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BACKGROUND: Oncoplastic breast-conserving surgery may allow women with early breast cancer to avoid a mastectomy, but many women undergo more extensive surgery, even when breast-conserving options are offered. The aim of the ANTHEM qualitative study was to explore factors influencing women's surgical decision-making for and against oncoplastic breast-conserving surgery. METHODS: Semi-structured interviews were conducted with a purposive sample of women who had received either oncoplastic breast-conserving surgery or a mastectomy with or without immediate breast reconstruction to explore their rationale for procedure choice. Interviews were transcribed verbatim and analysed thematically. Trial registration number: ISRCTN18238549. RESULTS: A total of 27 women from 12 centres were interviewed. Out of these, 12 had chosen oncoplastic breast-conserving surgery and 15 had chosen a mastectomy with or without immediate breast reconstruction. Overwhelmingly, women's decisions were guided by their surgical teams. Decision-making for and against oncoplastic breast-conserving surgery was influenced by three key inter-related factors: perceptions of oncological safety; the importance of maintaining/restoring femininity and body image; and practical issues. Oncological safety was paramount. Women who reported feeling reassured that oncoplastic breast-conserving surgery was oncologically safe were happy to choose this option. Those who were not reassured were more likely to opt for a mastectomy, as a perceived 'safer' option. Most women wished to maintain/restore femininity, with the offer of immediate breast reconstruction essential to make a mastectomy an acceptable option. Practical issues such as the perceived magnitude of the surgery were a lesser concern. CONCLUSION: Decision-making is complex and heavily influenced by the surgical team. High-quality, accurate information about surgical options, including appropriate reassurance about the short- and long-term oncological safety of oncoplastic breast-conserving surgery is vital if women are to make fully informed decisions.
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Neoplasias de la Mama , Toma de Decisiones , Mamoplastia , Mastectomía Segmentaria , Mastectomía , Investigación Cualitativa , Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/psicología , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Adulto , Mamoplastia/métodos , Mastectomía/métodos , Anciano , Reino Unido , Entrevistas como AsuntoRESUMEN
Mobulid species are endangered globally, and the market trade for gill plates is believed to be a major threat. Successful conservation and the sustainable use of mobulids therefore require an objective understanding of consumer characteristics and preferences for gill plates. Previous studies focused on qualitative descriptions, and reliable quantitative analyses are currently lacking. We used a latent class choice experiment method and a semistructured questionnaire to provide important new quantitative information about gill plate consumer characteristics and the heterogeneous nature of demand for gill plates. From May to July 2019, we conducted a field study in Guangzhou, the primary consumption hub for mobulid gill plates in mainland China. Utilizing a simple random sampling method, we engaged in face-to-face interviews with 428 consumers of gill plates in the major trading markets in Guangzhou. Our results showed that 59.8% of consumers of gill plates were over 40 years old, 62.6% were female, 80.7% had annual household incomes of <200,000 yuan, and 84.5% recognized the medical and health value of gill plates and purchased them. About seventy-two percent of consumers preferred to purchase imported and less expensive gill plates from unprotected species, but they had a strong preference for large gill plates from protected species, such as Mobula birostris. This contradiction arose from consumers' lack of knowledge of mobulids and their conservation status. We found, for example, female consumers over 40 years old had the least understanding of conservation status of mobulid species and the link between size of gill plates and rarity of mobulids. This suggests there may be opportunities to promote mobulid conservation through education and marketing targeted at this demographic. Consumers who had a positive preference for gill plates from protected species (regardless of price) (10%) may be harder to influence. Overall, we believe education alone is not enough and that the conservation of mobulids would benefit from an integrated approach that involves conservation education and strengthened trade regulations, such as the introduction of traceability systems and a stiffer legal framework for consumption of protected species.
