Modelling the impacts of projected future climate change on water resources in north-west England

International audienceOver the last two decades, the frequency of water resource drought in the UK, coupled with the more recent pan-European drought of 2003, has increased concern over changes in climate. Using the UKCIP02 Medium-High (SRES A2) scenario for 2070?2100, this study investigates the impact of climate change on the operation of the Integrated Resource Zone (IRZ), a complex conjunctive-use water supply system in north-western England. The results indicate that the contribution of individual sources to yield may change substantially but that overall yield is reduced by only 18%. Notwithstanding this significant effect on water supply, the flexibility of the system enables it to meet modelled demand for much of the time under the future climate scenario, even without a change in system management, but at significant expense for pumping additional abstraction from lake and borehole sources. This research provides a basis for the future planning and management of the complex water resource system in the north-west of England

Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision

Background Older patients with early-stage rectal cancer are under-represented in clinical trials and, therefore, little high-quality data are available to guide treatment in this patient population. The TREC trial was a randomised, open-label feasibility study conducted at 21 centres across the UK that compared organ preservation through short-course radiotherapy (SCRT; 25 Gy in five fractions) plus transanal endoscopic microsurgery (TEM) with standard total mesorectal excision in adults with stage T1–2 rectal adenocarcinoma (maximum diameter ≤30 mm) and no lymph node involvement or metastasis. TREC incorporated a non-randomised registry offering organ preservation to patients who were considered unsuitable for total mesorectal excision by the local colorectal cancer multidisciplinary team. Organ preservation was achieved in 56 (92%) of 61 non-randomised registry patients with local recurrence-free survival of 91% (95% CI 84–99) at 3 years. Here, we report acute and long-term patient-reported outcomes from this non-randomised registry group. Methods Patients considered by the local colorectal cancer multidisciplinary team to be at high risk of complications from total mesorectal excision on the basis of frailty, comorbidities, and older age were included in a non-randomised registry to receive organ-preserving treatment. These patients were invited to complete questionnaires on patient-reported outcomes (the European Organisation for Research and Treatment of Cancer Quality of Life [EORTC-QLQ] questionnaire core module [QLQ-C30] and colorectal cancer module [QLQ-CR29], the Colorectal Functional Outcome [COREFO] questionnaire, and EuroQol-5 Dimensions-3 Level [EQ-5D-3L]) at baseline and at months 3, 6, 12, 24, and 36 postoperatively. To aid interpretation, data from patients in the non-randomised registry were compared with data from those patients in the TREC trial who had been randomly assigned to organ-preserving therapy, and an additional reference cohort of aged-matched controls from the UK general population. This study is registered with the ISRCTN registry, ISRCTN14422743, and is closed. Findings Between July 21, 2011, and July 15, 2015, 88 patients were enrolled onto the TREC study to undergo organ preservation, of whom 27 (31%) were randomly allocated to organ-preserving therapy and 61 (69%) were added to the non-randomised registry for organ-preserving therapy. Non-randomised patients were older than randomised patients (median age 74 years [IQR 67–80] vs 65 years [61–71]). Organ-preserving treatment was well tolerated among patients in the non-randomised registry, with mild worsening of fatigue; quality of life; physical, social, and role functioning; and bowel function 3 months postoperatively compared with baseline values. By 6–12 months, most scores had returned to baseline values, and were indistinguishable from data from the reference cohort. Only mild symptoms of faecal incontinence and urgency, equivalent to less than one episode per week, persisted at 36 months among patients in both groups. Interpretation The SCRT and TEM organ-preservation approach was well tolerated in older and frailer patients, showed good rates of organ preservation, and was associated with low rates of acute and long-term toxicity, with minimal effects on quality of life and functional status. Our findings support the adoption of this approach for patients considered to be at high risk from radical surgery. Funding Cancer Research UK

Diagnostic accuracy of preoperative computed tomography used alone to detect lymph-node involvement at radical nephrectomy

OBJECTIVE: The aim of this study was to compare preoperative computed tomography (CT) with pathological findings in patients undergoing lymphadenectomy at the time of nephrectomy for renal cancer-associated lymphadenopathy. MATERIALS AND METHODS: Data from 515 consecutive nephrectomy surgeries (2004-2012) in a single university-affiliated centre were analysed to identify patients who had undergone lymph-node dissection concomitant with nephrectomy. Preoperative CT imaging was subjected to multiple repeated independent blinded reviews (two radiologists and one surgeon, each individually and on two separate occasions). Retroperitoneal lymph-node status was subjectively categorized (in a manner not based purely on size criteria) at each review as: 1 = unequivocally positive, 2 = equivocally positive, 3 = equivocally negative, or 4 = unequivocally negative. These findings were compared with pathological analysis, and interobserver and intraobserver agreement was assessed using non-weighted kappa () statistics. RESULTS: In total, 71 patients were stratified as category 1 (n = 18), 2 (n = 14), 3 (n = 31) and 4 (n = 8); pathological lymph-node metastasis was present in 14 (78%), four (28%), four (13%) and zero patients, respectively. Sensitivity, specificity, positive and negative predictive values for preoperative CT were 82%, 71%, 56% and 90%, respectively. Intraobserver agreement was greater for the radiologists (values 0.490, 0.540) than for the surgeon (value 0.393). Interobserver agreement was strongest for radiological category 1 (unequivocally positive; value 0.75). Receiver operating characteristics curves did not reveal significant differences in any observer accuracy. CONCLUSION: Contrary to concerns about a high false-positive rate, metastasis within regional lymph nodes can be predicted with reasonable accuracy by preoperative CT imaging alone

A systematic methodology for design of retrofit actions with longevity

This article presents a method for the design of retrofit actions with focus on energy savings that permits a systematic and thorough assessment of potential failures, anticipated maintenance and the expected durability of the retrofit actions. The proposed method combines the use of failure mode and effect analysis (FMEA) to permit identifying likely failure modes from which maintenance actions could be planned and the limit states (LS) method to assess the durability of the given retrofit action. One case study was completed to illustrate the application of: (1) the FMEA and LS method and (2) the proposed method for a retrofit action of an internal insulated solid wall of masonry bonded with lightweight aggregate concrete and floor division of concrete. It was evident that FMEA is useful regarding failure-mode identification and maintenance planning, and the LS method has its strength in durability assessment. Combining the use of both the FMEA and LS methods allowed improved design of new energy-saving retrofit actions, given that a thorough risk assessment was possible that included a decision-making process on maintenance planning, durability assessment and decision on potential redesign of retrofit actions.Dr. Michael A. Lacasse: https://orcid.org/0000-0001-7640-3701Dr. Michael A. Lacasse: https://orcid.org/0000-0001-7640-3701Peer reviewed: YesNRC publication: Ye