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This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.
The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.
Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.
In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.
This chapter builds on previous chapters, on crowds (Chapter 15) and emergencies and disasters (Chapter 16), to show the relationship between the two. It describes a programme of research that has examined the extent to which shared social identity determines collective behaviour in emergencies and disasters.
We recognise that engagement and action by the public is necessary when communities and agencies in them plan for emergencies. The increased threat of major incidents, disasters and terrorist attacks means that professional responders will not always be in place in time or in sufficient number to help (Cole et al., 2011; see Chapter 16).
The social identity approach is relevant here because it explains the conditions under which crowds and groups of people can operate as psychological communities that support their members in times of danger and stress. This chapter also describes how social identity principles have been applied to understanding informal psychosocial support among some refugees of war.
This chapter does two things. First, it shows how social identity principles can explain the basic psychological and behavioural effects of crowd membership. Second, it describes some recent research and applied work that shows how these basic effects operate to contribute to harmonious outcomes in potentially dangerous crowd events.
We begin by explaining some of the fundamental psychology of crowd membership in the next section.
This chapter draws together a selection of the key themes that recur in Section 3 of this book. One of the features of this section is that the authors focus on occurrences that are, statistically, uncommon. In terms of risk, these events are relatively moderate to low in probability but high in psychosocial impact. Thus, each of the serious events and types of incident covered in this section of the book pose threats to people, their families and communities, and to whole societies.
Perhaps, then, it might appear odd that the editors have selected these matters for inclusion in this book. Commentaries on them, which range from disasters through sectarian division and bloodshed to extremism, radicalisation and terrorism, are included in our quest for learning and inspiration in general terms as much as finding solutions to these and other circumstances that affect people.
To bring together stakeholders in the United Kingdom to establish national priorities for research in single-ventricle heart conditions.
This study comprised two surveys and a workshop. The initial public online survey asked respondents up to three questions they would like answered for research. Responses were classified as unanswered, already answered, or unable to be answered by scientific research. In the follow-up survey, unanswered questions were divided into categories and respondents were asked to rank categories and questions by priority. A stakeholder workshop attended by patients, parents, healthcare professionals, researchers, and charities was held to determine the final list of research priorities.
A total of 128 respondents posed 344 research questions, of which 271 were classified as unanswered, and after removing duplicates, 204 questions remained, which were divided into 20 categories. In the second survey, 56 (49.1%) respondents successfully ranked categories and questions. A total of 39 participants attended the workshop, drawing up a list of 30 research priorities across nine priority categories. The nine priority categories are: Associated co-morbidities; Brain & neurodevelopment; Exercise; Fontan failure; Heart function; Living with a single ventricle heart condition; Management of the well-functioning Fontan circulation; Surgery & perioperative care; and Transplantation, mechanical support & novel therapies.
Through a multi-stage process, we engaged a wide range of interested parties to establish a list of research priorities in single-ventricle heart conditions. This provides a platform for clinicians, researchers, and funders in the United Kingdom and elsewhere to address the most important questions and improve outcomes in these rare but high-impact CHDs.
Acute reactivity of the stress hormone cortisol is reflective of early adversity and stress exposure, with some studies finding that the impact of adversity on the stress response differs by race. The objectives of the current study were to characterize cortisol reactivity to two dyadically based stress paradigms across the first year of life, to examine cortisol reactivity within Black and White infants, and to assess the impact of correlates of racial inequity including socioeconomic status, experiences of discrimination, and urban life stressors, as well as the buffering by racial socialization on cortisol patterns. Salivary cortisol reactivity was assessed at 4 months of age during the Still Face paradigm (N = 207) and at 12 months of age across the Strange Situation procedure (N = 129). Infants demonstrated the steepest recovery after the Still Face paradigm and steepest reactivity to the Strange Situation procedure. Race differences in cortisol were not present at 4 months but emerged at 12 months of age, with Black infants having higher cortisol. Experiences of discrimination contributed to cortisol differences within Black infants, suggesting that racial discrimination is already “under the skin” by 1 year of age. These findings suggest that race-related differences in hypothalamic–pituitary–adrenal reactivity are present in infancy, and that the first year of life is a crucial time period during which interventions and prevention efforts for maternal–infant dyads are most likely able to shape hypothalamic–pituitary–adrenal reactivity thereby mitigating health disparities early across the life course.