Características y preferencias de los consumidores de placas branquiales de mobúlidos en China Resumen Las especies de mobúlidos están en peligro de extinción en todo el mundo y se considera al mercado de placas branquiales como una amenaza principal. Por lo tanto, la conservación exitosa y el uso sustentable de los mobúlidos requiere del entendimiento objetivo de las características y preferencias de los consumidores de estas placas branquiales. Los estudios previos se han enfocado en descripciones cualitativas, por lo que actualmente no hay suficientes análisis cuantitativos confiables. Usamos un método de experimento de elección de clase latente y un cuestionario semiestructurado para proporcionar información cuantitativa nueva e importante sobre las características de los consumidores de placas branquiales y la naturaleza heterogénea de la demanda de estas placas. Realizamos un estudio de campo entre mayo y julio de 2019 en Guangzhou, el principal centro de consumo de placas branquiales de mobúlidos en el interior de China. Utilizamos un método de muestreo aleatorio simple para entrevistar caraacara a 428 consumidores de placas branquiales en los principales mercados de Guangzhou. Nuestros resultados mostraron que el 59.8% de los consumidores son mayores a 40 años, 62.6% son mujeres, 80.7% tienen un ingreso doméstico anual mayor a 200,000 yuan y 84.5% reconocieron el valor médico y para la salud que tienen las placas branquiales, razones por las que las compran. El 72% de los consumidores prefirió comprar las placas importadas y menos caras de especies no protegidas, aunque tuvieron una mayor preferencia por las placas más grandes de las especies protegidas, como Mobula birostris. Esta contradicción se debe a la falta de conocimiento que tienen los consumidores sobre los mobúlidos y su estado de conservación. Descubrimos que, por ejemplo, las consumidoras de más de 40 años tienen el menor conocimiento del estado de conservación de los mobúlidos y la conexión entre el tamaño de las placas branquiales y la rareza de la especie. Lo anterior sugiere que podría haber oportunidad de promover la conservación de los mobúlidos por medio de la educación y la mercadotecnia enfocada en este grupo demográfico. Podría ser más difícil influir sobre el 10 % de los consumidores, el cual tiene una preferencia positiva por las placas branquiales de las especies protegidas (sin importar el precio). En general creemos que la educación por sí sola no es suficiente y que la conservación de los mobúlidos se beneficiaría de una estrategia integrada que involucre la educación para la conservación y regulaciones de mercado fortalecidas, como la introducción de los sistemas de trazabilidad y un marco legal más rígido para el consumo de las especies protegidas.
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Conservación de los Recursos Naturales , Comportamiento del Consumidor , China , Animales , Adulto , Femenino , Masculino , Conservación de los Recursos Naturales/métodos , Humanos , Persona de Mediana Edad , Especies en Peligro de ExtinciónRESUMEN
PURPOSE: Oncoplastic breast-conserving surgery (OPBCS) may be a better option than mastectomy ± immediate breast reconstruction (IBR) for women with breast cancer but studies directly comparing the techniques are lacking. We surveyed UK breast units to determine the current practice of OPBCS to inform the design of a future comparative study. METHODS: An electronic survey was developed to explore the current practice of OPBCS. This included the local availability of volume displacement and/or replacement techniques; number of cases performed; contraindications and approach to contralateral symmetrisation. Summary data for each survey item were calculated and overall provision of care examined. RESULTS: 58 UK centres completed the survey, including 43 (74%) stand-alone breast and 15 (26%) combined breast/plastics units. Over 40% of units (n = 24) treated more than 500 cancers/year. Most units offered volume displacement techniques (TMs) (97%). Over two-thirds (n = 39. 67%) of units offered local perforator flaps (LPF). Approximately a half of units (10/19) not performing LPF were planning to introduce them in the next 12-24 months. A third (n = 19, 33%) of units routinely performed simultaneous contralateral symmetrisation mostly with two-surgeon operating. There were limited oncological restrictions to OPBCS with no contraindications for multifocal cancers in most centres; 65% of units (36/55) offered OPBCS for multicentric disease. Extensive DCIS was a contraindication in a minority of units. CONCLUSIONS: OPBCS is widely available in the UK but contraindications and approaches to contralateral symmetrisation were variable. Work is now needed to prospectively evaluate the outcomes of OPBCS vs mastectomy ± IBR to support informed decision-making.
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Neoplasias de la Mama , Mamoplastia , Colgajo Perforante , Femenino , Humanos , Mastectomía Segmentaria/métodos , Mastectomía/métodos , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Encuestas y Cuestionarios , Reino Unido/epidemiologíaRESUMEN
BACKGROUND & OBJECTIVES: Sentinel lymph node biopsy (SLNB) is an accurate and reliable method for staging the axilla in early breast cancer. The gold standard technique for localizing the sentinel lymph node (SLN) is the use of radioisotope with or without blue dye. However, this technique has its limitations. Various alternatives have been explored to overcome the disadvantages of the standard SLNB technique and superparamagnetic iron oxide mapping agents have garnered significant attention. The SMART study aims to compare the magnetic technique using the superparamagnetic iron oxide particles (SPIO, Sienna+®) to the radioisotope technique (Tc99) +/- blue dye, for SLN identification in patients with early breast cancer. METHODS: A prospective, multicenter study was done that recruited 109 clinically node-negative early-stage breast cancer patients from five centres in the United Kingdom (UK). The patients received radioisotope ± blue dye injections, followed by intraoperative injection of magnetic tracer prior to SLNB. The sentinel node identification rate was compared between the magnetic and standard techniques to evaluate detection rate (per patient and per node), non-inferiority and concordance. RESULTS: Data was analysed for 107 patients. The per patient detection rate was 98.13% (105/107) when using the magnetic tracer and 92.26% (103/107) when using the standard technique. The nodal detection rate was 93.07% (188/202 nodes) when using the magnetic tracer and 96.53% (195/202) when using the standard technique. Of the 31 patients with positive sentinel lymph nodes (SLNs), all 31 (100%) were detected by both techniques. CONCLUSION: Our study demonstrates that the magnetic technique is a feasible method for SLNB, with an identification rate that is not inferior to the standard technique. The magnetic technique offers a suitable alternative to the standard technique thereby avoiding the need for the complexities of nuclear medicine, the hazards of radiation and the anaphylaxis risk of blue dye.
