Post mastectomy radiotherapy in breast cancer: a survey of current United Kingdom practice

Purpose: Radiotherapy (RT) is increasingly used following mastectomy for breast cancer While indications for post-mastectomy radiotherapy (PMRT) are clear in patient groups at high risk of local recurrence, guidelines are less clear in intermediate-risk patients and patients with ductal carcinoma in situ (DCIS). This study aimed to determine variations in the use of PMRT in the United Kingdom (UK).

Methods: A postal survey of all consultant breast surgeon members of the Association of Breast Surgery in the UK.

Results: Tumour size and nodal status were confirmed as the most important indications for PMRT There was significant variation in the influence of other factors such as tumour grade, lymphovascular invasion and margin status. Nineteen per cent of respondents stated that they would consider the use of PMRT in cases of DCIS alone.

Conclusions: There is significant variation in practice across the UK with regard to the use of PMRT in intermediate risk breast cancer and patients with DCIS. Further work is required to determine which patients in these groups are likely to benefit from the use of PMRT.

A review of topographic controls on moraine distribution

Ice-marginal moraines are often used to reconstruct the dimensions of former ice masses, which are then used as proxies for palaeoclimate. This approach relies on the assumption that the distribution of moraines in the modern landscape is an accurate reflection of former ice margin positions during climatically controlled periods of ice margin stability. However, the validity of this assumption is open to question, as a number of additional, nonclimatic factors are known to influence moraine distribution. This review considers the role played by topography in this process, with specific focus on moraine formation, preservation, and ease of identification (topoclimatic controls are not considered). Published literature indicates that the importance of topography in regulating moraine distribution varies spatially, temporally, and as a function of the ice mass type responsible for moraine deposition. In particular, in the case of ice sheets and ice caps ( > 1000 km2), one potentially important topographic control on where in a landscape moraines are deposited is erosional feedback, whereby subglacial erosion causes ice masses to become less extensive over successive glacial cycles. For the marine-terminating outlets of such ice masses, fjord geometry also exerts a strong control on where moraines are deposited, promoting their deposition in proximity to valley narrowings, bends, bifurcations, where basins are shallow, and/or in the vicinity of topographic bumps. Moraines formed at the margins of ice sheets and ice caps are likely to be large and readily identifiable in the modern landscape. In the case of icefields and valley glaciers (10–1000 km2), erosional feedback may well play some role in regulating where moraines are deposited, but other factors, including variations in accumulation area topography and the propensity for moraines to form at topographic pinning points, are also likely to be important. This is particularly relevant where land-terminating glaciers extend into piedmont zones (unconfined plains, adjacent to mountain ranges) where large and readily identifiable moraines can be deposited. In the case of cirque glaciers (< 10 km2), erosional feedback is less important, but factors such as topographic controls on the accumulation of redistributed snow and ice and the availability of surface debris, regulate glacier dimensions and thereby determine where moraines are deposited. In such cases, moraines are likely to be small and particularly susceptible to post-depositional modification, sometimes making them difficult to identify in the modern landscape. Based on this review, we suggest that, despite often being difficult to identify, quantify, and mitigate, topographic controls on moraine distribution should be explicitly considered when reconstructing the dimensions of palaeoglaciers and that moraines should be judiciously chosen before being used as indirect proxies for palaeoclimate (i.e., palaeoclimatic inferences should only be drawn from moraines when topographic controls on moraine distribution are considered insignificant).

Helping the most vulnerable out of the poverty trap and reducing inequality: Policies, strategies, and services for individuals with Autism Spectrum Disorder, including intellectual and neurodevelopmental disabilities: Benchmarking Autism Services Efficacy: BASE Project (Volume 3) Secondary Data analysis

