Mass transport in PEM water electrolysers: A review

While hydrogen generation by alkaline water electrolysis is a well-established, mature technology and currently the lowest capital cost electrolyser option; polymer electrolyte membrane water electrolysers (PEMWEs) have made major advances in terms of cost, efficiency, and durability, and the installed capacity is growing rapidly. This makes the technology a promising candidate for large-scale hydrogen production, and especially for energy storage in conjunction with renewable energy sources – an application for which PEMWEs offer inherent advantages over alkaline electrolysis. Improvements in PEMWE technology have led to increasingly high operational current densities, which requires adequate mass transport strategies to ensure sufficient supply of reactant and removal of products. This review discusses the current knowledge related to mass transport and its characterisation/diagnosis for PEMWEs, considering the flow channels, liquid-gas diffusion layer, and polymer electrolyte membrane in particular

Phase II study of docetaxel in combination with epirubicin and protracted venous infusion 5-fluorouracil (ETF) in patients with recurrent or metastatic breast cancer. A Yorkshire breast cancer research group study

This study was originally designed as a phase I/II study, with a dose escalation of docetaxel in combination with epirubicin 50 mg m⁻² and 5-fluorouracil (5-FU) 200 mg m⁻² day⁻¹. However, as dose escalation was not possible, the study is reported as a phase II study of the combination to assess response and toxicity. A total of 51 patients with locally advanced or metastatic breast cancer were treated on this phase II study, with doses of docetaxel 50 mg m⁻², epirubicin 50 mg m⁻² and infusional 5-FU 200 mg m⁻² day⁻¹ for 21 days. The main toxicity of this combination was neutropenia with 89% of patients having grade 3 and 4 neutropenia, and 39% of patients experiencing febrile neutropenia. Nonhaematological toxicity was mild. The overall response rate in the assessable patients was 64%, with median progression-free survival of 38 weeks, and median survival of 70 weeks. The ETF regimen was found to be toxic, and it was not possible to escalate the dose of docetaxel above the first dose level. This regimen has therefore not been taken any further, but as a development of this a new study is ongoing, combining 3-weekly epirubicin, weekly docetaxel and capecitabine, days 1-14

Surgery of the primary tumour in women with metastatic breast cancer at diagnosis in England and Wales – how do treatment rates vary at an individual and regional level?

BACKGROUND: Surgery to the primary tumour in women with metastatic breast cancer (MBC) has traditionally been reserved for palliative purposes, and European guidelines suggest it should be performed on an individualised basis1. A lack of consensus on the effectiveness of a procedure can lead to treatment variation in clinical practice. We examined what proportion of women with MBC aged 50+yrs received surgery to the primary tumour, and explored what patient and clinical characteristics influence receipt of surgery, as part of the National Audit of Breast Cancer in Older Patients (NABCOP). METHODS: Details of the NABCOP are available at www.nabcop.org.uk. Data on women aged 50+yrs newly diagnosed with MBC at diagnosis between January 2014 and December 2018 in England and Wales were obtained from national cancer registry datasets linked to routine hospital episodes. Receipt of surgery up to 3 years from diagnosis was examined using Kaplan Meier estimates, both nationally and between Cancer Alliances. The relationship between patient/tumour factors and time to surgery was analysed using log rank tests and a flexible parametric regression model (FPM). RESULTS: Between 2014 and 2018, 7316 women aged 50+yrs with MBC at diagnosis were identified. Overall, 18.7% women had surgery to the primary tumour within 1 year from diagnosis. Having surgery at 1 year was more common among younger women (50–59 yrs vs 80+yrs: 29.8% vs 8.6%, adjusted HR 1.79), those with T1/T2 tumours (T1/T2 vs T3/T4: 33.1% vs 20.8%, adjusted HR 1.72), and positive nodal stage (N0 vs N+: 19.3% vs 29.1%, adjusted HR 1.54). Rates of surgery within 1 year from diagnosis reduced over time, from 23.7% in 2014 to 15.7% in 2018, but to a greater degree among women aged 50–69 yrs (34.8% in 2014 to 21.1% in 2018) compared with women aged 70+yrs: 15.6% to 11.5%. Overall rates of surgery varied from 11.6% to 32.2% between the 20 Cancer Alliance/regions across England and Wales. CONCLUSIONS: Almost 20% of women aged 50+yrs with MBC at diagnosis received breast surgery within 1 year from diagnosis, but this varied between regions in England and Wales, and the use of surgery has decreased in recent years. Research is required to understand why treatment variation exists as well as to generate better evidence on the value of surgery in patients with MBC

Surgical decisions in older women with early breast cancer: patient and disease factors.

BACKGROUND: Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer . METHODS: Women aged 50 years or above with unilateral stage 1-3A early invasive breast cancer diagnosed in 2014-2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery. RESULTS: Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70-74, 75-79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness. CONCLUSION: The reasons for the observer differences should be further explored to ensure consistency in treatment decisions

Change in the Use of Fractionation in Radiotherapy Used for Early Breast Cancer at the Start of the COVID-19 Pandemic: A Population-Based Cohort Study of Older Women in England and Wales.