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Neoplasias de la Mama , Ganglio Linfático Centinela , Humanos , Femenino , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Ganglio Linfático Centinela/diagnóstico por imagen , Ganglio Linfático Centinela/cirugía , Ganglio Linfático Centinela/patología , Axila/patología , Estudios Prospectivos , Ganglios Linfáticos/patología , Biopsia del Ganglio Linfático Centinela/métodos , Radioisótopos , Nanopartículas Magnéticas de Óxido de HierroRESUMEN
China is one of the world's leading consumer markets for wildlife products, yet there is little understanding of how demand will change in the future. In this study, we investigate the consumptive habits and attitudes of the millennial 'Juilinghou' demographic - a subset of society in China with the potential to substantially influence future demand for wildlife products. We surveyed 350 Chinese university students across Harbin and Beijing, China, and found that the intended future consumption of wildlife products was relatively low in this population but with a strong orientation towards wildlife products with medicinal properties. Seventy percent of those respondents who had used and/or intended to use wildlife products were willing to try substitutes, but this was heavily dependent on their price (cheaper) and quality. The insights gained through this survey are intended to meaningfully inform future initiatives to introduce sustainable substitutability into wildlife markets to alert future wildlife product consumers to alternative choices. Supplementary Information: The online version contains supplementary material available at 10.1007/s10745-021-00279-0.
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Sustainable wildlife management (SWM) is based on a synergy of traditional/local knowledge, advances in scientific knowledge, and fast-evolving economic and social circumstances. A widely accepted cornerstone of SWM globally is that conservation and utilization need to be effectively integrated, emphasizing the benefits humans can derive from biodiversity, thereby further encouraging people to protect and value wildlife though its management. However, with demand from biological resources growing at an unprecedented rate and the emergence of social media, conservationists must respond quickly to new challenges and conflicts associated with species management and public policy. For example, the rise of the "Compassionate Conservation" (CC) movement, fueled by social marketing and media, which promotes the welfare of individual animals, has introduced a set of challenges for conventional conservation management as it opposes most or all forms of wildlife utilization and hunting. CC advocates are increasingly influential at global and national policy levels; hence, it is imperative that conservationists are informed and aware of the future challenges from a rapidly changing global society. In this paper, we report the findings of a large semi-structured questionnaire in China which investigated the attitude of the urban public toward sustainable wildlife management (SWM) and wildlife conservation across a range of issues and identified the key socio-economic and demographic factor drivers for those attitudes. The survey was conducted from November 2018 to October 2020, across 15 cities randomly selected among China's seven administrative geographic regions. The survey was initially conducted through face-to-face interviews, but later, due to COVID-19 restrictions, was completed via online questionnaires. A Likert seven-point scale method was used to score the public's degree of agreement or disagreement for each question; a multivariate stepwise linear regression method was used to analyze whether the overall attitude of the respondents toward SWM and wildlife conservation was affected by their demographic characteristics; and a classification and regression tree (CART) was used to conduct an in-depth analysis of the issues with negative scores in the questionnaire, so as to understand how the respondents' demographic characteristics affected the public's attitude about such issues, which could supplement results obtained from the multivariate stepwise linear regression analysis. The results show that the public are broadly supportive of SWM, but only moderately so. On issues of "Animal Welfare and Rights," "Wildlife Utilization and Captive Breeding," and "Trophy Hunting", the core concerns of the "Compassionate Conservation" movement and the overall public view are more antagonistic to conventional SWM. We also find specific demographic characteristics significantly influence attitudes about SWM, with vegetarians, those with religious beliefs, and with lower educational standards demonstrating weaker support for SWM. For younger people, "Animal Welfare and Rights" is a special concern, hence, we identify this as a key issue to be addressed for SWM and conservation in the future. Our research suggests that conservation organisations may need to adapt their management aims and practices to avoid direct conflict with the rising tide of animal rights sentiment, especially among the young. Furthermore, significant investment will be required to promote science-based conservation in social marketing on all social media platforms to help educate and engage the public with the science behind conservation management.
