Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA)

As the mean age of the global population increases, breast cancer in older individuals will be increasingly encountered in clinical practice. Management decisions should not be based on age alone. Establishing recommendations for management of older individuals with breast cancer is challenging because of very limited level 1 evidence in this heterogeneous population. In 2007, the International Society of Geriatric Oncology (SIOG) created a task force to provide evidence-based recommendations for the management of breast cancer in elderly individuals. In 2010, a multidisciplinary SIOG and European Society of Breast Cancer Specialists (EUSOMA) task force gathered to expand and update the 2007 recommendations. The recommendations were expanded to include geriatric assessment, competing causes of mortality, ductal carcinoma in situ, drug safety and compliance, patient preferences, barriers to treatment, and male breast cancer. Recommendations were updated for screening, primary endocrine therapy, surgery, radiotherapy, neoadjuvant and adjuvant systemic therapy, and metastatic breast cancer.

Serial clustering of extratropical cyclones in a multi-model ensemble of historical and future simulations

This study has investigated serial (temporal) clustering of extra-tropical cyclones simulated by 17 climate models that participated in CMIP5. Clustering was estimated by calculating the dispersion (ratio of variance to mean) of 30 December-February counts of Atlantic storm tracks passing nearby each grid point. Results from single historical simulations of 1975-2005 were compared to those from historical ERA40 reanalyses from 1958-2001 ERA40 and single future model projections of 2069-2099 under the RCP4.5 climate change scenario. Models were generally able to capture the broad features in reanalyses reported previously: underdispersion/regularity (i.e. variance less than mean) in the western core of the Atlantic storm track surrounded by overdispersion/clustering (i.e. variance greater than mean) to the north and south and over western Europe. Regression of counts onto North Atlantic Oscillation (NAO) indices revealed that much of the overdispersion in the historical reanalyses and model simulations can be accounted for by NAO variability. Future changes in dispersion were generally found to be small and not consistent across models. The overdispersion statistic, for any 30 year sample, is prone to large amounts of sampling uncertainty that obscures the climate change signal. For example, the projected increase in dispersion for storm counts near London in the CNRMCM5 model is 0.1 compared to a standard deviation of 0.25. Projected changes in the mean and variance of NAO are insufficient to create changes in overdispersion that are discernible above natural sampling variations.

The meteorology of the Western Indian Ocean, and the influence of the east African highlands

This paper reviews the meteorology of the Western Indian Ocean and uses a state–of–the–art atmospheric general circulation model to investigate the influence of the East African Highlands on the climate of the Indian Ocean and its surrounding regions. The new 44–year re–analysis produced by the European Centre for Medium range Weather Forecasts (ECMWF) has been used to construct a new climatology of the Western Indian Ocean. A brief overview of the seasonal cycle of the Western Indian Ocean is presented which emphasizes the importance of the geography of the Indian Ocean basin for controlling the meteorology of the Western Indian Ocean. The principal modes of inter–annual variability are described, associated with El Niño and the Indian Ocean Dipole or Zonal Mode, and the basic characteristics of the subseasonal weather over the Western Indian Ocean are presented, including new statistics on cyclone tracks derived from the ECMWF re–analyses. Sensitivity experiments, in which the orographic effects of East Africa are removed, have shown that the East African Highlands, although not very high, play a significant role in the climate of Africa, India and Southeast Asia, and in the heat, salinity and momentum forcing of the Western Indian Ocean. The hydrological cycle over Africa is systematically enhanced in all seasons by the presence of the East African Highlands, and during the Asian summer monsoon there is a major redistribution of the rainfall across India and Southeast Asia. The implied impact of the East African Highlands on the ocean is substantial. The East African Highlands systematically freshen the tropical Indian Ocean, and act to focus the monsoon winds along the coast, leading to greater upwelling and cooler sea–surface temperatures.

Water reuse for irrigated agriculture in Jordan: challenges of soil sustainability and the role of management strategies

Reclaimed water provides an important contribution to the water balance in water-scarce Jordan, but the quality of this water presents both benefits and challenges. Careful management of reclaimed water is required to maximize the nutrient benefits while minimizing the salinity risks. This work uses a multi-disciplinary research approach to show that soil response to irrigation with reclaimed water is a function of the management strategies adopted on the farm by the water user. The adoption of management methods to maintain soil productivity can be seen to be a result of farmers’ awareness to potentially plant-toxic ions in the irrigation water (70% of Jordan Valley farmers identified salinization as a hazard from irrigation with reclaimed water). However, the work also suggests that farmers’ management capacity is affected by the institutional management of water. About a third (35%) of farmers in the Jordan Valley claimed that their ability to manage salinization was limited by water shortages. Organizational interviews revealed that institutional awareness of soil management challenges was quite high (34% of interviewees described salinization as a risk from water reuse), but strategies to address this challenge at the institutional level require greater development.

