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Pre-operative radiotherapy (PRT) and pre-operative chemoradiotherapy (PCRT) prior to mastectomy and immediate breast reconstruction for locally advanced breast cancer have the potential to reduce radiation late-effects and expedite oncologic treatment. Recent feasibility work indicates that PCRT is safe and technically possible. Here, we present a systematic review of currently available data on clinical, oncological, reconstructive and aesthetic outcomes. A prospectively registered search of Medline (Ovid), EMBASE (Ovid), EMCARE (Ovid) and CINAHL (EBSCO) databases was performed in August 2023. Clinical, oncological, reconstructive and aesthetic outcomes were appraised with risk of bias (ROBINS-I) and methodological quality determined (STROBE checklist) for each study. Twenty-two published articles (19 journal articles and 3 abstracts) were identified reporting the outcomes of 1258 patients with median follow-up between 19.0–212.4 months. Patients received neoadjuvant chemotherapy in 20 studies. Rates of locoregional recurrence and overall survival ranged between 0–21.7% and 82.0%−98.3% respectively. Rates of flap loss or necrosis ranged from 0–7.6%. Rates of revisional procedures ranged between 1.9–35.3%. Patient-reported outcomes were reported in 7 studies and were mostly 'good' or 'excellent'. PRT and PCRT preceding mastectomy and breast reconstruction produce acceptable oncological outcomes with rates of surgical complication and reconstructive outcomes within normal limits, however, the majority of available studies are of low methodological quality and at high risk of bias. A pragmatic randomised trial comparing PRT versus PMRT in the setting of breast reconstruction is now urgently required to guide surgical practice. [ABSTRACT FROM AUTHOR]

Background: The role of children and young people (CYP) in transmission of SARS-CoV-2 in household and educational settings remains unclear. We undertook a systematic review and meta-analysis of contact-tracing and population-based studies at low risk of bias.Methods: We searched 4 electronic databases on 28 July 2021 for contact-tracing studies and population-based studies informative about transmission of SARS-CoV-2 from 0 to 19 year olds in household or educational settings. We excluded studies at high risk of bias, including from under-ascertainment of asymptomatic infections. We undertook multilevel random effects meta-analyses of secondary attack rates (SAR: contact-tracing studies) and school infection prevalence, and used meta-regression to examine the impact of community SARS-CoV-2 incidence on school infection prevalence.Findings: 4529 abstracts were reviewed, resulting in 37 included studies (16 contact-tracing; 19 population studies; 2 mixed studies). The pooled relative transmissibility of CYP compared with adults was 0.92 (0.68, 1.26) in adjusted household studies. The pooled SAR from CYP was lower (p = 0.002) in school studies 0.7% (0.2, 2.7) than household studies (7.6% (3.6, 15.9) . There was no difference in SAR from CYP to child or adult contacts. School population studies showed some evidence of clustering in classes within schools. School infection prevalence was associated with contemporary community 14-day incidence (OR 1.003 (1.001, 1.004), p<0.001).Interpretation: We found no difference in transmission of SARS-CoV-2 from CYP compared with adults within household settings. SAR were markedly lower in school compared with household settings, suggesting that household transmission is more important than school transmission in this pandemic. School infection prevalence was associated with community infection incidence, supporting hypotheses that school infections broadly reflect community infections. These findings are important for guiding policy decisions on shielding, vaccination school and operations during the pandemic. [ABSTRACT FROM AUTHOR]