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The widespread dissemination of information related to wildlife utilization in new online media and traditional media undoubtedly impacts societal conservation concepts and attitudes, thus triggering public discussions on the relationship between conservation and utilization. A study on how public attitudes and concepts are affected by the related information on wildlife utilization is helpful to implement the scientific wildlife conservation and management strategies, and to propose targeted measures to optimize the information environment. We designed the questionnaire to investigate the public's awareness and agreement with related information on wildlife utilization so as to measure how information with different dissemination channels, source types, and content orientation influenced the public's concept of wildlife conservation and utilization. The questionnaire was distributed in seven major geographical regions throughout China. Out of a total of 1645 questionnaires that were collected, 1294 questionnaires were valid, with an effective rate of 78.7%. Results show that respondents had the greatest awareness of information on preventing unsustainable and illegal utilization, and the lowest awareness of information on promoting unsustainable utilization, and that awareness of information that against utilization was higher than that of information which supported sustainable utilization. At the same time, respondents showed the greatest agreement for information on preventing unsustainable utilization and the lowest agreement for information on promoting unsustainable utilization; also, their agreement with information that against utilization was higher than that for information which supported sustainable use. Respondents had a high level of awareness of information on wildlife related to COVID-19 provided by experts. Gender, age, the level of development of the city in which they live, education, vegetarianism, and religious beliefs all affected respondents' agreement with related information on wildlife utilization. This research suggests that the publicity and education of scientific conservation methods should be emphasized in the future conservation education. In addition, scholars in the field of wildlife research should assume the role of 'influencer' and give full play to the scientific guidance of public opinion.
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Many global biodiversity hotspots have been cultivated for food for centuries and their unique agrobiodiversity is now under threat from land-use conversion, land abandonment or agricultural intensification. Wildlife-friendly farming (WFF) certification is a market-based approach that aims to alleviate the threats through charging a premium over conventional food products. This study explores the economic demand for WFF to protect biodiversity and maintain traditional rice cultivation in the Satoyama landscape of Japan by quantifying the price differential for key attributes of a landscape scale WFF scheme using choice experiments with consumers. A novel component of this study was to combine the choice experiment data with qualitative interviews with stakeholders together with observational and participatory approaches to identify underlying motivations for purchase decisions and to assess using a mixed methods approach the potential of WFF schemes to support landscape scale conservation and rural development. We found that consumer's willingness to pay (WTP) for organic rice was the highest, with a premium of 2937 JPY (26.83 USD) compared to non-organic rice. Respondents were also willing to pay more for all rice that conserves individual target species, with WTP for bird species the highest and for rice produced specifically in the traditional Satoyama landscapes. Although a WFF-Satoyama programme would bring public benefits and support rural livelihoods we suggest there are several challenges to widespread adoption that include an ageing farming population, a lack of appropriate business skills and technical capacity, and obstacles arising from Japanese land use policies concerning forestry and hunting.
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Animales Salvajes , Conservación de los Recursos Naturales , Agricultura , Animales , Biodiversidad , JapónRESUMEN
INTRODUCTION: Approximately 40% of the 55 000 women diagnosed with breast cancer each year in the UK undergo mastectomy because they are considered unsuitable for standard breast-conserving surgery (BCS) due to tumour size or multiple tumour foci. Mastectomy can significantly impact women's quality of life, and only one in four women currently undergo immediate breast reconstruction (IBR).Level 2 oncoplastic breast-conserving surgery (OPBCS) combines removing the cancer with a range of plastic surgical volume replacement (eg, local perforator flaps) and volume displacement techniques (eg, therapeutic mammaplasty) that can extend the role of BCS and may allow some women not suitable for standard BCS to avoid mastectomy. High-quality research to determine whether OPBCS offers a safe and effective alternative to mastectomy±IBR is currently lacking. Preliminary work is needed to ensure a future large-scale study is feasible and well designed and addresses questions important to patients and the National Health Service. METHODS AND ANALYSIS: Mixed methods will be used to inform feasibility and design of a future large-scale study comparing the clinical effectiveness and cost-effectiveness of OPBCS and mastectomy±IBR. It will have four parts: (1) a National Practice Questionnaire to determine current practice and provision of oncoplastic breast and reconstructive surgery in the UK; (2) a pilot multicentre prospective cohort study to explore the proportion of patients choosing OPBCS versus mastectomy, the proportion in OPBCS is successful and clinical and patient-reported outcomes of different techniques at 3 and 12 months postsurgery; (3) a qualitative interview study to explore patients' attitudes to different procedures, rationale for decision-making and perceptions of outcomes; and (4) design of the future study.All centres offering OPBCS and mastectomy in the UK will be invited to participate. Recruitment is planned to commence winter 2020 and continue for 12 months. ETHICS AND DISSEMINATION: The study has ethical approval from the Wales Research Ethics Committee 6 National Research Ethics Service (REC Ref 20/WA/0225). Results will be presented at national and international meetings and published in peer-reviewed journals. We will work with patients to develop lay summaries and share these through patient groups and breast cancer charities. TRIAL REGISTRATION NUMBER: ISRCTN18238549.
