The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment.

BackgroundThe landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely.MethodsPlastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012-2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management.ResultsIn this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]).ConclusionsDecisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions

Kinematic quantities of finite elastic and plastic deformation

Kinematic quantities for finite elastic and plastic deformations are defined via an approach that does not rely on auxiliary elements like reference frame and reference configuration, and that gives account of the inertial-noninertial aspects explicitly. These features are achieved by working on Galilean spacetime directly. The quantity expressing elastic deformations is introduced according to its expected role: to measure how different the current metric is from the relaxed/stressless metric. Further, the plastic kinematic quantity is the change rate of the stressless metric. The properties of both are analyzed, and their relationship to frequently used elastic and plastic kinematic quantities is discussed. One important result is that no objective elastic or plastic quantities can be defined from deformation gradient.Comment: v5: minor changes, one section moved to an Appendix, 26 pages, 2 figure

Equilibrium structure and fluctuations of suspensions of colloidal dumbbells

We investigate the structure and equilibrium linear-response dynamics of suspensions of hard colloidal dumbbells using Brownian Dynamics computer simulations. The focus lies on the dense fluid and plastic crystal states of the colloids with investigated aspect (elongation-to-diameter) ratios varying from the hard sphere limit up to 0.39, which is roughly the stability limit of the plastic crystal phase. We find expected structural changes with larger elongation with respect to the hard sphere reference case and very localized orientational correlations, typically just involving next-neighbor couplings. These relatively weak correlations are also reflected in only minor effects on the translational and rotational diffusion coefficients for most of the investigated elongations. However, the linear response shear viscosity exhibits a dramatic increase at high packing fractions ($\phi\gtrsim 0.5$) beyond a critical anisotropy factor of about $L^* \simeq 0.15$ which is surprising in view of the relatively weak changes found before on the level of colloidal self-dynamics. We suspect that even for the small investigated anisotropies, newly occurring, collective rotational-translational couplings must be made responsible for the slow time scales appearing in the plastic crystal.Comment: Molecular Physics 201

Analysis of thermal stress and metal movement during welding

Objectives of study were: investigation of temperature changes caused by welding arc with analysis of temperature distribution; development of system of mathematical statements describing thermal stresses and plastic strains during welding; and development of system of mathematical solutions and computer programs for one-dimensional analysis

Reversible plasticity in amorphous materials

A fundamental assumption in our understanding of material rheology is that when microscopic deformations are reversible, the material responds elastically to external loads. Plasticity, i.e. dissipative and irreversible macroscopic changes in a material, is assumed to be the consequence of irreversible microscopic events. Here we show direct evidence for reversible plastic events at the microscopic scale in both experiments and simulations of two-dimensional foam. In the simulations, we demonstrate a link between reversible plastic rearrangement events and pathways in the potential energy landscape of the system. These findings represent a fundamental change in our understanding of materials--microscopic reversibility does not necessarily imply elasticity.Comment: Revised pape