Lymphoedema after cancer treatment is a chronic and disabling complication that presents a significant health care burden during survivorship with limited treatment options. Vascularised lymph node transfer (VLNT) can reconstruct lymphatic flow to reduce limb volumes, but limited higher-order evidence exists to support its effectiveness. The aim of the study was to systematically review and meta-analyse the effectiveness of VLNT in reducing upper limb (UL) or lower limb (LL) volume and cellulitis episodes in patients with cancer treatment–related lymphoedema (CTRL). PubMed, Medline (Ovid) and Embase databases were searched between January 1974 and December 2019. Full-length articles where VLNT was the sole therapeutic procedure for CTRL, reporting volumetric limb, frequency of infection episodes and/or lymphoedema-specific quality-of-life data, were included in a random-effects meta-analysis of circumferential reduction rate (CRR). Methodological quality was assessed using STROBE/CONSORT, and a novel, lymphoedema-specific scoring tool was used to assess lymphoedema-specific methodological reporting. Sensitivity analyses on the site of VLNT harvest and recipient location were performed. Thirty-one studies (581 patients) were eligible for inclusion. VLNT led to significant limb volume reductions in UL (above elbow pooled CRRs [CRR P ] = 42.7% [95% confidence interval (CI): 36.5–48.8]; below elbow CRR P = 34.1% [95% CI: 33.0–35.1]) and LL (above knee CRR P = 46.8% [95% CI: 43.2–50.4]; below knee CRR P = 54.6% [95% CI: 39.0–70.2]) CTRL. VLNT flaps from extra-abdominal donor sites were associated with greater volume reductions (CRR P = 49.5% [95% CI: 46.5–52.5]) than those from intra-abdominal donor sites (CRR P = 39.6% [95% CI: 37.2–42.0]) and synchronous autologous breast reconstruction/VLNT flaps (CRR P = 32.7% [95% CI: 11.1–54.4]) (p < 0.05). VLNT was also found to reduce the mean number of cellulitis episodes by 2.1 episodes per year (95% CI: −2.7– −1.4) and increased lymphoedema-specific quality-of-life scores (mean difference in Lymphoedema-Specific Quality of Life (LYMQOL) "overall domain" = +4.26). VLNT is effective in reducing excess limb volume and cellulitis episodes in both UL and LL lymphoedema after cancer treatment. However, significant heterogeneity exists in outcome reporting, and standardisation of reporting processes is recommended. • Lymphoedema is a disabling complication that burdens cancer survivorship. • Vascularised lymph node transfer (VLNT) reconstructs lymphatic return. • Meta-analysis showed VLNT can reduce limb volume and cellulitis episodes. • Extra-abdominal donor sites more effectively reduced limb volumes than intra-abdominal donor sites. • Standardised outcome reporting and randomised trials are recommended. [ABSTRACT FROM AUTHOR]

In the face of protracted stagnation following the global financial crisis, democratic governments who remain committed to neoliberalism are still required to secure popular support for their programmes. This article evaluates how this dilemma has presaged a shift in the relationship between governmental attempts to maintain neoliberal legitimacy and the imposition of authoritarian reforms. We argue that, in the aftermath of the 2015 refugee crisis, this shift has consisted of the elevation of home affairs policy and the advance of a 'mutated' politics of legitimation characterised by explicit forms of 'othering' and hostility towards the wider political system. Drawing on the examples of the UK and France, we show how this deepening authoritarianism has manifested along two interconnected axes: (1) increased police powers and suppression of protests and civil liberties; (2) enhanced border security and restrictions on citizenship. Contributing to scholarship on authoritarian neoliberalism, we argue that this elevation of home affairs not only augurs the intensification of authoritarianism, but also reveals how governments have utilised popular resistance to authoritarian reforms to generate new forms of reactionary 'consent'. [ABSTRACT FROM AUTHOR]

Abstract The effect of irradiation temperature on the crystallographic stability of the ternary carbides Ti 3 SiC 2 and Ti 3 AlC 2 was investigated in the 350 to 600 °C temperature range, using 2 MeV protons to a fluence of 2.25 × 1018 protons cm−2. Both materials shrink along the basal planes and expand normal to them. Defect recovery decreases the magnitude of these anisotropic lattice changes with increasing irradiation temperature. However, reduced recovery in Ti 3 AlC 2 causes irradiated surface exfoliation at low temperatures and elevated damage rates. The extent of lattice change suggests that in-reactor use of these compositions will likely be limited to high-temperature applications. Graphical abstract Unlabelled Image [ABSTRACT FROM AUTHOR]

