screening methods using risk calculations would have high uptake. Raising awareness of preventative therapy is important and the breast cancer community has yet to find the optimum timing and formula for discussing it and must accept women's informed preferences above artificial targets. REGISTRATION NUMBERS: The PIONEER study was granted Health Research Authority (HRA) ethical approval by the Westminster Ethics Committee. IRAS project ID 265619, ClinicalTrials.gov Identifier: NCT04574063. Recruitment began in September 2020 and was completed in October 2021
Agronomy and economics of two novel energy crops: Sida Hermaphrodita (L.) Rusby and Silphium Perfoilatum L.
No full textThe PhD project of title “Agronomy and Economics of two novel energy crops: Sida hermaphrodita (L.) Rusby and Silphium perfoliatum L.” was first conceptualised within the international project SidaTim. The main aim of the PhD was to reduce the uncertainty associated with the adoption of Sida hermaphrodita (L.) Rusby and Silphium perfoliatum L., through data gathering and evaluating their agronomic, economic and environmental performance. The main objectives of the PhD were: to review all available information and publications regarding the cultivation and energy production
of the two species; to assess their agronomic performance in the UK; to examine the impact of their establishment on soil carbon; to determine their profitability against other potential crops across a European gradient; and to evaluate the greenhouse gas emissions associated with their cultivation. The novelty of the research lies on the establishment and assessment of two novel bioenergy crops in the UK compared across a range of climatic conditions, addressing the knowledge gaps regarding reliability and availability of information and assessment of their agronomic, economic and environmental performance.
The first year of the project was dedicated to background research, collecting and processing the first set of soil analyses, producing all Silphium perfoliatum (L.) seedlings from seed, importing Sida hermaphrodita (L.) Rusby seeds from Germany, and in 2017 establishing an experimental site in Silsoe, Bedfordshire, UK. During the first three years,the mean maximum height of Sida hermaphrodita (L.) Rusby originated from seedlings was 198 cm and the maximum stem diameters were 14-18 mm. The mean maximum height of Silphium perfoliatum (L.) was 158 cm over three years and the maximum stem diameters were 14-16 mm. As opposed to the expected increase in maximum heights and diameters with time until plantation maturity, an overall reduction in maximum heights and diameters was recorded with time for Sida hermaphrodita (L.) Rusby, whilst only maximum diameters of Silphium perfoliatum (L.) decreased with time.
Each year from February 2018, a winter harvest to measure the solid biomass production of Sida hermaphrodita (L.) Rusby and a summer harvest to measure the green biomass production of both Sida hermaphrodita (L.) Rusby and Silphium perfoliatum L. were carried out until September 2020. Mean dry biomass yields of Sida hermaphrodita (L.) Rusby plants grown from transplants for solid fuel for combustion were 1.7, 5.4, and 3.7 t DM ha⁻¹ in 2018, 2019, and 2020 respectively. Green biomass yields of Sida hermaphrodita (L.) Rusby for anaerobic digestion were on average 10.8, 8.1, 6.0 t DM ha⁻¹ in 2018, 2019, and 2020 respectively. The recorded declines in harvested biomass from Sida hermaphrodita (L.) Rusby are attributed to the combined effect of plant mortality, management and fertilisation practices. The corresponding mean green biomass yields of Silphium perfoliatum L. for anaerobic digestion were 4.6, 6.7, 8.9 t DM ha⁻¹ in 2018, 2019, and 2020.
The second and third year focussed on objectives three and four, as well as collecting and processing the second set of soil analyses, data analysis, and writing up. The bulk density of the soil across 0-5 cm and 10-15 cm changed from 1.4-1.7 g cm³ prior to cultivation in 2017, to a uniform 1.4 g cm³ in 2020. The concentration of soil organic carbon at 0-5 cm decreased from 2.58% in 2017 to 1.85% in 2020, whereas at 10-15 cm, it increased from 1.86% to 2.12% over the three years. Overall, the mean soil organic carbon stocks (0-15 cm) declined from 65.0-67.6 t C ha⁻¹ in 2017 in 55.2-58.3 t C ha⁻¹ in 2020.
The profitability of Sida hermaphrodita (L.) Rusby and Silphium perfoliatum (L.) was predicted over a rotation of 16 years and compared to that of an arable rotation and two other energy crops for the particular case of the UK and three other European countries. The calculated net present value (NPV) of Sida hermaphrodita (L.) Rusby was -1,591 £ ha⁻¹ without subsidies and 1,075 £ ha⁻¹ with subsidies; the corresponding net present values for Silphium perfoliatum (L.) were 3,031 £ ha⁻¹ and 5,607 £ ha⁻¹ . The study also calculated how much prices and costs would need to change for the NPV of the two crops to match the NPV of the most profitable energy crop or the arable rotation.
