Early breast cancer sharing the decision: a critical appraisal

Great debate surrounds the issue of patients with breast cancer participating in surgical/medical decision making and their ability to give an informed consent. Health care professionals must balance the need to safeguard the rights of patients, respect their autonomy and yet be sensitive to the changes and individual variations a patient may demonstrate as they progress from diagnosis to the end point of their disease. The premise underpinning the study and literature review, reflected in the published works presented here, focuses on a woman's right to access, should she choose, accurate information to make an informed treatment choice based on an exploration of the literature which reviews the ethical issues including autonomy, informed consent, advocacy, communication, access to information, approaches to shared decision making, psychiatric morbidity and evidence based medicine. Objectives of the Study Reflected in the Published Work Presented Here: 1. To determine the acceptability of an interactive video system, in addition to the standard informational care and support provided by the clinicians and clinical nurse specialist, as a means of providing information about the risks and benefits of treatment choices-surgery and subsequent adjuvent chemotherapy - to women with early breast cancer who are facing choices about treating their early breast cancer. 2. To determine whether providing information to women with early breast cancer using an interactive system significantly reduces anxiety and depression associated with the diagnosis and treatment of this condition. 3. To determine whether providing information using an interactive video system, to women about treatment choices significantly increases patient satisfaction with the choice they have made. To assess this for a two year period patients attending for surgical treatment for early breast cancer were recruited, after full discussion and written consent, into a randomised control trial to evaluate the acceptability and effectiveness of the interactive video system. Eligible patients (100)included all women with an early primary invasive breast cancer who had a genuine choice between treatment options.. Patients excluded from recruitment and viewing the Interactive Video (IVD)/Shared Decision - Making Programme (SDP) were all women who did not have a straightforward choice. All patients in the intervention group completed the following: a. Acceptability of the Interactive Video; b. Assessment of Health Status, The SF36 (Ware and Sherbourne 1992) c. The Hospital Anxiety and Depression (HAD) scale (Zigmond & Snaith 1983) After nine months the patients were again asked to complete the three questionnaires but at this point Questionnaire 1. elicits the patient's satisfaction with their treatment choice

Host hindrance to HIV-1 replication in monocytes and macrophages

Monocytes and macrophages are targets of HIV-1 infection and play critical roles in multiple aspects of viral pathogenesis. HIV-1 can replicate in blood monocytes, although only a minor proportion of circulating monocytes harbor viral DNA. Resident macrophages in tissues can be infected and function as viral reservoirs. However, their susceptibility to infection, and their capacity to actively replicate the virus, varies greatly depending on the tissue localization and cytokine environment. The susceptibility of monocytes to HIV-1 infection in vitro depends on their differentiation status. Monocytes are refractory to infection and become permissive upon differentiation into macrophages. In addition, the capacity of monocyte-derived macrophages to sustain viral replication varies between individuals. Host determinants regulate HIV-1 replication in monocytes and macrophages, limiting several steps of the viral life-cycle, from viral entry to virus release. Some host factors responsible for HIV-1 restriction are shared with T lymphocytes, but several anti-viral mechanisms are specific to either monocytes or macrophages. Whilst a number of these mechanisms have been identified in monocytes or in monocyte-derived macrophages in vitro, some of them have also been implicated in the regulation of HIV-1 infection in vivo, in particular in the brain and the lung where macrophages are the main cell type infected by HIV-1. This review focuses on cellular factors that have been reported to interfere with HIV-1 infection in monocytes and macrophages, and examines the evidences supporting their role in vivo, highlighting unique aspects of HIV-1 restriction in these two cell types

DNA metabarcoding of orchid-derived products reveals widespread illegal orchid trade

In eastern Mediterranean countries orchids continue to be collected from the wild for the production of salep, a beverage made of dried orchid tubers. In this study we used nrITS1 and nrITS2 DNA metabarcoding to identify orchid and other plant species present in 55 commercial salep products purchased in Iran, Turkey, Greece and Germany. Thirty samples yielded a total of 161 plant taxa, and 13 products (43%) contained orchid species and these belonged to 10 terrestrial species with tuberous roots. Another 70% contained the substitute ingredient Cyamopsis tetraganoloba (Guar). DNA metabarcoding using the barcoding markers nrITS1 and nrITS2 shows the potential of these markers and approach for identification of species used in salep products. The analysis of interspecific genetic distances between sequences of these markers for the most common salep orchid genera shows that species level identifications can be made with a high level of confidence. Understanding the species diversity and provenance of salep orchid tubers will enable the chain of commercialization of endangered species to be traced back to the harvesters and their natural habitats, and thus allow for targeted efforts to protect or sustainably use wild populations of these orchids

Data from: DNA metabarcoding of orchid-derived products reveals widespread illegal orchid trade

