Fungal spores as palaeoenvironmental indicators of anthropogenic activity

Fungal spores often occur in palynological preparations and have been successfully incorporated in both biostratigraphic and palaeoenvironmental investigations. However, the majority of palynologists choose to ignore such microfossils, primarily because of the difficulties relating to their identification. Where they have been used conventional palynological extraction procedures have been implemented in the preparation of samples. The suitability of such techniques for the recovery of fungal palynomorphs has been assumed in many cases.The objectives of this thesis were to study the effect of different processing techniques on the recovery of fungal palynomorphs, to propose a suitable morphological recording system and to investigate the potential of using fungal palynomorphs as palaeoenvironmental indicators of anthropogenic activity.Following the specification of a suitable extraction procedure for fungal palynomorphs and an appropriate morphological recording system 215 types were described. These types were encountered in samples from modern and archaeological situations and across a variety of different environments. The types fall into 19 morphological categories as defined in the recording system. Many of the types are restricted to either modern or archaeological sample sets although some are common to both. 96 types are comparable to known fungal taxa, 8 are considered algal in origin, 4 are parasite eggs and 1 has been identified as a rhizopod species. The remaining 106 can only be classified morphologically until they can be related to known taxa.Although an objective was to employ the Comparative Approach and use the palynomorph assemblages from known modem environments in the palaeoenvironmental interpretation of the archaeological material, it was not feasible. This is principally because of the limited overlap of taxa between modern and archaeological samples and is most likely a reflection of the restricted range of material considered. However, this approach demonstrates a promising future, subject to more extensive sampling regimes.Palaeoenvironmental interpretation of the archaeological samples was possible using the Indicator Species Approach. The results support and often enhance other forms of palaeoenvironmental analysis and in no instance were contra- indications encounteredThis success testifies to the importance of fungal palynology and the need for continuing research in this area

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

The value of open-source clinical science in pandemic response: lessons from ISARIC

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