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Ovarian Cancer is usually diagnosed at an advanced stage. Extensive or ultra-radical surgery aims to improve the outcome by removing all visible tumour. National Institute for Health and Care Excellence UK 2013 Guidance expressed concern about its efficacy and safety, recommending research comparing complication rates, survival and quality of life with those following standard surgery. We present prospective observational data on quality of life and survival following surgery for advanced ovarian cancer. Innovative methods were used to collect patient reported outcomes and complex surgical information to compare outcomes of surgery of greater or lesser complexity used in routine practice.
Methods
A cohort study collected disease, surgical, complications, survival and quality of life data (validated instruments including EURO-QOL, EORTC-30 and OVA28) across a 2-year period in 12 United Kingdom sites and in parallel studies in Melbourne, Australia and Kolkata, India.
Results
Two hundred and sixty patients undergoing cytoreductive surgery were recruited in 12 months. Centres varied in utilisation of complex surgical procedures. Excluding patients with inoperable disease, 125 patients underwent low, 70 intermediate and 63 high Surgical Complexity Score (SCS) procedures. Complete cytoreduction with < 1cm residual disease was achieved in 100/125 (80 percent) low, 65/70 (92 percent) intermediate, and 57/63 (90 percent) high SCS groups (p = 0.023). Compliance with 12 months questionnaires was 89%. All surgical groups had improved EORTC QLC 30 Global at 12 months compared with prior to operation, with overlapping 95% confidence intervals and no between group differences at 12 months. Complications, survival and quality of life adjusted for disease burden and surgical complexity over 2 years’ follow-up will be described.
Conclusions
Results will inform the update of NICE Interventional Procedures guidance recommendations on clinical governance arrangements for ovarian cancer surgery and enable clinicians and patients to better understand the outcomes of surgery, informing the consent process.
The chapter summarises the main findings from the SDG chapters (1–17) combined with the results from a workshop in 2018 to answer the following questions: How is Agenda 2030 likely to interact with forests and people? What are the possible synergies, trade-offs between goals and targets? What are the contextual conditions that shape the interactions between SDGs and targets and subsequent impacts on forests and people? Two broad groups of SDGs emerge. One includes SDGs that primarily focus on institutional, governance and social conditions. Those contribute to an enabling environment for inclusive forest management and conservation with associated livelihood benefits. A second group of SDGs affect land use directly and thus are expected to impact forests. Progress in the first group of SDGs results in synergistic interactions and positive outcomes for forests and peoples. Among the second group of SDGs, the potential for trade-offs is high, with important repercussions for forest and people. Understanding the potential for these trade-offs is essential in order to avoid implementation pathways that favour a small subset of these SDGs at the expense of the others.
The introductory chapter introduces the Agenda 2030 and its 17 SDGs and briefly presents the process that led to its adoption. It discusses the nature of the SDGs, recognising the great variation in the nature, scope and function of the SDGs and related targets, and drawing attention to the interlinkages among the goals and targets. Forests provide ecosystem services that are crucial for human welfare and for reaching the SDGs. The chapter gives a brief overview of the world’s forests and forests’ contributions to the SDGs. Forests are only mentioned in two SDGs (SDG 6 and SDG 15). However, due to the interrelated nature of the SDGs and targets, the implementation of the SDG agenda will inevitably influence forests and forest-related livelihoods and the possibilities to achieve the forest specific targets. Understanding the potential impacts of SDGs on forests, forest-related livelihoods and forest-based options to generate progress towards achieving the SDGs, as well as the related tradeoffs and synergies, is crucial for efforts undertaken to reach these goals. It is especially important for reducing potential negative impacts and to leverage opportunities to create synergies that will ultimately determine whether comprehensive progress towards the SDGs will be accomplished.
This chapter summarises the lessons learnt in the book, based on a reflection process amongst the editors and a joint workshop with the lead authors. The key messages are that 1) forests are a crucial base for sustainable development, and need to be fully considered in all related decision making, 2) the SDGs will impact forests and the people dependent on them in many ways, with the exact impact being highly dependant on the respective ecological and socio-economic context, 3) the SDGs include partially conflicting visions for forests and people, corresponding to distinct values and interests, involving the necessity to consider trade-offs and set priorities when implementing them, 4) there are fundamental values and principles that may guide sustainable development related to forests and people regardless of the context, including basic human rights but also forest-specific aspects and principles for how existing trade-offs can be managed, 5) that there is the necessity to continuously learn from, and adapt, the process of implementing the SDGs. The chapter concludes by addressing the urgency of creative and forward-looking human engagement at the forest–people interface, to make sure that sustainable development can benefit both forests and people.
