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Purpose: There are a wide variety of intraoperative techniques available in breast surgery to achieve low rates for positive margins of excision. The objective of this systematic review was to determine the pooled diagnostic accuracy of intraoperative breast margin assessment techniques that have been evaluated in clinical practice. Methods: This study was performed in accordance with PRISMA guidelines. A systematic search of the literature was conducted to identify studies assessing the diagnostic accuracy of intraoperative margin assessment techniques. Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included in the meta-analysis. A bivariate model for diagnostic meta-analysis was used to determine overall pooled sensitivity and specificity. Results: Sixty-one studies were eligible for inclusion in this systematic review and meta-analysis. Cytology demonstrated the best diagnostic accuracy, with pooled sensitivity of 0.92 (95 % CI 0.77–0.98) and a pooled specificity of 0.95 (95 % CI 0.90–0.97). The findings also indicate good diagnostic accuracy for optical spectroscopy, with a pooled sensitivity of 0.86 (95 % CI 0.76–0.93) and a pooled specificity of 0.92 (95 % CI 0.82–0.97). Conclusion: Pooled data indicate that optical spectroscopy, cytology and frozen section have the greatest diagnostic accuracy of currently available intraoperative margin assessment techniques. However, long turnaround time for results and their resource intensive nature has prevented widespread adoption of these methods. The aim of emerging technologies is to compete with the diagnostic accuracy of these established techniques, while improving speed and usability.

AimThe overamplification of human epidermal growth factor (HER2) in breast cancer (BC) has been the subject of numerous research publications since its discovery in 1987. This is the first bibliometric analysis (BA) conducted on HER2-positive (HER2+) BC. The purpose of this BA is to analyze the published research on HER2+ BC from 1987 to 2024, highlighting the most significant scientific literature, as well as the main contributing authors and journals, and evaluating the impact of clinical and lab-based publications on HER2+ BC research.MethodsThe Web of Science Core Collection (WoSCC) was searched using the terms “Breast cancer” OR “Breast carcinoma” OR “Breast tumor” AND “HER2 positive” OR “HER2+”. The search was limited by publication year (1987–2024) and only full English articles were included. WoS returned 7,469 relevant results, and from this dataset, a bibliometric analysis was conducted using the “analyze results” and “journal citation report” functions in WoS and the VOSviewer 1.6.16 software to generate bibliographic coupling and co-citation analysis of authors.ResultsThe analysis encompassed a total of 7,469 publications, revealing a notable increase in the annual number of publications, particularly in recent years. The United States, China, Italy, Germany, and Spain were the top five most prolific countries. The top five significant institutions that published HER2+ research were the University of Texas System, Unicancer, UTMD Anderson Cancer Center, Harvard University, and University of California System. Breast Cancer Research and Treatment, Clinical Cancer Research, and Clinical Breast Cancer were the top three notable journals with the highest number of HER2+ BC publications. Dennis Slamon (Nc = 45,411, H-index = 51) and Jose Baselga (Nc = 32,592, H-index = 55) were the most prolific authors. Evolving research topics include anti-HER2 therapy in the neoadjuvant setting, treatment of metastatic HER2+ BC, and overcoming therapy resistance.ConclusionThis study provides an overview of HER2+ BC research published over the past three decades. It provides insight into the most cited papers and authors, and the core journals, and identifies new trends. These manuscripts have had the highest impact in the field and reflect the continued evolution of HER2 as a therapeutic target in BC.

Abstract Stream networks in Arctic and high-elevation regions underlain by frozen ground (i.e., permafrost) are expanding and developing in response to accelerating global warming, and intensifying summertime climate variability. The underlying processes governing landscape dissection in these environments are varied, complex and challenging to unravel due to air-temperature-regulated feedbacks and shifts to new erosional regimes as climate change progresses. Here we use multiple sources of environmental information and physical models to reconstruct and understand a 60-year history of landscape-scale channelization and evolution of the Muskox Valley, Axel Heiberg Island. A time series of air photographs indicates that freeze-thaw-related polygon fields can form rapidly, over decadal time scales. Supporting numerical simulations show that the presence of polygons can control how surface runoff is routed through the landscape, exerting a basic control on channelization, which is sensitive to the timing, duration and magnitude of hydrograph events, as well as seasonal air temperature trends. These results collectively highlight that the occurrence and dynamics of polygon fields modulate channel network establishment in permafrost-rich settings undergoing changes related to a warming climate.

Globally, the rapid retreat of coastal cliffs poses a profound risk to property, transport infrastructure, and public safety. To quantify and compare cliff top and cliff face retreat and identify erosion processes, this study combines historical (1842–2000) maps and orthophotos with contemporary UAV surveys (2019–2023) to quantify cliff top and cliff face retreat along a 240 m wide coastal drumlin in Galway Bay, Ireland. Retreat rates for the cliff top and cliff face were calculated using 2D mapping and 3D modelling, respectively. Critically, the choice of method has a significant impact on calculated rates of cliff top retreat, with output from the 2D mapping approach (0.14 +/− 0.02 m yr−1) being double that of the 3D modelling approach (0.08 +/− 0.02 m year−1). The aperiodic development of a talus cone, which temporarily protects the cliff from storm waves, also influences estimates of cliff retreat. The repeat cycles of talus slope formation and removal in this high wave energy environment suggest that the drumlin scarp transitions between a periodically transport-limited and supply-limited system over short- and long-time periods, respectively, on the continuum of cliff types. These results warrant further research to identify and quantify the rates, patterns, drivers (marine and subaerial processes), and timing of cliff retreat in response to climate change.