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Neoplasias de la Mama , Mamoplastia , Neoplasias de la Mama/cirugía , Estudios de Factibilidad , Femenino , Humanos , Mastectomía , Mastectomía Segmentaria , Estudios Multicéntricos como Asunto , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Calidad de Vida , Medicina Estatal , GalesRESUMEN
Online crowdfunding can help address the perennial financial shortfalls in environmental conservation and management. Although many online crowdfunding campaigns fail to collect any funds due to not achieving their targets, little is known about what drives success. To address this knowledge gap, we applied a mixed-methods approach to data from 473 successful and failed campaigns hosted on the online crowdfunding platform Readyfor. We found that fundraising performance varied by topic, with campaigns on pet animal management outperforming those focussed on landscape management and sustainable use. We also found that marketing strategies associated with online findability and increased reach through social networks, increased fundraising success. However, the existence of other environmental campaigns running simultaneously, reduced the chance of success, which implies that the selecting popular topics does not always increase the likelihood of success due to increased competition. Wider applications of marketing could enhance the ability of environmental crowdfunding campaigns to raise funds.
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Colaboración de las Masas , Obtención de Fondos , Animales , Conocimiento , ProbabilidadRESUMEN
Wildlife conservation and management has become a very complex public policy issue in China as concerns over on animal welfare and empathy for animals have grown. Science-based conservation strategies that are oriented toward sustainable wildlife management (SWM) are under threat as these new attitudes and values emerge and take hold. This study accesses the attitudes of college students towards SWM and wildlife conservation, and investigates demographic characteristics influencing their attitudes in China, a country that is traditionally associated with consumptive use of wildlife and SWM, but where new ideas about wildlife conservation are emerging. From October 2018 to April 2019, nine universities (including "Double First-Class" universities, first-tier universities, second-tier universities), and four three-year colleges in China were selected as survey locations, and face-to-face interviews were conducted with 1991 students. A total of 1977 questionnaires were recovered, of which 1739 were valid, with a completion rate of 88%. A Likert seven-point scale method was used to score students' attitudes, and a classification and regression tree (CART) was used to analyze whether their attitudes were affected by their demographic characteristics. The results show that although students are broadly supportive of the theory of SWM, some are deeply antagonistic about on SWM on issues that arouse strong emotions such as "Animal Welfare and Rights" and "Trophy Hunting". Demographic characteristics of students affect their degree of support for the SWM with support for SWM lower among vegetarians, freshmen, and students who have taken environmental protection electives. This research suggests that the theory of SWM requires to be refreshed and adapted to appeal to the younger generation of Chinese students, with SWM principles integrated into the environmental education programs of universities and three-year colleges. More attention should also be attached to media publicity by the government about wildlife conservation so as to enhance awareness of the need for SWM.
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Some 5-10% of all breast cancers are associated with a pathogenic variant in a breast cancer-associated gene (BRCA1/BRCA2). Historically, with referral to the Nottingham University Hospitals NHS Trust's clinical genetics department for genetic testing, waiting times were on average 12-14 weeks for an initial appointment and 4-6 months to obtain results from the date of testing. A specialist, nurse-led mainstreaming cancer genetics (MCG) service was set up in the trust's Nottingham Breast Institute (NBI) to: reduce waiting times for the initial consultation, counselling, consent and obtaining results for BRCA1/BRCA2 gene testing; and to ensure appropriate patients with breast cancer were offered genetic testing. Two breast clinical nurse specialists were trained so they could counsel, consent and give results for the BRCA1/BRCA2 gene testing directly to patients. Average waiting times for results from the time of testing were reduced to 35.8 days under the nurse-led service, which enabled oncologists and patients to consider individual treatment options at an earlier time. The MCG service reduced waiting times, resulting in an improved, more streamlined service for patients undergoing genetic testing. The MCG service extended the scope of practice of the breast nurse clinical specialists, embedded an expert advanced nursing role in the breast multidisciplinary team and developed nurse mentoring opportunities.