AIMS: Adjuvant radiotherapy is recommended for most patients with early breast cancer (EBC) receiving breast-conserving surgery and those at moderate/high risk of recurrence treated by mastectomy. During the first wave of COVID-19 in England and Wales, there was rapid dissemination of randomised controlled trial-based evidence showing non-inferiority for five-fraction ultra-hypofractionated radiotherapy (HFRT) regimens compared with standard moderate-HFRT, with guidance recommending the use of five-fraction HFRT for eligible patients. We evaluated the uptake of this recommendation in clinical practice as part of the National Audit of Breast Cancer in Older Patients (NABCOP). MATERIALS AND METHODS: Women aged ≥50 years who underwent surgery for EBC from January 2019 to July 2020 were identified from the Rapid Cancer Registration Dataset for England and from Wales Cancer Network data. Radiotherapy details were from linked national Radiotherapy Datasets. Multivariate mixed-effects logistic regression models were used to assess characteristics influential in the use of ultra-HFRT. RESULTS: Among 35 561 women having surgery for EBC, 71% received postoperative radiotherapy. Receipt of 26 Gy in five fractions (26Gy5F) increased from <1% in February 2020 to 70% in April 2020. Regional variation in the use of 26Gy5F during April to July 2020 was similar by age, ranging from 49 to 87% among women aged ≥70 years. Use of 26Gy5F was characterised by no known nodal involvement, no comorbidities and initial breast-conserving surgery. Of those patients receiving radiotherapy to the breast/chest wall, 85% had 26Gy5F; 23% had 26Gy5F if radiotherapy included regional nodes. Among 5139 women receiving postoperative radiotherapy from April to July 2020, nodal involvement, overall stage, type of surgery, time from diagnosis to start of radiotherapy were independently associated with fractionation choice. CONCLUSIONS: There was a striking increase in the use of 26Gy5F dose fractionation regimens for EBC, among women aged ≥50 years, within a month of guidance published at the start of the COVID-19 pandemic in England and Wales

Radiotherapy following breast-conserving surgery for screen-detected ductal carcinoma in situ: indications and utilisation in the UK. Interim findings from the Sloane Project

Use of radiotherapy (RT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) varies according to country, precedent and prejudice. Results from a preliminary analysis of the data available within the UK Sloane Project can be appreciated in the context of the uncertainty concerning the selection of adjuvant RT following BCS for DCIS. There was a marked geographical variation in the use of RT within the United Kingdom. However, overall, patients with DCIS treated with BCS were significantly more likely to have RT planned (and given) if they had large (⩾15 mm), intermediate or high-grade tumours or if central comedo-type necrosis was present. Unexpectedly, margin width did not appear to have a significant effect on the decision-making process. However, the Van Nuys Prognostic Index did significantly affect the chances of getting planned RT in the univariate analysis, suggesting that clinicians may be starting to use this scoring system in routine practice to assist in decision making

Radiotherapy after mastectomy for screen-detected ductal carcinoma in situ

Background. A role for radiotherapy after mastectomy for ductal carcinoma in situ (DCIS) is unclear. Using a prospective audit of DCIS detected through the NHS Breast Screening Programme we sought to determine a rationale for the use of postmastectomy radiotherapy for DCIS. Methods. Over a nine year period, from 9,972 patients with screen-detected DCIS and complete surgical, pathology, radiotherapy and follow up data, 2,944 women underwent mastectomy for DCIS of whom 33 (1.12%) received radiotherapy. Results. Use of post mastectomy radiotherapy was significantly associated with a close (<1mm) pathology margin, particularly (χ2(1) 95.81; p<0.00001), DCIS size (χ2 (3) 16.96; p<0.001) and the presence of microinvasion (χ2(1) 3.92; p<0.05). At median follow up 61 months, no woman who received radiotherapy had an ipsilateral further event, and only 1/33 women (3.0%) had a contralateral event. Of the women known not to have had radiotherapy post mastectomy, 45/2,894 (1.6%) had an ipsilateral further event and 83 (2.9%) had a contralateral event. Conclusion: For DCIS treated by mastectomy, a close (<1mm) margin, large tumour size and microinvasion, may merit radiotherapy to reduce ipsilateral recurrence

A game prototype for understanding the safety issues of a lifeboat launch

© 2018 The Author(s) Novel, advanced game techniques provide us with new possibilities to mimic a complicated training process, with the added benefit of enhanced safety. In this paper, we design and implement a 3D game with the support of virtual reality equipment which imitates the process of a lifeboat launch, involving both tractor manoeuvres and boat operations. It is a complex but vital process which can save lives at sea but also has many potential hazards. The primary objective of the game is to allow novices to better understand the sequence of the operations and manage the potential risks which may occur during the launch process. Additionally, the game has been promoted to the general public for educational purposes and to raise awareness of the safety issues involved. The key modules of the game are designed based on physical simulations to give the players enhanced plausible cognition and enjoyable interaction. We conducted two case studies for the two purposes of the games: one for training with volunteers without launching experience and the other for public awareness of the potential hazards with young children. The game is proven to be very promising for future professional training, and it serves the educational purpose of awareness of the safety issues for general public while being entertaining