In eastern Mediterranean countries orchids continue to be collected from the wild for the production of salep, a beverage made of dried orchid tubers. In this study we used nrITS1 and nrITS2 DNA metabarcoding to identify orchid and other plant species present in 55 commercial salep products purchased in Iran, Turkey, Greece and Germany. Thirty samples yielded a total of 161 plant taxa, and 13 products (43%) contained orchid species and these belonged to 10 terrestrial species with tuberous roots. Another 70% contained the substitute ingredient Cyamopsis tetraganoloba (Guar). DNA metabarcoding using the barcoding markers nrITS1 and nrITS2 shows the potential of these markers and approach for identification of species used in salep products. The analysis of interspecific genetic distances between sequences of these markers for the most common salep orchid genera shows that species level identifications can be made with a high level of confidence. Understanding the species diversity and provenance of salep orchid tubers will enable the chain of commercialization of endangered species to be traced back to the harvesters and their natural habitats, and thus allow for targeted efforts to protect or sustainably use wild populations of these orchids

Abrupt intrinsic and extrinsic responses of southwestern Iberian vegetation to millennial-scale variability over the past 28 ka

We present new high-resolution pollen records combined with palaeoceanographic proxies from the same samples in deep-sea cores SHAK06-5K and MD01-2444 on the southwestern Iberian Margin, documenting regional vegetation responses to orbital and millennial-scale climate changes over the last 28 ka. The chronology of these records is based on high-resolution radiocarbon dates of monospecific samples of the planktonic foraminifera Globigerina bulloides, measured from SHAK06-5K and MD01-2444 and aligned using an automated stratigraphical alignment method. Changes in temperate and steppe vegetation during Marine Isotope Stage 2 are closely coupled with sea surface temperature (SST) and global ice-volume changes. The peak expansion of thermophilous woodland between ~10.1 and 8.4 cal ka bp lags behind the boreal summer insolation maximum by ~2 ka, possibly arising from residual high-latitude ice-sheets into the Holocene. Rapid changes in pollen percentages are coeval with abrupt transitions in SSTs, precipitation and winter temperature at the onset and end of Heinrich Stadial 2, the ice-rafted debris event and end of Heinrich Stadial 1, and the onset of the Younger Dryas, suggesting extrinsically forced southwestern Iberian ecosystem changes by abrupt North Atlantic climate events. In contrast, the abrupt decline in thermophilous elements at ~7.8 cal ka bp indicates an intrinsically mediated abrupt vegetation response to the gradually declining boreal insolation, potentially resulting from the crossing of a seasonality of precipitation threshold

Dryad Salep PGM data

Salep samples 1-55 (chip 1 and chip 2). Per chip raw demultiplexed data. Per chip demultiplexed and split on primer data processed. Primer sequences. The number of reads per MOTU as well as the top BLAST hits per MOTU were compiled using custom scripts available online as part of the HTS-barcode-checker pipeline http://145.136.240.164:8080/ [56]

De Boer et al. DNA metabarcoding of orchid-derived products reveals widespread illegal orchid trade. Proceedings of the Royal Society B. DOI: 10.1098/rspb.2017-1182. Electronic Supplementary Material (ESM) Table S4

Plant species detected in more than 20 % of samples, excluding orchids (presence as % in total samples in parentheses)

De Boer et al. DNA metabarcoding of orchid-derived products reveals widespread illegal orchid trade. Proceedings of the Royal Society B. DOI: 10.1098/rspb.2017-1182. Electronic Supplementary Material (ESM) Text S1

Detailed methods

De Boer et al. DNA metabarcoding of orchid-derived products reveals widespread illegal orchid trade. Proceedings of the Royal Society B. DOI: 10.1098/rspb.2017-1182. Figure S1

In eastern Mediterranean countries orchids continue to be collected from the wild for the production of salep, a beverage made of dried orchid tubers. In this study we used nrITS1 and nrITS2 DNA metabarcoding to identify orchid and other plant species present in 55 commercial salep products purchased in Iran, Turkey, Greece and Germany. Thirty samples yielded a total of 161 plant taxa, and 13 products (43%) contained orchid species and these belonged to 10 terrestrial species with tuberous roots. Another 70% contained the substitute ingredient <i>Cyamopsis tetraganoloba</i> (Guar). DNA metabarcoding using the barcoding markers nrITS1 and nrITS2 shows the potential of these markers and approach for identification of species used in salep products. The analysis of interspecific genetic distances between sequences of these markers for the most common salep orchid genera shows that species level identifications can be made with a high level of confidence. Understanding the species diversity and provenance of salep orchid tubers will enable the chain of commercialization of endangered species to be traced back to the harvesters and their natural habitats, and thus allow for targeted efforts to protect or sustainably use wild populations of these orchids