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Genes BRCA1 , Genes BRCA2 , Asesoramiento Genético/métodos , Pruebas Genéticas/métodos , Síndrome de Cáncer de Mama y Ovario Hereditario/diagnóstico , Síndrome de Cáncer de Mama y Ovario Hereditario/genética , Pautas de la Práctica en Enfermería/organización & administración , Adulto , Inglaterra , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Historically, the treatment of iliac artery occlusive disease required a surgical bypass usually consisting of an aortobifemoral bypass or an iliofemoral bypass. With the advent of balloon angioplasty and stenting, these procedures are frequently replaced with endovascular options. However, the treatment of diffuse occlusive disease of the external iliac artery (EIA) using balloon angioplasty and/or stenting does not carry a favorable long-term patency rate. Remote endarterectomy of the EIA using ring dissectors with balloon assistance provides a novel, controlled, safe, and durable treatment of the diseased and/or occluded EIA. METHODS: A retrospective review over the past 6 years was performed at our institution identifying patients treated with balloon-assisted remote endarterectomy of the EIA by the current five practicing vascular surgeons. The technique involves exposure of the ipsilateral common femoral artery. With nonocclusive disease, direct access into the common femoral artery is performed, a wire is traversed through the diseased EIA, and a balloon is inflated at the origin of the vessel providing hemostasis and control. A femoral endarterectomy is performed, and a ring dissector is passed over the endarterectomized material including the wire and balloon catheter and advanced remotely through the EIA up to the balloon. The balloon is briefly deflated, repositioned within the ring dissector, and reinflated, thus cutting the plaque. This allows for retraction of the inflated balloon and cutter, removing the endarterectomized core plaque. The procedure is similar for the treatment of an occluded EIA, but wire access across the occluded vessel is normally achieved with contralateral access. In both cases, the balloon provides control and hemostasis and is critically important in the rare treatment of vessel rupture. RESULTS: A total of 101 vessels were treated in 97 patients. The procedure was successful in 98 vessels (97%) with failure related to vessel rupture requiring conversion to an iliofemoral bypass. The estimated patency rate at three years was 94% with a median follow-up of 20 months. Restenosis/occlusion in four patients seemed to be related to a severe sclerotic response. The EIA was occluded 32% of the time. The common iliac artery (CIA) was diseased requiring angioplasty and stenting 29% of the time and a stent was placed at the transition zone between endarterectomized vessel and nontreated proximal most EIA or distal most CIA 58% of the time. There were no perioperative deaths. CONCLUSIONS: Balloon-assisted remote endarterectomy of the diffusely diseased and/or occluded EIA is a safe and durable option. It precludes the need for a prosthetic conduit and the risk of associated infection. It also involves a single groin incision and negates the need for retroperitoneal exposure of the CIA.
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Angioplastia de Balón , Arteriopatías Oclusivas/terapia , Endarterectomía , Arteria Ilíaca/cirugía , Anciano , Angioplastia de Balón/efectos adversos , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/fisiopatología , Terapia Combinada , Endarterectomía/efectos adversos , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Advances in implantable biologic and synthetic products over the last decade have enabled surgeons to replace traditional submuscular implant-based breast reconstruction techniques with a prepectoral or muscle-sparing technique. Prepectoral breast reconstruction is becoming increasingly popular among surgeons and patients due to the preservation of normal chest wall anatomy, with the restoration of body image with minimal morbidity. In this article, we have described a guide to prepectoral or muscle-sparing breast reconstruction with a particular emphasis on patient selection, technique and postoperative outcomes. Hence, a joint consensus guide from European and USA breast and plastic reconstructive surgeons has been agreed, and a crowd-writing method has been adopted to produce this guide.
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BACKGROUND: Management of breast ductal carcinoma in situ (DCIS) has various approaches with distinct institutional specific practice. Here, we review DCIS management in a single institution with emphasize on re-operation rates and outcome. METHODS: Breast ductal carcinoma in situ cases diagnosed at the Nottingham Breast Institute between 1987 and 2017 were identified (n = 1249). Clinicopathological data were collected. Cases were histologically reviewed, and different factors associated with primary operation selection, re-excision, presence of residual tumor in the re-excision specimens, use of radiotherapy and ipsilateral recurrences were analyzed. RESULTS: 34% of DCIS patients were initially treated by mastectomy and were more frequently symptomatic, of high nuclear tumor grade, size >40 mm, and associated with comedo necrosis and Paget's disease of the nipple. Further surgery was due to involved or narrow surgical margins. Residual tumor tissue was detected in 53% of the re-excision specimens. Re-excision rates of patients treated with breast-conserving surgery (BCS) were reduced from approximately 70% to 23%, and the final mastectomy rates decreased from 60% to 20%. Changes in surgical practice with acceptance of smaller excision margins and more frequent use of local radiotherapy have led to a significant decrease not only in the re-excision rate but also in the final mastectomy rate together with non-significant reduction in 5- and 10-year local recurrence rates. CONCLUSION: Although BCS is increasingly the preferred primary surgical option for DCIS management, a proportion of low-risk DCIS patients continue to undergo re-excision surgery or completion mastectomy. Despite acceptance of smaller margins, recurrence rate is decreasing.