Forests provide vital ecosystem services crucial to human well-being and sustainable development, and have an important role to play in achieving the seventeen Sustainable Development Goals (SDGs) of the United Nations 2030 Agenda. Little attention, however, has yet focused on how efforts to achieve the SDGs will impact forests and forest-related livelihoods, and how these impacts may, in turn, enhance or undermine the contributions of forests to climate and development. This book discusses the conditions that influence how SDGs are implemented and prioritised, and provides a systematic, multidisciplinary global assessment of interlinkages among the SDGs and their targets, increasing understanding of potential synergies and unavoidable trade-offs between goals. Ideal for academic researchers, students and decision-makers interested in sustainable development in the context of forests, this book will provide invaluable knowledge for efforts undertaken to reach the SDGs. This title is available as Open Access via Cambridge Core.
Depression is a leading cause of disability, with older people particularly susceptible to poor outcomes.
Aims
To investigate whether the prevalence of depression and antidepressant use have changed across two decades in older people.
Method
The Cognitive Function and Ageing Studies (CFAS I and CFAS II) are two English population-based cohort studies of older people aged ≥65 years, with baseline measurements for each cohort conducted two decades apart (between 1990 and 1993 and between 2008 and 2011). Depression was assessed by the Geriatric Mental State examination and diagnosed with the Automated Geriatric Examination for Computer-Assisted Taxonomy algorithm.
Results
In CFAS I, 7635 people aged ≥65 years were interviewed, of whom 1457 were diagnostically assessed. In CFAS II, 7762 people were interviewed and diagnostically assessed. Age-standardised depression prevalence in CFAS II was 6.8% (95% CI 6.3–7.5%), representing a non-significant decline from CFAS I (risk ratio 0.82, 95% CI 0.64–1.07, P = 0.14). At the time of CFAS II, 10.7% of the population (95% CI 10.0–11.5%) were taking antidepressant medication, more than twice that of CFAS I (risk ratio 2.79, 95% CI 1.96–3.97, P < 0.0001). Among care home residents, depression prevalence was unchanged, but the use of antidepressants increased from 7.4% (95% CI 3.8–13.8%) to 29.2% (95% CI 22.6–36.7%).
Conclusions
A substantial increase in the proportion of the population reporting taking antidepressant medication is seen across two decades for people aged ≥65 years. However there was no evidence for a change in age-specific prevalence of depression.
A Bromus tectorum L. (downy brome) biotype with cross-resistance to sulfosulfuron has been identified. The resistant biotype was selected with primisulfuron in Poa pratensis L. (Kentucky bluegrass) plots near Madras, OR. The plots received two treatments of 20 g ai ha−1 primisulfuron in the fall of 1993, 1994, and 1995. In 1995, control of B. tectorum decreased and greenhouse studies confirmed that the biotype was resistant to primisulfuron. Cross-resistance to sulfosulfuron also was confirmed in greenhouse studies. Metabolism of sulfosulfuron rather than an insensitive site of action is the likely cause of the cross-resistance.
The repeated use of sulfonylurea (SU) herbicides to control broadleaf weeds in wheat fields and right-of-ways has selected for herbicide-resistant Russian thistle populations. A survey was conducted in 1991 and 1992 to ascertain the relative occurrence of SU-resistant Russian thistle in eastern Washington state. The 55 574 km2 survey area was divided into 149 equal sample areas. All sample areas were surveyed for Russian thistle and seed was collected from plants in 86 sample areas. No Russian thistle was found in the center of the remaining 63 sample areas. Seeds were collected, by plant, from 30 plants at each site. Site samples were tested in the greenhouse for resistance or susceptibility to chlorsulfuron. Populations that were either homogeneous or heterogeneous for chlorsulfuron-resistance were found in 70% of the sample areas and all of the plants were susceptible in 30% of the sample areas.
The movement of sulfonylurea herbicide-resistant (R) kochia pollen was investigated in a spring barley field near Moscow, ID, using a Nelder plot design in 1991 and 1992. Each 61 m diameter plot had 16 rays spaced 22.5° apart and contained 211 kochia plants. There were 12 susceptible (S) plants and one R plant along each ray. The R and S plants were 1.5 m and 3.0 to 30.5 m from the center of the plot, respectively. Wind direction and speed in the 16 vectors, air and soil temperature, and rainfall were monitored continuously. Mature kochia seed was collected from individual plants, planted in the greenhouse, and sprayed with chlorsulfuron to test for resistant F1 progeny. Results from the 2-yr study showed outcrossing of R pollen onto S plants at rates up to 13.1% per plant 1.5 m from the R plants and declining to 1.4% per plant or less 29 m from the R plants. At least 35% of the total R x S crosses occurred in the direction of prevailing southeastward winds. Predicted percentages of R x S crosses per plant ranged from 0.16 to 1.29 at 1.5 m, and 0.00 to 0.06% at 29 m. Thus, resistant kochia pollen can spread the sulfonylurea-resistant trait at least 30 m during each growing season.