Despite an emerging evidence base for the efficacy of supported computerized cognitive behavioural therapy (eCBT), uptake in services has been slow. Therapists’ beliefs about eCBT may constitute a barrier to offering eCBT to clients, but little research has investigated this topic. The aim of this study was to investigate therapist attitudes towards eCBT in one inner-city Improving Access to Psychological Therapies (IAPT) service using a survey design. Data were analysed using descriptive statistics. Thirty-three therapists took part in the study. Although 97% of participants reported that they knew ‘what eCBT involves’, and 62% reported that they were ‘confident to offer eCBT to clients’, only 10% endorsed that ‘there is a strong evidence-base to support the use of eCBT’. Two-thirds of the sample believed that eCBT ‘could be effective for mild and moderate mental health difficulties’, but most participants believed that eCBT would perform ‘worse’ or ‘much worse’ than face-to-face interventions for a range of disorders. Barriers to offering eCBT related predominantly to assumptions about client expectations of therapy, and perceived lack of a therapeutic relationship. Participants identified the provision of training on eCBT for those recommending treatment options to clients as a potential solution. Results from this study highlight therapists’ attitudes to eCBT that might contribute to low uptake rates of eCBT. Particularly, misperceptions about the evidence base for eCBT may be prevalent. Appropriate training and ongoing supervision for therapists are considered as interventions that may increase acceptance of eCBT as a valid treatment option.
The molecular, neurobiological, and physical health impacts of child maltreatment are well established, yet mechanistic pathways remain inadequately defined. Telomere length (TL) decline is an emerging molecular indicator of stress exposure with definitive links to negative health outcomes in maltreated individuals. The multiple confounders endemic to human maltreatment research impede the identification of causal pathways. This study leverages a unique randomized, cross-foster, study design in a naturalistic translational nonhuman primate model of infant maltreatment. At birth, newborn macaques were randomly assigned to either a maltreating or a competent control mother, balancing for sex, biological mother parenting history, and social rank. Offspring TL was measured longitudinally across the first 6 months of life (infancy) from peripheral blood. Hair cortisol accumulation was also determined at 6, 12, and 18 months of age. TL decline was greater in animals randomized to maltreatment, but also interacted with biological mother group. Shorter TL at 6 months was associated with higher mean cortisol levels through 18 months (juvenile period) when controlling for relevant covariates. These results suggest that even under the equivalent social, nutritional, and environmental conditions feasible in naturalistic translational nonhuman primate models, early adverse caregiving results in lasting molecular scars that foreshadow elevated health risk and physiologic dysregulation.
Insulin is a central regulatory factor in the control of nutrient partitioning during growth and development. It has been demonstrated that the rate of protein deposition is elevated in porcine muscle following insulin infusion (WrayCahen 1998), and that the degree of adiposity is positively associated with plasma insulin concentration (Wood et al., 1977; Polonsky 1995). The objective of the study was to examine the effect of plasma glucose and insulin concentrations on growth performance in two porcine genotypes.
To determine which concomitant boost technique is dosimetrically superior in the treatment of breast cancer; volumetric-modulated arc therapy (VMAT) or fixed field intensity-modulated radiotherapy (ff-IMRT).
Materials and methods
In total, 30 breast patients were re-planned with both VMAT and fixed field concomitant boost intensity-modulated radiotherapy techniques. A hybrid technique was used delivering 80% of the dose through tangential beams and 20% through an integrated boost. A two-tailed t-test sample for means was used to compare the dosimetric differences between the techniques.
Maximum dose was statistically lower for VMAT; 103·2 versus 103·7% for ff-IMRT along with statistically lower V2 Gy doses to the contralateral lung (0·7 versus 1·6%) and heart for both left- (19·0%/22·6%), and right- (5·5%/8·8%) sided patients, respectively. ff-IMRT boasted significantly lower ipsilateral lung V20, V18 and V10 Gy (7·9/8·6/13·1 versus 8·1/8·8/13·4%) than VMAT, respectively. No differences were found with minimum coverage, mean dose and V5 Gy to all organs at risk (OARs).
VMAT and ff-IMRT techniques demonstrate excellent target coverage and OAR sparing facilitated by the hybrid planning technique and deep inspiration breath hold. There is no obvious dosimetrically superior option between the two techniques. Reduced treatment times with VMAT make it more desirable to implement clinically.
The surviving fabric of the house at Moor Park, near Rickmansworth, Hertfordshire, built in 1679–84 for the Duke and Duchess of Monmouth on the site of an older house, is hidden inside the present stone casing by James Thornhill of c 1725. Its design is attributed to Hugh May, and it was constructed by a team of Office of Works craftsmen, many of whom were working with May at Windsor Castle, Berkshire. Analysis of the remaining structure, together with new research into the documentary evidence, has permitted a reconstruction of the roof along with partly conjectural reconstructions of the elevations and of some interior features. The study throws light on the process of commissioning, building and interior finishing of the house, the materials used, the close-knit circle of architects and craftsmen involved and the possible intervention of the clients. It illustrates the originality of the designs and is compared to May’s other works and other houses of the period.