1) Executive Summary
Legislation (Autism Act NI, 2011), a cross-departmental strategy (Autism Strategy 2013-2020) and a first action plan (2013-2016) have been developed in Northern Ireland in order to support individuals and families affected by Autism Spectrum Disorder (ASD) without a prior thorough baseline assessment of need. At the same time, there are large existing data sets about the population in NI that had never been subjected to a secondary data analysis with regards to data on ASD. This report covers the first comprehensive secondary data analysis and thereby aims to inform future policy and practice.
Following a search of all existing, large-scale, regional or national data sets that were relevant to the lives of individuals and families affected by Autism Spectrum Disorder (ASD) in Northern Ireland, extensive secondary data analyses were carried out. The focus of these secondary data analyses was to distill any ASD related data from larger generic data sets. The findings are reported for each data set and follow a lifespan perspective, i.e., data related to children is reported first before data related to adults.
Key findings:
Autism Prevalence:
Of children born in 2000 in the UK,
• 0.9% (1:109) were reported to have ASD, when they were 5-year old in 2005;
• 1.8% (1:55) were reported to have ASD, when they were 7-years old in 2007;
• 3.5% (1:29) were reported to have ASD, when they were 11-year old in 2011.
In mainstream schools in Northern Ireland
• 1.2% of the children were reported to have ASD in 2006/07;
• 1.8% of the children were reported to have ASD in 2012/13.

Economic Deprivation:
• Families of children with autism (CWA) were 9%-18% worse off per week than families of children not on the autism spectrum (COA).
• Between 2006-2013 deprivation of CWA compared to COA nearly doubled as measured by eligibility for free school meals (from near 20 % to 37%)
• In 2006, CWA and COA experienced similar levels of deprivation (approx. 20%), by 2013, a considerable deprivation gap had developed, with CWA experienced 6% more deprivation than COA.
• Nearly 1/3 of primary school CWA lived in the most deprived areas in Northern Ireland.
• Nearly ½ of children with Asperger’s Syndrome who attended special school lived in the most deprived areas.

Unemployment:
• Mothers of CWA were 6% less likely to be employed than mothers of COA.
• Mothers of CWA earned 35%-56% less than mothers of COA.
• CWA were 9% less likely to live in two income families than COA.

Health:
• Pre-diagnosis, CWA were more likely than COA to have physical health problems, including walking on level ground, speech and language, hearing, eyesight, and asthma.
• Aged 3 years of age CWA experienced poorer emotional and social health than COA, this difference increased significantly by the time they were 7 years of age.
• Mothers of young CWA had lower levels of life satisfaction and poorer mental health than mothers of young COA.
Education:
• In mainstream education, children with ASD aged 11-16 years reported less satisfaction with their social relationships than COA.
• Younger children with ASD (aged 5 and 7 years) were less likely to enjoy school, were bullied more, and were more reluctant to attend school than COA.
• CWA attended school 2-3 weeks less than COA .
• Children with Asperger’s Syndrome in special schools missed the equivalent of 8-13 school days more than children with Asperger’s Syndrome in mainstream schools.
• Children with ASD attending mainstream schooling were less likely to gain 5+ GCSEs A*-C or subsequently attend university.



Further and Higher Education:
• Enrolment rates for students with ASD have risen in Further Education (FE), from 0% to 0.7%.
• Enrolment rates for students with ASD have risen in Higher Education (HE), from 0.28% to 0.45%.
• Students with ASD chose to study different subjects than students without ASD, although other factors, e.g., gender, age etc. may have played a part in subject selection.
• Students with ASD from NI were more likely than students without ASD to choose Northern Irish HE Institutions rather than study outside NI.

Participation in adult life and employment:
• A small number of adults with ASD (n=99) have benefitted from DES employment provision over the past 12 years.
• It is unknown how many adults with ASD have received employment support elsewhere (e.g. Steps to Work).
•
Awareness and Attitudes in the General Population:
• In both the 2003 and 2012 NI Life and Times Survey (NILTS), NI public reported positive attitudes towards the inclusion of children with ASD in mainstream education (see also BASE Project Vol. 2).

Gap Analysis Recommendations:
This was the first comprehensive secondary analysis with regards to ASD of existing large-scale data sets in Northern Ireland. Data gaps were identified and further replications would benefit from the following data inclusion:
• ASD should be recorded routinely in the following datasets:
o Census;
o Northern Ireland Survey of Activity Limitation (NISALD);
o Training for Success/Steps to work; Steps to Success;
o Travel survey;
o Hate crime; and
o Labour Force Survey.
• Data should be collected on the destinations/qualifications of special school leavers.
• NILT Survey autism module should be repeated in 5 years time (2017) (see full report of 1st NILT Survey autism module 2012 in BASE Project Report Volume 2).
• General public attitudes and awareness should be assessed for children and young people, using the Young Life and Times Survey (YLT) and the Kids Life and Times Survey (KLT); (this work is underway, Dillenburger, McKerr, Schubolz, & Lloyd, 2014-2015).
 

