The role of surgery in the treatment of older women with breast cancer

A significant proportion of women diagnosed with breast cancer are over the age of 70 years and there is evidence that these patients frequently do not receive standard treatments, including surgical procedures and adjuvant therapies, which would be routine practice in younger age groups. The factors underlying this may include the physiological effects of ageing, differences in the biology and stage of the tumour at presentation, patient co-morbidities and patient and clinician preferences. The interaction of all these factors needs to be considered when individualising treatment plans for patients. For some patients this will need to be undertaken in the context of an extended multidisciplinary team setting with additional input from geriatricians, in addition to surgeons and oncologists, in defining a treatment plan. Little is known about the preferences of older patients in their choice of surgical treatment for breast cancer and further research is required to increase the evidence base for the rational management of older women with breast cancer

Urban floods: a case study in the Savigliano area (North-Western Italy)

Flood processes and effects are examined, concerning two rivers in an urbanized area in North-Western Italy (Piedmont – Cuneo Plain). In May 2008, some areas in Northern Italy were struck by intense and persistent rainfall. In the Cuneo province (Southern Piedmont), floodplain with some urban areas was inundated over ca. ten square kilometres, and the city of Savigliano (about 21 000 inhabitants) was particularly hit by flood. A purposely-made historical research has evidenced approximately fifty flood events as having occurred since 1350 in the Savigliano area. Based upon historical data, both documents and maps, GIS (Geographical Information System) technique and field surveys were used to quantitatively assess the growing urbanization of the city and to describe flood processes and effects over years. This work aims to describe the dynamic behaviour of the 2008 flood, also comparing it to past events, in particular those that occurred in 1896. It is emphasized how the knowledge of past events can be helpful in reducing urban flooding

INFLUENCE OF BOND-SLIP ON NUMERICAL FRAGILITY CURVES AND STRUCTURAL RELIABILITY OF RC STRUCTURAL INTERNAL BEAM-COLUMN SUB-ASSEMBLY

In this paper results obtained from monotonic nonlinear static analyses performed on Re-inforced Concrete (RC) internal beam-column sub-assembly are shown. Bond-slip phenome-non between steel longitudinal bars and surrounding concrete is also taken into account in order to predict the numerical response under lateral actions of the RC internal beam-column sub-assembly investigated. The study is addressed, through parametric models and Monte Carlo simulations, to pro-pose preliminary fragility curves for different damage states of the RC internal beam-column sub-assembly, including materials inherent uncertainties

Typological seismic losses assessment by damaged masonry buildings after L’Aquila 2009 and Emilia 2012 earthquakes

In this paper a seismic risk analysis of masonry buildings based on damage data from the 2009 L'Aquila and 2012 Emilia earthquakes. The seismic vulnerability is described by fragility curves from which economic loss curves are derived for each representative typological class of masonry buildings. The information on the buildings was collected by the Italian Civil Protection Department with the AeDES form and available in the Observed Damage Database (D.a.D.O.). The reliability of the database considered, however, was improved by carrying out a process of estimating undamaged buildings from data from the 15th ISTAT census. Finally, for each damage level, according to EMS-98 scale, a procedure to derive the Expected Annual Loss is presented, so as to express its percentage contribution in the seismic risk assessment

Seismic risk analysis on masonry buildings damaged by L’Aquila 2009 and Emilia 2012 earthquakes

Earthquakes in the recent past continue to provide more and more information on the seismic behavior of existing buildings and on the related economic losses. For the reason it is interesting to compare the damage of buildings stocks archived after earthquakes survey activities. In this paper a study of the damage occurred on masonry buildings after L’Aquila 2009 and Emilia 2012 earthquakes is carried out, by considering the data available in the web-gis Da.D.O platform. Firstly, fragility curves are illustrated and compared by considering the vulnerability classes of Da.D.O. (Class A, Class B and Class C1). Then, an approach is proposed in order to evaluate the total Expected Annual Loss (EALtot) and its contributions due to the several damage level (D1, …, D5). The preliminary obtained results show that, with reference to the two masonry buildings stocks considered, the higher contribution to the (EALtot) is given by the damage level D3, that may be considered as the life safety limit state. In the case analyzed, the corresponding EALD3 results almost equal to 1/3 of EALtot

A gis spatial analysis model for landslide hazard mapping application in alpine area

n/

Global Curriculum in Surgical Oncology

Background The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. Materials and Methods The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. Results A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. Conclusions A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environmen

Healthcare professionals' preferences for surgery or primary endocrine therapy to treat older women with operable breast cancer

Introduction : Primary endocrine therapy (PET) is an alternative treatment to surgery for oestrogen receptor (ER) positive operable breast cancer in older women. However, there is variable use of PET in the UK, with up to 40% of patients aged over 70 receiving PET instead of surgery in some regions. Treatment options offered to patients rely heavily on healthcare professional (HCP) assessment and opinion on which treatments are appropriate. Materials and methods : This was a mixed methods study combining semi-structured interviews with HCPs working in high and low PET regions in the UK, followed by a postal questionnaire survey distributed via the Association of Breast Surgery (ABS). Results : Thirty-four HCPs (20 breast surgeons; 13 nurse specialists; 1 geriatrician) were interviewed from 14 sites across the UK and 252/641 questionnaires returned (39%). There was an overriding view that PET is not suitable for patients under the age of 80 unless there are significant comorbidities. Opinion was split regarding the best way to treat patients with dementia. Patient preference was generally stated to be the most important factor when considering treatment, however only around a quarter 65/244 (26.6%) felt that all patients over the age of 70 should be offered PET as an alternative treatment option. Conclusions : Opinions differ on the best way to treat women over 70 with operable breast cancer, especially if they have co-existing dementia, as well as whether they should be offered PET as a treatment option. This may be a significant cause of treatment variation in the UK. Keywords : Breast cancer; Primary endocrine therapy; Surgery; Elderly; Older; Mixed methods.</p