Using an Excel model developed based on the IPCC guidelines, the greenhouse gas emissions for Sida hermaphrodita (L.) Rusby and Silphium perfoliatum (L.) production were calculated for a 16-year period. On a per annum basis, overall greenhouse gas emissions were estimated respectively at 4.2, 0.3, 2.2, -4.0 and -0.6 t CO2 eq ha⁻¹ for the arable rotation, short rotation coppice, Miscanthus, Sida hermaphrodita (L.) Rusby and Silphium perfoliatum (L.) systems. The environmental assessment demonstrated that cultivating Sida hermaphrodita (L.) Rusby and Silphium perfoliatum (L.) could potentially contribute to reducing greenhouse gas emissions.PhD in Water including Desig
The use of ultrasound in the clinical re-staging of the axilla after neoadjuvant chemotherapy (NACT).
No full textINTRODUCTION: Ultrasound (US) is the imaging modality of choice for staging the axilla prior to surgery in patients with breast cancer (BC). High pathological complete response rates in the axilla after NACT mean a more conservative approach to surgery can be considered. Radiological re-staging is important in this decision making. After the presentation of results from ACOSOG Z1071 in December 2012, formal ultrasound re-assessment of the axilla after primary therapy was specifically requested in our institution. We report on the accuracy of axillary US (aUS) for identifying residual axillary disease post-NACT. METHODS: Data were collected on patients who had proven axillary disease prior to NACT and underwent axillary lymph node dissection after NACT between January 2013 and December 2015. Post-chemotherapy aUS reports and axillary pathology reports were classified as positive or negative for abnormal lymph nodes and for residual disease (cCR and pCR respectively). RESULTS: The sensitivity and specificity of aUS was 71% and 88% respectively. The negative predictive value (NPV) was 83%. The false negative rate was 29%. CONCLUSIONS: Axillary ultrasound provides clinically useful information post-NACT, which will guide surgical decision-making. Patients with aUS-negative axillae are likely to have a lower false negative rate of SLNB after NACT (Boughey et al.). However, aUS does not replace the need to identify and biopsy the nodes which were proven to be positive prior to NACT
A scoring system for 3D surface images of breast reconstruction developed using the Delphi consensus process.
No full textINTRODUCTION: Evaluation of aesthetics after breast reconstruction is challenging. In the absence of an objective measurement, panel assessment is widely adopted. Heterogeneity of scales and poor internal consistency make comparison difficult. Development and validation of an expert panel scale using a Delphi consensus process is described. It was designed specifically for use as the gold standard for development of an objective evaluation tool using 3-Dimensional Surface Imaging (3D-SI). MATERIALS AND METHODS: 20 items relating to aesthetic assessment were identified for consideration in the Delphi consensus process. Items were selected for inclusion in the definitive panel scale by iterative rounds of voting according to importance, consensus discussion, and a final vote. The Delphi-derived scale was tested on a clinical research series for intra- and inter-panellist, and intra-panel reliability, and correlation with Patient Reported Outcome Measures (PROMs). RESULTS: 61 surgeons participated in the Delphi process. Oncoplastic and plastic surgeons were represented. The Delphi-derived scale included symmetry, volume, shape, position of breast mound, nipple position, and a global score. Intra-panellist reliability ranged from poor to almost perfect (wκ<0to0.86), inter-rater reliability was fair (ICC range 0.4-0.5) for individual items and good (ICC0.6) for the global score, intra-panel reliability was moderate to substantial (wκ0.4-0.7), and correlation with PROMs was moderate (r = 0.5p < 0.01). CONCLUSIONS: The Delphi-derived panel evaluation is at least as good as other scales in the literature and has been developed specifically to provide expert evaluation of aesthetics after breast reconstruction. The logistical constraints of panel assessment remain, reinforcing the need to develop an objective evaluation method
Appropriate Similarity Measures for Author Cocitation Analysis
No full textWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Bilateral mammoplasty for cancer: Surgical, oncological and patient-reported outcomes.