Open Data: European Ambitions and Local Efforts. Experiences from Austria

The member states of the European Union are faced with the challenges of handling “big data” as well as with a growing impact of the supranational level. Given that the success of efforts at European level strongly depends on corresponding national and local activities, i.e., the quality of implementation and the degree of consistency, this chapter centers upon the coherence of European strategies and national implementations concerning the reuse of public sector information. Taking the City of Vienna’s open data activities as an illustrative example, we seek an answer to the question whether and to what extent developments at European level and other factors have an effect on local efforts towards open data. We find that the European Commission’s ambitions are driven by a strong economic argumentation, while the efforts of the City of Vienna have only very little to do with the European orientation and are rather dominated by lifestyle and administrative reform arguments. Hence, we observe a decoupling of supranational strategies and national implementation activities. The very reluctant attitude at Austrian federal level might be one reason for this, nationally induced barriers—such as the administrative culture—might be another. In order to enhance the correspondence between the strategies of the supranational level and those of the implementers at national and regional levels, the strengthening of soft law measures could be promising.

Flexible energetics of cheetah hunting strategies provide resistance against kleptoparasitism

Population viability is driven by individual survival, which in turn depends on individuals balancing energy budgets. As carnivores may function close to maximum sustained power outputs, decreased food availability or increased activity may render some populations energetically vulnerable. Prey theft may compromise energetic budgets of mesopredators, such as cheetahs and wild dogs, which are susceptible to competition from larger carnivores. We show that daily energy expenditure (DEE) of cheetahs was similar to size-based predictions and positively related to distance traveled. Theft at 25% only requires cheetahs to hunt for an extra 1.1 hour per day, increasing DEE by just 12%. Therefore, not all mesopredators are energetically constrained by direct competition. Other factors that increase DEE, such as those that increase travel, may be more
important for population viability.

Attentional bias to food-related visual cues: is there a role in obesity?

The incentive sensitisation model of obesity suggests that modification of the dopaminergic associated reward systems in the brain may result in increased awareness of food-related visual cues present in the current food environment. Having a heightened awareness of these visual food cues may impact on food choices and eating behaviours with those being most aware of or demonstrating greater attention to food-related stimuli potentially being at greater risk of overeating and subsequent weight gain. To date, research related to attentional responses to visual food cues has been both limited and conflicting. Such inconsistent findings may in part be explained by the use of different methodological approaches to measure attentional bias and the impact of other factors such as hunger levels, energy density of visual food cues and individual eating style traits that may influence visual attention to food-related cues outside of weight status alone. This review examines the various methodologies employed to measure attentional bias with a particular focus on the role that attentional processing of food-related visual cues may have in obesity. Based on the findings of this review, it appears that it may be too early to clarify the role visual attention to food-related cues may have in obesity. Results however highlight the importance of considering the most appropriate methodology to use when measuring attentional bias and the characteristics of the study populations targeted while interpreting results to date and in designing future studies.

Effects of Elodea nuttallii on temperate freshwater plants, microalgae and invertebrates: small differences between invaded and uninvaded areas

The invasive aquatic plant species Elodea nuttallii could pose a considerable risk to European freshwater ecosystems based on its current distribution, rate of spread and potential for high biomass. However, little research has been conducted on the impacts of this species on native biota. This study takes an ecosystem-wide approach and examines the impact of E. nuttallii on selected physicochemical parameters (dissolved oxygen and pH), algae, invertebrate and macrophyte communities. Elodea nuttallii had small but significant impacts on plant, invertebrate and algal species. The richness of algal periphyton was lower on E. nuttallii than on native macrophytes. The taxonomic composition of invertebrate communities associated with E. nuttallii differed from that associated with similar native plant species, but did not differ in terms of total biomass or species richness. Macrophyte species richness and total cover were positively correlated with percentage cover of E. nuttallii. Not all macrophyte species responded in the same way to E. nuttallii invasion; cover of the low-growing species, Elodea canadensis and charophytes were negatively correlated with E. nuttallii cover, whilst floating-rooted plants were positively correlated with E. nuttallii cover. All observed differences in the macrophyte community were small relative to other factors such as nutrient levels, inter-annual variation and differences between sites. Despite this, the observed negative association between E. nuttallii and charophytes is a key concern due to the rarity and endangered status of many charophyte species.