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Neoplasias de la Mama/cirugía , Carcinoma Intraductal no Infiltrante/cirugía , Mastectomía Segmentaria/estadística & datos numéricos , Adulto , Anciano , Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Femenino , Humanos , Márgenes de Escisión , Mastectomía Segmentaria/normas , Persona de Mediana Edad , Reoperación/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
Non-governmental organisations (NGOs) play a key role in biodiversity conservation. The majority of these organisations rely on public donations to fund their activities, and therefore fundraising success is a determinant of conservation outcomes. In spite of this integral relationship, the key principals for fundraising success in conservation are still guided by expert opinion and anecdotal evidence, with very few quantitative studies in the literature. Here we assessed the behaviour of monetary donors across twenty-five different species-focused conservation campaigns organised by an NGO conservation and environmental society. The Australian Geographic Society (AGS) carried out fundraising campaigns over a five and half year period using an identical methodology in thirty-four of its country-wide network of outlet shops. AGS owns and operates these shops that sell toys and games related to science and nature. We tested how the following factors influenced monetary donations from members of the public:1) campaign duration, 2) appeal and familiarity of species, 3) species geographic distribution relative to the fundraising location, 4) level of income and education of potential donors, 5) age and gender profile of potential donors. Contrary to past research, we found most of these factors did not significantly influence the amount of donations made to each campaign by members of the public. Larger animals did elicit a significantly higher amount donated per transaction than smaller animals, as did shops located in poorer neighbourhoods. Our study findings contrast with past research that has focused largely on hypothetical donations data collected via surveys, and demonstrates the complexity and case-specific nature of relationships between donor characteristics and spending patterns. The study highlights the value of assessing real-world fundraising campaigns, and illustrates how collaboration between academia and NGOs could be used to better tailor fundraising campaigns to maximise donations from individual citizens.
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Conservación de los Recursos Naturales/economía , Obtención de Fondos , Organizaciones/economía , Animales , Australia , Biodiversidad , Conservación de los Recursos Naturales/estadística & datos numéricos , Femenino , Obtención de Fondos/estadística & datos numéricos , Humanos , Masculino , Mercadotecnía , Organizaciones/estadística & datos numéricos , Factores SocioeconómicosRESUMEN
Reducing Emissions from Deforestation and forest Degradation (REDD+) aims to avoid forest conversion to alternative land-uses through financial incentives. Oil-palm has high opportunity costs, which according to current literature questions the financial competitiveness of REDD+ in tropical lowlands. To understand this more, we undertook regional fine-scale and coarse-scale analyses (through carbon mapping and economic modelling) to assess the financial viability of REDD+ in safeguarding unprotected forest (30,173 ha) in the Lower Kinabatangan floodplain in Malaysian Borneo. Results estimate 4.7 million metric tons of carbon (MgC) in unprotected forest, with 64% allocated for oil-palm cultivations. Through fine-scale mapping and carbon accounting, we demonstrated that REDD+ can outcompete oil-palm in regions with low suitability, with low carbon prices and low carbon stock. In areas with medium oil-palm suitability, REDD+ could outcompete oil palm in areas with: very high carbon and lower carbon price; medium carbon price and average carbon stock; or, low carbon stock and high carbon price. Areas with high oil palm suitability, REDD+ could only outcompete with higher carbon price and higher carbon stock. In the coarse-scale model, oil-palm outcompeted REDD+ in all cases. For the fine-scale models at the landscape level, low carbon offset prices (US $3 MgCO2e) would enable REDD+ to outcompete oil-palm in 55% of the unprotected forests requiring US $27 million to secure these areas for 25 years. Higher carbon offset price (US $30 MgCO2e) would increase the competitiveness of REDD+ within the landscape but would still only capture between 69%-74% of the unprotected forest, requiring US $380-416 million in carbon financing. REDD+ has been identified as a strategy to mitigate climate change by many countries (including Malaysia). Although REDD+ in certain scenarios cannot outcompete oil palm, this research contributes to the global REDD+ debate by: highlighting REDD+ competitiveness in tropical floodplain landscapes; and, providing a robust approach for identifying and targeting limited REDD+ funds.