No full textINTRODUCTION: Bilateral mammoplasty (BM) can optimise oncological safety and aesthetic outcomes in women with large or ptotic breasts whose tumour to breast volume ratio or tumour location pose a challenge to standard breast-conserving therapy (BCT) and for whom mastectomy (with or without reconstruction) may be the only alternative. METHODS: We undertook a comprehensive analysis of surgical outcomes (complications according to the Clavien Dindo classification), acute radiation morbidity (Radiation Therapy Oncology Group classification), oncological outcomes, and patient satisfaction (BREAST-Q questionnaire) in women who underwent BM for breast cancer (BC) from June 2009-November 2014. RESULTS: 168 women were included. Median age was 55 years (range:33-84) and median tumour size at imaging 35 mm (range:0-170). Median specimen weight was 242 g (range 39-1824). The wise pattern technique was used in 87.5% of procedures. At least one complication occurred in 68 (40.5%) women, mostly Clavien Dindo grade 1. Grade 3 complications were infrequent (8.9%) but occurred mainly on the therapeutic mammoplasty (TM) side (p < 0.05). Complications were associated with higher BMI, specimen weight and longer time to radiotherapy (p < 0.05). Median follow-up was 37 months (range: 13-77). Local recurrence occurred in 3 (1.8%), distant metastases in 5 (3.0%), and 10 (6.0%) women have died. The median score for 'satisfaction with breasts' was 77 (range: 0-100). CONCLUSIONS: This study provides concurrent data on surgical, oncological and patient-reported outcomes. It offers evidence that BM is an effective treatment for breast cancer in large- or ptotic-breasted women
3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment.
No full textBACKGROUND: Two-thirds of patients with early breast cancer undergo breast-conserving treatment (BCT). Aesthetic outcome is important and has long term implications for psychosocial wellbeing. The aesthetic goal of BCT is symmetry for which there is no gold-standard measure. Panel scoring is the most widely adopted assessment but has well-described limitations. This paper describes a model to objectively report aesthetic outcome using measures derived from 3-dimensional surface images (3D-SI). METHOD: Objective measures and panel assessment were undertaken independently for 3D-SI of women who underwent BCT 1-5 years previously. Univariate analysis was used to test for association between measures and panel score. A forward stepwise multiple linear regression model was fitted to identify 3D measurements that jointly predicted the mean panel score. The fitted model coefficients were used to predict mean panel scores for an independent validation set then compared to the mean observed panel score. RESULTS: Very good intra-panel reliability was observed for the training and validation sets (wκ = 0.87, wκ = 0.84). Six 3D-measures were used in the multivariate model. There was a good correlation between the predicted and mean observed panel score in the training (n = 190) and validation (n = 100) sets (r = 0.68, r = 0.65). The 3D model tended to predict scores towards the median. The model was calibrated which improved the distribution of predicted scores. CONCLUSION: A six-variable objective aesthetic outcome model for BCT has been described and validated. This can predict and could replace panel assessment, facilitating the independent and unbiased evaluation of aesthetic outcome to communicate and compare results, benchmark practice, and raise standards
"Closing the R&D Gap, Evaluating the Sources of R&D Spending"
No full textBoth spending and tax policies have been implemented in the United States with the goal of stimulating private sector research and development (R&D). Karier questions whether current R&D policy, especially the research and experimentation tax credit, can contribute to closing the gap between nondefense expenditures on R&D in the United States and such expenditures in other countries, such as Japan and Germany. He also explores possible changes to our current R&D policy to make it more effective.
Rediscovery of Rubus pendulus Rusby (Rosaceae) and a new record for the flora of Ecuador
No full textA new record of Rubus for Ecuador is described. Rubus pendulus Rusby is a climbing shrub or vine originally described from Huila in Colombia 90 years ago. Here, we report seven new localities in Ecuador where this species grows. Rubus pendulus is morphologically differentiated from all the Ecuadorian Rubus species and a detailed botanical description, illustrations and photographs are provided. This is the first time that R. pendulus’ stipules and flowers are described, as they were unavailable in the original description. We also report possible hybridization between R. urticifolius Poir. and R. pendulus, as the samples reviewed showed mixed characteristics from both species
Rediscovery of Rubus pendulus Rusby (Rosaceae) and a new record for the flora of Ecuador
No full textA new record of Rubus for Ecuador is described. Rubus pendulus Rusby is a climbing shrub or vine originally described from Huila in Colombia 90 years ago. Here, we report seven new localities in Ecuador where this species grows. Rubus pendulus is morphologically differentiated from all the Ecuadorian Rubus species and a detailed botanical description, illustrations and photographs are provided. This is the first time that R. pendulus’ stipules and flowers are described, as they were unavailable in the original description. We also report possible hybridization between R. urticifolius Poir. and R. pendulus, as the samples reviewed showed mixed characteristics from both species
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