Introduction: Burn injury in the elderly is associated with increased morbidity and mortality. It is not uncommon for biological age, or frailty, to differ from chronological age in this patient group and thus predicting individual clinical outcomes remains challenging. It has been previously shown that Rockwood's Clinical Frailty Scale, a global clinical measure of fitness and frailty in older people, can be a useful adjunct for predicting outcomes for elderly patients with burns >10% TBSA. We refine our previous work to investigate the impact of frailty on mortality of elderly patients with thermal burns of any size admitted to a burns unit and explore its role as a meaningful adjunct to the modified Baux score.Methods: A retrospective analysis of case notes for all patients ≥65years admitted to our burns centre as an in-patient during an 8-year period was performed with standard demographics, burn injury parameters, length of stay and mortality outcomes collected. Measures of frailty were reviewed and statistically analysed to assess the impact of biological aging on clinical outcome in order to assess how the modified Baux score may be developed for the elderly using Frailty Score.Results: 239 patients met the inclusion criteria. Mean age was 77years (range: 65-99years) and mean burn size was 14.46% TBSA (Range: 0.1-98% TBSA). The modified Baux and Frailty Score were both independent predictors of mortality (p<0.0001). Increased premorbid Frailty Score was associated with increased in-hospital (OR: 2.33, 95% CI: 1.63-3.34) and one-year mortality (OR: 3.13, 95% CI: 2.22-4.41) independent of burn size compared to the modified Baux Score (IHM OR: 1.09; 95% CI: 1.07-1.13, 1yr M: OR 1.08; 95% CI: 1.05-1.11). The Frailty Score (>3) was a much more sensitive predictor of one-year mortality (Sensitivity: 83.9%; Specificity: 66.4%) than the modified Baux (>97) (Sensitivity: 59.8%; Specificity: 82.9%). A Frailty Score >3 when combined with the modified Baux score demonstrated increased area under ROC curve for both in-hospital (0.89 (95% CI: 0.85-0.94); p=0.02) and one-year (0.88 (95% CI: 0.84-0.92); p=0.02) mortality when compared to the modified Baux alone.Conclusion: We demonstrate that Frailty Score can be used to independently predict in-hospital and one-year mortality for thermal burns of any size in the elderly admitted as an in-patient to a burns unit. We also find that the Frailty Score can be employed in combination with the modified Baux score to improve mortality prediction. We recommend that Frailty Score is integrated into the modified Baux score and used to focus burn care resources appropriately. [ABSTRACT FROM AUTHOR]

The response of Ti 3 SiC 2 , Ti 3 AlC 2 , Ti 2 AlC and Cr 2 AlC MAX phases under simulated primary water has been explored for the first time. Samples were tested for 28 days in 300 °C water with the addition of 2 ppm LiOH. The Ti-based MAX phases formed oxides of TiO and TiFeO 3 . X-ray diffraction and scanning electron microscopy showed no evidence of a passive Al or Si-based layer forming during testing. A-layer dissolution was observed to cause delamination of the layered structure. In contrast, Cr 2 AlC showed little change during autoclave testing, suggesting that a thin passivating chromia layer was formed. [ABSTRACT FROM AUTHOR]

Abstract: Eighty-seven hips with an infected total hip arthroplasty were treated with an antibiotic spacer and 6 weeks of antibiotics. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) measurements were repeated before attempted reimplanation, and a synovial fluid white blood cell (WBC) count was obtained intraoperatively. Nine hips (10.1%) had persistent infections. The mean ESR, CRP, and synovial fluid WBC count and differential decreased significantly (P < .001) between stages; however, the ESR remained elevated (>30 mm/h) in 50 patients (62.5%) and the CRP remained elevated (>10 mg/L) in 22 patients (27.5%) in whom the infection had been eradicated. The synovial fluid WBC count was the best test for identifying persistent infection, with an optimum cutoff of 3528 WBCs/µL(sensitivity, 78%; specificity, 96%) and an area under the curve of 0.91. The ESR and CRP were not sufficiently rigorous to aid in diagnosis and frequently failed to normalize even in patients without persistent infection. [ABSTRACT FROM AUTHOR]

The virial theorem is a fundamental property for multiparticle systems in quantum mechanics, and offers an elegant relationship between kinetic and potential energies of quantum states. In this paper, we study applications of the virial theorem for improving eigenvalue calculations of multiparticle systems. We propose the virial steepest descent scheme and the two-point linear extrapolation , to improve the accuracy of such eigenvalue calculations through post-processing eigenvalue data obtained from standard methods. Mathematical analysis of both methods is presented. Examples are included to illustrate the efficiency of both methods. [ABSTRACT FROM AUTHOR]