Current practice and surgical outcomes of neoadjuvant chemotherapy for early breast cancer : UK NeST study

Funding Information: This work was funded by a grant from the Association of Breast SurgeryPeer reviewedPublisher PD

Emplotment as Epic in Archaeological Writing: The Site Monograph as Narrative

To emplot a narrative as epic is to present a story of vast scope and multiple plots as a legitimate member of a tradition of other such stories. This article argues that emplotment as epic is the broadest of three levels of plot in archaeological writings. At that level, the site monograph emerges as a characteristically archaeological form of narrative, fundamental to archaeology as a discipline and a source of chronic anxiety for archaeologists. The ‘stories’ told in site monographs are epic in length, diversity of materials covered and multiplicity of themes, plots and authors. Indeed, the more complexities of that sort the better, since those are features that help to emplot the work as good archaeology

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The influence of the Gonads on Protein Metabolism

It has long been known that the gonads exercise an important effect on the individual, nut only in recent years has it been recognized how intricate and vast this effect can be. From the earliest of times it was common knowledge that gonadectomy in either males or females resulted in sterility. Associated with this sterility were several well marked physical and mental changes, as represented by the non-appearance of the secondary sexual characters, which were shown ti be dependent on the internal secretions of the gonads. The nature of these secondary sexual characters is well-known and the changed in the individual are detailed in all text books of physiology. But the effects produced by these internal secretions have since been shown to be far more complicated involved than had hitherto been thought