Art book publishers in countries remote from the main world markets have to overcome formidable problems if they are to succeed in publishing books on the art and artists of their own countries. Quality cannot be sacrificed, but the books must be economically viable. Co-publishing offers the best strategy for increasing sales of appropriate publications overseas; co-editions, featuring well known artists, may do well enough to subsidise other books which have an important contribution to make to the documentation of the nation’s art but which are less likely to sell abroad.
Maize in Canada is grown mainly in the south-eastern part of the country. No comprehensive studies on Canadian maize yield levels have been done so far to analyse the barriers of obtaining optimal yields associated with cultivar, environmental stress and agronomic management practices. The objective of the current study was to use a modelling approach to analyse the gaps between actual and potential (determined by cultivar, solar radiation and temperature without any other stresses) maize yields in Eastern Canada. The CSM–CERES–Maize model in DSSAT v4·6 was calibrated and evaluated with measured data of seven cultivars under different nitrogen (N) rates across four sites. The model was then used to simulate grain yield levels defined as: yield potential (YP), water-limited (YW, rainfed), and water- and N-limited yields with N rates 80 kg/ha (YW, N-80N) and 160 kg/ha (YW, N-160N). The options were assessed to further increase grain yield by analysing the yield gaps related to water and N deficiencies. The CSM–CERES–Maize model simulated the grain yields in the experiments well with normalized root-mean-squared errors <0·20. The model was able to capture yield variations associated with varying N rates, cultivar, soil type and inter-annual climate variability. The seven calibrated cultivars used in the experiments were divided into three grades according to their simulated YP: low, medium and high. The simulation results for the 30-year period from 1981 to 2010 showed that the average YP was 15 000 kg/ha for cultivars with high yield potential. The YP is generally about 6000 kg/ha greater than the actual yield (YA) at each experimental site in Eastern Canada. Two-thirds of this gap between YP and YA is probably associated with water stress, as a gap of approximately 4000 kg/ha between the YW and the YP was simulated. This gap may be reduced through crop management, such as introducing irrigation to improve the distribution of available water during the growing season. The simulated yields indicated a gap of about 3000 and 1000 kg/ha between YW and YW,N-80N for cultivars with high YP and low YP, respectively. The gap between YW and YW,N-160N decreased to <2000 kg/ha for high Yp cultivars with little difference for the low Yp cultivars. The different yield gaps among cultivars suggest that cultivars with high YP require high N rates but cultivars with low YP may need only low N rates.
We show that the available constraints relating to 6LiBeB Galactic evolution can be accounted for by the so-called superbubble model, according to which particles are efficiently accelerated inside superbubbles out of a mixture of supernova ejecta and ambient interstellar medium. The corresponding energy spectrum is required to be flat at low energy (in E−1 below 500 MeV/n, say), as expected from Bykov's acceleration mechanism. The only free parameter is also found to have the value expected from standard SB dynamical evolution models. Our model predicts a slope 1 (primary) and a slope 2 (secondary) behaviour at respectively low and high metallicity, with all intermediate slopes achieved in the transition region, between 10−2 and 10−1Z⊙.
The history of Audley End can be divided into three principal phases: the Tudor house, a conversion of the buildings of Walden Abbey, c.1538–1605; the Jacobean house, built by Thomas, 1st Earl of Suffolk, in two stages after c. 1605 and held by successive Earls until 1745, save for the period 1667–1701 when it was a Royal Palace; and the rehabilitation and later expansion of the surviving core of the Jacobean house from 1752 onwards, by Elizabeth, Countess of Portsmouth, and her successors. The aim of this paper is to give a preliminary account of some of the results of research in progress for the Department of the Environment into the first two of these phases.
This paper investigates the demands on social work resources in the north east region of the Department For Family and Community Services in South Australia, and examines the attitudes of workers to the question of access. Twenty three social workers, working predominantly in Child and Family Teams, were interviewed. A two part questionnaire was devised. The initial data covered information relating to the frequency, duration and supervision of access visits. The second part of the questionnaire used a semi-structured, open-ended format in order to explore social workers' knowledge and values in respect to access. The results of these interviews are presented and the implications for policy and practice in relation to statutory social work are discussed.
Internal working models of self and others and expectations of early relationships formed from early attachment experiences strongly influence the ways in which the child relates to others and the world. Infants whose early emotional needs have not been adequately met may come to view the world as comfortless and unpredictable and develop relationships that are marked by anxiety or detachment.
This paper presents some of the foundations of attachment theory and case examples are used to illustrate the ways in which children develop anxious or detached patterns of attachment. Attachment difficulties, together with environmental influences, are thought to be a genesis of later behavioural problems such as poor impulse control, aggression, prolonged emotional dependency and extreme difficulty in relating to other children.