Asunto(s)
Arecaceae/crecimiento & desarrollo , Conservación de los Recursos Naturales/economía , Producción de Cultivos/economía , Bosques , BorneoRESUMEN
Fostering local community tolerance for endangered carnivores, such as tigers (Panthera tigris), is a core component of many conservation strategies. Identification of antecedents of tolerance will facilitate the development of effective tolerance-building conservation action and secure local community support for, and involvement in, conservation initiatives. We use a stated preference approach for measuring tolerance, based on the 'Wildlife Stakeholder Acceptance Capacity' concept, to explore villagers' tolerance levels for tigers in the Bangladesh Sundarbans, an area where, at the time of the research, human-tiger conflict was severe. We apply structural equation modeling to test an a priori defined theoretical model of tolerance and identify the experiential and psychological basis of tolerance in this community. Our results indicate that beliefs about tigers and about the perceived current tiger population trend are predictors of tolerance for tigers. Positive beliefs about tigers and a belief that the tiger population is not currently increasing are both associated with greater stated tolerance for the species. Contrary to commonly-held notions, negative experiences with tigers do not directly affect tolerance levels; instead, their effect is mediated by villagers' beliefs about tigers and risk perceptions concerning human-tiger conflict incidents. These findings highlight a need to explore and understand the socio-psychological factors that encourage tolerance towards endangered species. Our research also demonstrates the applicability of this approach to tolerance research to a wide range of socio-economic and cultural contexts and reveals its capacity to enhance carnivore conservation efforts worldwide.
Asunto(s)
Actitud , Especies en Peligro de Extinción , Tigres , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Animales Salvajes , Bangladesh , Conservación de los Recursos Naturales/métodos , Características Culturales , Ecosistema , Femenino , Geografía , Humanos , Ganado , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Vietnam is a significant consumer of wildlife, particularly wild meat, in urban restaurant settings. To meet this demand, poaching of wildlife is widespread, threatening regional and international biodiversity. Previous interventions to tackle illegal and potentially unsustainable consumption of wild meat in Vietnam have generally focused on limiting supply. While critical, they have been impeded by a lack of resources, the presence of increasingly organised criminal networks and corruption. Attention is, therefore, turning to the consumer, but a paucity of research investigating consumer demand for wild meat will impede the creation of effective consumer-centred interventions. Here we used a mixed-methods research approach comprising a hypothetical choice modelling survey and qualitative interviews to explore the drivers of wild meat consumption and consumer preferences among residents of Ho Chi Minh City, Vietnam. Our findings indicate that demand for wild meat is heterogeneous and highly context specific. Wild-sourced, rare, and expensive wild meat-types are eaten by those situated towards the top of the societal hierarchy to convey wealth and status and are commonly consumed in lucrative business contexts. Cheaper, legal and farmed substitutes for wild-sourced meats are also consumed, but typically in more casual consumption or social drinking settings. We explore the implications of our results for current conservation interventions in Vietnam that attempt to tackle illegal and potentially unsustainable trade in and consumption of wild meat and detail how our research informs future consumer-centric conservation actions.
Asunto(s)
Conservación de los Recursos Naturales , Comportamiento del Consumidor/economía , Conducta Alimentaria/psicología , Carne , Adolescente , Adulto , Anciano , Animales , Animales Salvajes , Conducta Alimentaria/ética , Femenino , Humanos , Funciones de Verosimilitud , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana , VietnamRESUMEN
Lowland tropical forests are increasingly threatened with conversion to oil palm as global demand and high profit drives crop expansion throughout the world's tropical regions. Yet, landscapes are not homogeneous and regional constraints dictate land suitability for this crop. We conducted a regional study to investigate spatial and economic components of forest conversion to oil palm within a tropical floodplain in the Lower Kinabatangan, Sabah, Malaysian Borneo. The Kinabatangan ecosystem harbours significant biodiversity with globally threatened species but has suffered forest loss and fragmentation. We mapped the oil palm and forested landscapes (using object-based-image analysis, classification and regression tree analysis and on-screen digitising of high-resolution imagery) and undertook economic modelling. Within the study region (520,269 ha), 250,617 ha is cultivated with oil palm with 77% having high Net-Present-Value (NPV) estimates ($413/ha-yr-$637/ha-yr); but 20.5% is under-producing. In fact 6.3% (15,810 ha) of oil palm is commercially redundant (with negative NPV of $-299/ha-yr-$-65/ha-yr) due to palm mortality from flood inundation. These areas would have been important riparian or flooded forest types. Moreover, 30,173 ha of unprotected forest remain and despite its value for connectivity and biodiversity 64% is allocated for future oil palm. However, we estimate that at minimum 54% of these forests are unsuitable for this crop due to inundation events. If conversion to oil palm occurs, we predict a further 16,207 ha will become commercially redundant. This means that over 32,000 ha of forest within the floodplain would have been converted for little or no financial gain yet with significant cost to the ecosystem. Our findings have globally relevant implications for similar floodplain landscapes undergoing forest transformation to agriculture such as oil palm. Understanding landscape level constraints to this crop, and transferring these into policy and practice, may provide conservation and economic opportunities within these seemingly high opportunity cost landscapes.