Review of \u3cem\u3eQueer Wars: The New Gay Right and Its Critics.\u3c/em\u3e Paul Robinson. Reviewed by Greg Mallon.

Book review of Paul Robinson, Queer Wars: The New Gay Right and Its Critics. Chicago: University of Chicago Press, 2005. $25.00 hardcover

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

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

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Creating Safe and Welcoming Residential Care Placements for LGBTQIA+ Youth

This chapter examines the special needs and challenges faced by LGBTQIA+ youth in residential child and youth care settings. The authors review data about LGBTQIA+ youth in care and describe two European programs that are striving to provide a secure, welcoming, and affirming living environment for LGBTQIA+ youth in child welfare systems. The Audre Project probed perspectives of LGBTQIA+ youth in residential and foster care placement as well the views of practitioners. Cornerstones Youth Care has been implementing an LGBTQIA+ focus within its Raising the Village model. The Raising the Village model is a framework for improving the quality of out-of-home care to young people through focusing decision-making around the individual young person and the carers and professionals involved

Protecting LGBTQ+ Children and Youth

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) children and adolescents, an often-invisible population, frequently viewed as “different” by their own families and in fact by society as a whole, are at high risk for neglect, abuse, and violence from family members and from within the child welfare systems that are designed to protect them. Self-identified LGBTQ+ children and youth, and those perceived to be because of gender expansiveness, reported that they were the victims of abuse, neglect, and violence. LGBTQ+ youth are disproportionately impacted by multiple forms of trauma, including physical abuse, sexual abuse, dating violence, sexual assault, and peer violence. The practices of child protection have made significant contributions to how systems respond to maltreated youth’s needs. However, LGBTQ+ youth are largely excluded from many child protection conversations

Protecting LGBTQ+ Children and Youth

Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) children and adolescents, an often-invisible population, frequently viewed as “different” by their own families and in fact by society as a whole, are at high risk for neglect, abuse, and violence from family members and from within the child welfare systems that are designed to protect them. Self-identified LGBTQ+ children and youth, and those perceived to be because of gender expansiveness, reported that they were the victims of abuse, neglect, and violence. LGBTQ+ youth are disproportionately impacted by multiple forms of trauma, including physical abuse, sexual abuse, dating violence, sexual assault, and peer violence. The practices of child protection have made significant contributions to how systems respond to maltreated youth’s needs. However, LGBTQ+ youth are largely excluded from many child protection conversations