Prevalence of refractive error in Europe: the European Eye Epidemiology (E3) Consortium

To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E³) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤−0.75 diopters (D), high myopia ≤−6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry). The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4–30.9], high myopia 2.7 % (95 % CI 2.69–2.73), hyperopia 25.2 % (95 % CI 25.0–25.4) and astigmatism 23.9 % (95 % CI 23.7–24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8–52.5) in 25–29 years-olds]. Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe.

Between Tradition and Modernity: Determining Spatial Systems of Privacy in the Domestic Architecture of Contemporary Iraq

The notion of privacy represents a central criterion for both indoor and outdoor social spaces in most traditional Arab settlements. This paper investigates privacy and everyday life as determinants of the physical properties of the built and urban fabric and will study their impact on traditional settlements and architecture of the home in the contemporary Iraqi city. It illustrates the relationship between socio-cultural aspects of public/private realms using the notion of the social sphere as an investigative tool of the concept of social space in Iraqi houses and local communities (Mahalla). This paper reports that in spite of the impact of other factors in articulating built forms, privacy embodies the primary role under the effects of Islamic rules, principles and culture. The crucial problem is the underestimation of traditional inherited values through opening social spaces to the outside that giving unlimited accesses to the indoor social environment creating many problems with regard to privacy and communal social integration.

The effects of pollution prevention on performance

As pressure for companies to improve their environmental performance has intensified in recent years, research attention has shifted away from establishing a link between environmental practices and performance towards consideration of other factors that might facilitate performance improvements. This paper has two key purposes; firstly, to investigate whether internal support processes interact with pollution prevention by positively moderating the relationship between pollution prevention and environmental performance, and; secondly, to assess whether the relationship between pollution prevention and cost performance is mediated by environmental performance.

Design/methodology/approach
It uses a cross-sectional survey of 1,200 UK-based food processing firms to gather information on environmental practices and performance. Regression analysis was conducted on a sample of 149 responding firms to assess the hypothesised relationships.

Findings
Support was found for two of the four moderated relationships hypothesised namely, suggesting that internal support processes support the environmental performance of some pollution prevention practices. Strong support for a mediated relationship between pollution prevention, environmental performance and cost performance was provided by the results.

Originality/value
This study provides an original contribution to the literature on the performance outcomes of environmental practices by considering a number indirect relationships between environmental practices and performance. This has implications for the interpretation of the relationship between environmental practices and performance.

A systematic review of population based epidemiological studies in Myasthenia Gravis

Background: The aim was to collate all myasthenia gravis (MG) epidemiological studies including AChR MG and MuSK MG specific studies. To synthesize data on incidence rate (IR), prevalence rate (PR) and mortality rate (MR) of the condition and investigate the influence of environmental and technical factors on any trends or variation observed.

Methods: Studies were identified using multiple sources and meta-analysis performed to calculate pooled estimates for IR, PR and MR.

Results: 55 studies performed between 1950 and 2007 were included, representing 1.7 billion population-years. For All MG estimated pooled IR (eIR): 5.3 per million person-years (C.I.: 4.4, 6.1), range: 1.7 to 21.3; estimated pooled PR: 77.7 per illion persons (C.I.: 64.0, 94.3), range 15 to 179; MR range 0.1 to 0.9 per millions person-years. AChR MG eIR: 7.3 (C.I.: 5.5, 7.8), range: 4.3 to 18.0; MuSK MG IR range: 0.1 to 0.32. However marked variation persisted between populations studied with similar methodology and in similar areas.

Conclusions: We report marked variation in observed frequencies of MG. We show evidence of increasing frequency of MG with year of study and improved study quality. This probably reflects improved case ascertainment. But other factors must also influence disease onset resulting in the observed variation in IR across geographically and genetically similar populations.