Russian thistle plant movement and seed dispersal were studied in 1991 and 1992 by placing Russian thistle plants in the center of wheat fields in eastern Washington. Three adjacent site treatments, with 24 plants on each site, were used each year; wheat stubble, summerfallow planted to winter wheat, and a “stationary” site. Plants in the “stationary” site were anchored to the ground to prevent tumbling. Plants in the stubble and summerfallow sites were allowed to tumble naturally. Individual plant movement was monitored and recorded weekly by satellite global positioning systems technology. Average estimated seed number per plant at the beginning of the experiment was 57,400 in 1991 and 66,000 in 1992. The direction plants moved correlated highly with wind direction. Some plants moved a maximum distance of 4069 m in 6 wks, while other plants moved only 60 m because of variable winds and being compressed by snow or frozen into wheat stubble. Average percentage seed loss in 1991 and 1992 for stationary plants was 15 and 26%, and for tumbling plants was 48 and 66%, respectively.
Background: Psychological therapy services are often required to demonstrate their effectiveness and are implementing systematic monitoring of patient progress. A system for measuring patient progress might usefully ‘inform supervision’ and help patients who are not progressing in therapy. Aims: To examine if continuous monitoring of patient progress through the supervision process was more effective in improving patient outcomes compared with giving feedback to therapists alone in routine NHS psychological therapy. Method: Using a stepped wedge randomized controlled design, continuous feedback on patient progress during therapy was given either to the therapist and supervisor to be discussed in clinical supervison (MeMOS condition) or only given to the therapist (S-Sup condition). If a patient failed to progress in the MeMOS condition, an alert was triggered and sent to both the therapist and supervisor. Outcome measures were completed at beginning of therapy, end of therapy and at 6-month follow-up and session-by-session ratings. Results: No differences in clinical outcomes of patients were found between MeMOS and S-Sup conditions. Patients in the MeMOS condition were rated as improving less, and more ill. They received fewer therapy sessions. Conclusions: Most patients failed to improve in therapy at some point. Patients’ recovery was not affected by feeding back outcomes into the supervision process. Therapists rated patients in the S-Sup condition as improving more and being less ill than patients in MeMOS. Those patients in MeMOS had more complex problems.
Studies were conducted to determine the relative fitness and competitive ability of an acetolactate synthase (ALS) inhibitor–resistant (R) downy brome biotype compared with a susceptible (S) biotype. In previous research, the mechanism of resistance was determined to be an altered ALS enzyme. Seed germination of the R biotype was compared with that of the S biotype at 5, 15, and 25 C. There were no different germination characteristics between R and S biotypes at 15 and 25 C. However, the R biotype germinated 27 h earlier than the S biotype and had reached over 60% germination when the S biotype initially germinated at 5 C. Under noncompetitive greenhouse conditions, growth of the R biotype was similar to that of the S biotype on the basis of shoot dry weight, leaf area, and plant height. Seed production of the R biotype was 83%, when compared with the S biotype, but seeds of the R biotype were larger than those of the S biotype. Replacement series experiments were conducted in the greenhouse to determine the relative competitive ability of R and S biotypes. No difference in competitive ability was observed between R and S biotypes on the basis of shoot dry weight, leaf area, or plant height. Thus, it appears that ALS-resistance trait is not associated with growth penalty in either noncompetitive or competitive conditions. In the absence of ALS inhibitors, these results suggest that the R biotype would remain at a similar frequency in a population of R and S biotypes.
Observational studies report associations between early menarche and higher levels of depressive symptoms and depression. However, no studies have investigated whether this association is causal.
Aims
To determine whether earlier menarche is a causal risk factor for depressive symptoms and depression in adolescence.
Method
The associations between a genetic score for age at menarche and depressive symptoms at 14, 17 and 19 years, and depression at 18 years, were examined using Mendelian randomisation analysis techniques.
Results
Using a genetic risk score to indicate earlier timing of menarche, we found that early menarche is associated with higher levels of depressive symptoms at 14 years (odds ratio per risk allele 1.02, 95% CI 1.005–1.04, n=2404). We did not find an association between the early menarche risk score and depressive symptoms or depression after age 14.
Conclusions
Our results provide evidence for a causal effect of age at menarche on depressive symptoms at age 14.