The capstone course serves to integrate accumulated knowledge with a culminating experience or project and is a common component in undergraduate and graduate programs. The research on capstones courses shows that many capstone experiences or projects involve students working with outside clients, such as local businesses and organizations, to solve problems or develop new projects or campaigns. Such capstone experiences or projects seek to offer students real-world, career-building experience, while the clients seek to benefit from the learned academic knowledge of the students. Where the literature is scarce on client-based capstone projects is when the client is the student's employer or career-related organization. A graduate program in administration at a public Midwestern university in the USA offers a different approach to the student--client model by requiring a degree-culminating capstone project that challenges adult students to apply their learned knowledge to solve administrative problems not for an outside client but at their place of employment or career-related organization. The researchers surveyed 66 alumni and interviewed 6 on how the capstone project had benefited their work-related learning and its impact on their employer or career-related organization. Students perceived an improvement in their ability to define and analyze administrative problems in their workplace, while the employers or organizations which implemented the project recommendations experienced positive organizational change. This case study contributes to the literature on capstone courses by examining the relevance of a work- or career-related capstone project to students and their workplace.

Summary: Background: A substantial proportion of attendances to ophthalmic emergency departments are for non-urgent presentations. We developed and evaluated a machine learning system (DemDx Ophthalmology Triage System: DOTS) to optimise triage, with the aim of reducing inappropriate emergency attendances and streamlining case referral when necessary. Methods: DOTS was built using retrospective tabular data from 11,315 attendances between July 1st, 2021, to June 15th, 2022 at Moorfields Eye Hospital Emergency Department (MEH) in London, UK. Demographic and clinical features were used as inputs and a triage recommendation was given (“see immediately”, “see within a week”, or “see electively”). DOTS was validated temporally and compared with triage nurses’ performance (1269 attendances at MEH) and validated externally (761 attendances at the Federal University of Minas Gerais - UFMG, Brazil). It was also tested for biases and robustness to variations in disease incidences. All attendances from patients aged at least 18 years with at least one confirmed diagnosis were included in the study. Findings: For identifying ophthalmic emergency attendances, on temporal validation, DOTS had a sensitivity of 94.5% [95% CI 92.3–96.1] and a specificity of 42.4% [38.8–46.1]. For comparison within the same dataset, triage nurses had a sensitivity of 96.4% [94.5–97.7] and a specificity of 25.1% [22.0–28.5]. On external validation at UFMG, DOTS had a sensitivity of 95.2% [92.5–97.0] and a specificity of 32.2% [27.4–37.0]. In simulated scenarios with varying disease incidences, the sensitivity was ≥92.2% and the specificity was ≥36.8%. No differences in sensitivity were found in subgroups of index of multiple deprivation, but the specificity was higher for Q2 when compared to Q4 (Q4 is less deprived than Q2). Interpretation: At MEH, DOTS had similar sensitivity to triage nurses in determining attendance priority; however, with a specificity of 17.3% higher, DOTS resulted in lower rates of patients triaged to be seen immediately at emergency. DOTS showed consistent performance in temporal and external validation, in social-demographic subgroups and was robust to varying relative disease incidences. Further trials are necessary to validate these findings. This system will be prospectively evaluated, considering human-computer interaction, in a clinical trial. Funding: The Artificial Intelligence in Health and Care Award (AI_AWARD01671) of the NHS AI Lab under National Institute for Health and Care Research (NIHR) and the Accelerated Access Collaborative (AAC).

Background The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) randomized trial demonstrated that a 3‐month transitional, tailored, progressive, multidomain physical rehabilitation intervention improves physical function, frailty, depression, and health‐related quality of life among older adults with acute decompensated heart failure. Whether there is differential intervention efficacy by race is unknown. Methods and Results In this prespecified analysis, differential intervention effects by race were explored at 3 months for physical function (Short Physical Performance Battery [primary outcome], 6‐Minute Walk Distance), cognition, depression, frailty, health‐related quality of life (Kansas City Cardiomyopathy Questionnaire, EuroQoL 5‐Dimension‐5‐Level Questionnaire) and at 6 months for hospitalizations and death. Significance level for interactions was P≤0.1. Participants (N=337, 97% of trial population) self‐identified in near equal proportions as either Black (48%) or White (52%). The Short Physical Performance Battery intervention effect size was large, with values of 1.3 (95% CI, 0.4–2.1; P=0.003]) and 1.6 (95% CI, 0.8–2.4; P