Understanding controls on cirque floor altitudes: insights from Kamchatka

Glacial cirques reflect former regions of glacier initiation, and are therefore used as indicators of past climate. One specific way in which palaeoclimatic information is obtained from cirques is by analysing their elevations, on the assumption that cirque floor altitudes are a proxy for climatically controlled equilibrium-line altitudes (ELAs) during former periods of small scale (cirque-type) glaciation. However, specific controls on cirque altitudes are rarely assessed, and the validity of using cirque floor altitudes as a source of palaeoclimatic information remains open to question. In order to address this, here we analyse the distribution of 3520 ice-free cirques on the Kamchatka Peninsula (eastern Russia), and assess various controls on their floor altitudes. In addition, we analyse controls on the mid-altitudes of 503 modern glaciers, currently identifiable on the peninsula, and make comparisons with the cirque altitude data. The main study findings are that cirque floor altitudes increase steeply inland from the Pacific, suggesting that moisture availability (i.e., proximity to the coastline) played a key role in regulating the altitudes at which former (cirque-forming) glaciers were able to initiate. Other factors, such as latitude, aspect, topography, geology and neo-tectonics seem to have played a limited (but not insignificant) role in regulating cirque floor altitudes, though south-facing cirques are typically higher than their north-facing equivalents, potentially reflecting the impact of prevailing wind directions (from the SSE) and/or variations in solar radiation on the altitudes at which former glaciers were able to initiate. Trends in glacier and cirque altitudes across the peninsula are typically comparable (i.e., values typically rise from both the north and south, inland from the Pacific coastline, and where glaciers/cirques are south-facing), yet the relationship with latitude is stronger for modern glaciers, and the relationship with distance to the coastline (and to a lesser degree with aspect) is notably weaker. These differences suggest that former glacier initiation (leading to cirque formation) was largely regulated by moisture availability (during winter months) and the control this exerted on accumulation; whilst the survival of modern glaciers is also strongly regulated by the variety of climatic and non climatic factors that control ablation. As a result, relationships between modern glacier mid-altitudes and peninsula-wide climatic trends are more difficult to identify than when cirque floor altitudes are considered (i.e., cirque-forming glaciers were likely in climatic equilibrium, whereas modern glaciers may not be).

HES6 drives a critical AR transcriptional programme to induce castration-resistant prostate cancer through activation of an E2F1-mediated cell cycle network

Castrate-resistant prostate cancer (CRPC) is poorly characterized and heterogeneous and while the androgen receptor (AR) is of singular importance, other factors such as c-Myc and the E2F family also play a role in later stage disease. HES6 is a transcription co-factor associated with stem cell characteristics in neural tissue. Here we show that HES6 is up-regulated in aggressive human prostate cancer and drives castration-resistant tumour growth in the absence of ligand binding by enhancing the transcriptional activity of the AR, which is preferentially directed to a regulatory network enriched for transcription factors such as E2F1. In the clinical setting, we have uncovered a HES6-associated signature that predicts poor outcome in prostate cancer, which can be pharmacologically targeted by inhibition of PLK1 with restoration of sensitivity to castration. We have therefore shown for the first time the critical role of HES6 in the development of CRPC and identified its potential in patient-specific therapeutic strategies.

Maintaining and reprogramming genomic androgen receptor activity in prostate cancer

Prostate cancer treatment is dominated by strategies to control androgen receptor (AR) activity. AR has an impact on prostate cancer development through the regulation of not only transcription networks but also genomic stability and DNA repair, as manifest in the emergence of gene fusions. Whole-genome maps of AR binding sites and transcript profiling have shown changes in the recruitment and regulatory effect of AR on transcription as prostate cancer progresses. Defining other factors that are involved in this reprogramming of AR function gives various opportunities for cancer detection and therapeutic intervention.

ChIPping away at gene regulation

The coordinated regulation of gene expression in higher eukaryotes is complex and poorly understood. Recent technological advances have allowed the first insights into these networks on a genome-wide scale. These investigations have identified transcription factor target sites in the genome and successfully predicted cooperative interactions with other factors. However, a detailed understanding of the processes that coordinate gene expression remains elusive. Here, we highlight the advances that have been made using current methods, and the need for new technologies to address the gaps in our knowledge and to map these complex pathways further.