The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Quantifying Earth system interactions for sustainable food production via expert elicitation

Several safe boundaries of critical Earth system processes have already been crossed due to human perturbations; not accounting for their interactions may further narrow the safe operating space for humanity. Using expert knowledge elicitation, we explored interactions among seven variables representing Earth system processes relevant to food production, identifying many interactions little explored in Earth system literature. We found that green water and land system change affect other Earth system processes strongly, while land, freshwater and ocean components of biosphere integrity are the most impacted by other Earth system processes, most notably blue water and biogeochemical flows. We also mapped a complex network of mechanisms mediating these interactions and created a future research prioritization scheme based on interaction strengths and existing knowledge gaps. Our study improves the understanding of Earth system interactions, with sustainability implications including improved Earth system modelling and more explicit biophysical limits for future food production

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Synthesis of calcium aluminates through the polymeric precursor route

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The impact of biodiesel blend ratio on vehicle performance and emissions

Biodiesel is synthesized via the transesterification of triglycerides contained within vegetable, animal, or waste oils. First-generation biofuels are not the solution to global transport energy needs; however, biodiesel does have a role to play in reducing greenhouse gas emissions from the transport sector, so long as necessary production can be achieved in a sustainable manner without negative impact on plant and animal biodiversity. The biodiesel content within diesel sold to consumers is set to increase in the future, with implications on vehicle fuel consumption, emissions, and base engine durability. This study examines the effects of increasing the biodiesel blend ratio on the performance and emissions of a production vehicle equipped with a common-rail direct-injection diesel engine, evaluated on a chassis rolls dynamometer, at various ambient temperatures. Results obtained show that reductions in engine-out carbon monoxide and hydrocarbon emissions do not always translate to lower tailpipe emissions as reduced exhaust gas temperatures at higher blend ratios lead to reduced catalyst conversion efficiencies and higher total cycle emissions. Catalyst conversion efficiencies for carbon monoxide and hydrocarbons over the New European Drive Cycle (NEDC) are reduced by 9-19 per cent (depending on the ambient temperature) for a 50:50 blend (B50) compared with the petroleum diesel (B0) baseline. Increasing the blend ratio caused a linear decrease in the vehicle's maximum tractive force. This reduction was of the order of 5 per cent for a B50 blend at low vehicle speeds and 6-10 per cent at higher speeds, which is greater than Would be expected on the basis of the differences in calorific values. Over the NEDC, the fuel consumption was found to increase with increasing blend ratio