Historical and current machine intelligence

In this article, we provide an initial insight into the study of MI and what it means for a machine to be intelligent. We discuss how MI has progressed to date and consider future scenarios in a realistic and logical way as much as possible. To do this, we unravel one of the major stumbling blocks to the study of MI, which is the field that has become widely known as "artificial intelligence"

Advertising, promotion, and the rise of a national building society movement in interwar Britain

This article examines the role of advertisement and promotion in the successful development of nationwide building societies in interwar Britain and the rapid overall growth of the building society movement. Major building societies are shown to have used extensive advertising to compensate for their initial lack of established national brands, promote home-ownership, and make savers aware of the attractive earnings and high security of building society savings. During a period when most building societies had very limited branch networks, extensive advertising increased the public profile of the major societies and thus assisted their rapid expansion via lower-cost modes such as agency networks.

Military competition and the emergence of nationalism: putting the logic of political survival into historical context

This essay aims to make a contribution to the conversation between IR and nationalism literatures by considering a particular question: What is the relationship between interstate military competition and the emergence of nationalism as a potent force in world politics? The conventional wisdom among international security scholars, especially neorealists, holds that nationalism can be more or less treated like a “technology” that allowed states to extract significant resources as well as manpower from their respective populations. This paper underlines some of the problems involved with this perspective and pushes forward an interpretation that is based on the logic of political survival. I argue that nationalism’s emergence as a powerful force in world politics followed from the “mutation” and absorption of the universalistic/cosmopolitan republican ideas that gained temporary primacy in Europe during the eighteenth century into particularistic nationalist ideologies. This transformation, in turn, can be best explained by the French Revolution’s dramatic impacts on rulers’ political survival calculi vis-à-vis both interstate and domestic political challenges. The analysis offered in this essay contributes to our understanding of the relationship between IR and nationalism while also highlighting the potential value of the political survival framework for exploring macrohistorical puzzles.

Historical and idealized climate model experiments: an intercomparison of Earth system models of intermediate complexity

Both historical and idealized climate model experiments are performed with a variety of Earth system models of intermediate complexity (EMICs) as part of a community contribution to the Intergovernmental Panel on Climate Change Fifth Assessment Report. Historical simulations start at 850 CE and continue through to 2005. The standard simulations include changes in forcing from solar luminosity, Earth's orbital configuration, CO2, additional greenhouse gases, land use, and sulphate and volcanic aerosols. In spite of very different modelled pre-industrial global surface air temperatures, overall 20th century trends in surface air temperature and carbon uptake are reasonably well simulated when compared to observed trends. Land carbon fluxes show much more variation between models than ocean carbon fluxes, and recent land fluxes appear to be slightly underestimated. It is possible that recent modelled climate trends or climate–carbon feedbacks are overestimated resulting in too much land carbon loss or that carbon uptake due to CO2 and/or nitrogen fertilization is underestimated. Several one thousand year long, idealized, 2 × and 4 × CO2 experiments are used to quantify standard model characteristics, including transient and equilibrium climate sensitivities, and climate–carbon feedbacks. The values from EMICs generally fall within the range given by general circulation models. Seven additional historical simulations, each including a single specified forcing, are used to assess the contributions of different climate forcings to the overall climate and carbon cycle response. The response of surface air temperature is the linear sum of the individual forcings, while the carbon cycle response shows a non-linear interaction between land-use change and CO2 forcings for some models. Finally, the preindustrial portions of the last millennium simulations are used to assess historical model carbon-climate feedbacks. Given the specified forcing, there is a tendency for the EMICs to underestimate the drop in surface air temperature and CO2 between the Medieval Climate Anomaly and the Little Ice Age estimated from palaeoclimate reconstructions. This in turn could be a result of unforced variability within the climate system, uncertainty in the reconstructions of temperature and CO2, errors in the reconstructions of forcing used to drive the models, or the incomplete representation of certain processes within the models. Given the forcing datasets used in this study, the models calculate significant land-use emissions over the pre-industrial period. This implies that land-use emissions might need to be taken into account, when making estimates of climate–carbon feedbacks from palaeoclimate reconstructions.