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Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. STROBE-compliant protocol ascertained CWPF outcomes between March 2011–March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. Across 15 centres, 507 patients with median age (54 years, IQR; 48–62), body mass index (25.4 kg/m2, IQR; 22.5–29), tumour size (26 mm, IQR; 18–35), and specimen weight (62 g, IQR; 40–92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11–39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes. This is the analysis of the largest aggregated cohort of patients (n=507, 2011-2021, 15 UK centres) undergoing partial breast reconstruction with a pedicled chest wall perforator flap to avoid deformity following breast conservation. Data demonstrates its applicability in T1-T2 tumours (median size,26 mm, IQR;18-35) with re-excision rates of 15.9 (7.5% during the planned second stage) and 1.8% completion mastectomy. Postoperative complication rates were 4.3% haematoma, 4.3% wound infection, 2.8% delayed wound healing, and 0.2% total flap loss. This study demonstrates that CWPF is a valuable option for patients with a higher tumour-to-breast volume ratio who wish to pursue breast-conserving surgery. [Display omitted] • PartBreCon study : A retrospective cohort study of partial breast reconstruction. • 15 centres, n = 507; T2 (26 mm), Breast conservation in 73.4% A-C cups, BMI (25.4). • Chest Wall Perforator Flaps - LiCAP (54%), AiCAP (19%), LiCAP-LTAP (20%), TDAP (2%). • Shows acceptable complications (12%) - re-operations (2.6%), flap loss (0.6%). • Low Mastectomy (2%) & Low Symmetrisation (1%); FU (23 m), local recurrence (1%). [ABSTRACT FROM AUTHOR]

In the West, Islam has been historically 'othered' as a religion and frequently linked to negative media representation, terrorism, and fundamentalism. As the aftermath of 9/11 witnessed a global rise in anti-Muslim rhetoric and action, there was a parallel increase in academic research on the Muslim community, including adults, youth, and children. In this paper, a systematic literature review was undertaken to explore how empirical studies over the last two decades have investigated experiences of growing up as young Muslims in an age of Islamophobia. Based on objective inclusion and exclusion criteria, pertinent databases were searched for research with contextual, temporal, topical relevance. NVivo Plus software was used for content-coding, quantitative processing, and qualitative thematic analyses of data. A rigorous screening process resulted in the identification, compilation, and methodical review of 87 journal articles, between 2001 - 2021, on the topic 'Islamophobia and Young Muslims.' The descriptive analysis represented that there has been a substantial increase in empirical studies on young Muslims in the last five years, particularly in the field of educational studies. A majority of these studies covered experiences of adolescent Muslims, between 13-20 years, residing in western countries like U.K., U.S.A., and Australia. Qualitative research designs were frequently employed, with a sample size of >50 participants. Through the word-count frequency output of NVivo, four meaningful and recurrent themes of 'Islamophobia', 'Identity', 'School', and 'Women' were derived. Content analysis of these themes revealed that studies widely researched on diverse interpretations of Islamophobia in the lives of young Muslims, identity negotiation strategies adopted by Muslim minority youth, school-based religious bullying, and gendered facets of Islamophobia. Research gaps showed a requirement for studies that capture heterogeneous narratives of Muslim youth in non-western countries and early childhood settings. Future research recommendations are of a unique child or youth-based theoretical conceptualization of Islamophobia, that particularly highlights youth perspectives of their own lived realities. [ABSTRACT FROM AUTHOR]

The application of the kerma-area product (P KA) meter is increased rapidly in dosimetry. This study presents measurements of P KA in adherence to the International Atomic Energy Agency protocol for 300 adult patients in digital radiographic procedures. Effective doses (ED) were calculated from P KA measurements and conversion coefficients (E-103/ P KA) obtained from the International Commission on radiological protection 103. In skull posteroanterior (PA), skull lateral (LAT), cervical spine anteroposterior (AP), cervical spine LAT, chest PA, abdomen AP, lumbar spine AP, pelvis AP and lumbar spine LAT, the third-quartile P KA values were found to be 0.2, 0.28, 0.33, 0.19, 0.26, 0.95, 0.93, 0.96 and 3.15 Gycm2, and estimated mean EDs were 0.005, 0.008, 0.056, 0.021, 0.037, 0.146, 0.165, 0.097 and 0.258 mSv, respectively. The third-quartile P KA values were suggested as local diagnostic reference levels (LDRLs). Results were compared with the diagnostic reference levels (DRLs) of the UK, the European Commission, previously published LDRLs in Greece and China by Metaxas et al. and Zhang and Chu, respectively. The P KA (third-quartile) value for cervical spine AP was 120% higher than UK 2010 DRLs, lumbar spine LAT was 123% higher than LDRLs given by Metaxas et al. and chest PA was 160% higher than UK 2010 DRLs and 225% higher than Metaxas et al. provided LDRLs. The P KA results were lower than the UK, and two studies in Greece by Metaxas et al. except for chest PA, cervical spine AP and lumbar spine LAT showed the need for further optimization. The LDRLs reported in this study may further contribute to establishing future national DRLs. [ABSTRACT FROM AUTHOR]

The British colonial regime in India was heavily dependent on the Indian Army, whose rank and file were Indians but whose officers were British. Despite the apathy of the Indian populace and the hostility of the Indian political parties, the Indian Army remained loyal to its colonial masters during World War II. This article examines the extent of that loyalty and the reasons behind it. Focusing principally on the Indian units that fought in Burma, it analyzes combat motivation and loyalty throughout the war. The article also considers the British elite's concern about the Indian soldiers' loyalty and whether it would change during postwar demobilization. [ABSTRACT FROM AUTHOR]

Introduction: Many patients with diabetes may require high-dose insulin treatment to achieve target HbA1c level, but the prevalence, disease burden, and patient characteristics of the population remain unclear. We therefore investigated people with insulin-treated diabetes in the UK from 2009 to 2013, who were prescribed high daily doses (> 200 units/day).Methods: A retrospective analysis was conducted using the UK primary care electronic dataset from the Clinical Practice Research Datalink (CPRD). Trends of demographics, insulin dose, clinical characteristics, and annualized incidence rate of the insulin initiators were analyzed. Patients with type 1 (T1D) or type 2 diabetes (T2D) and who were prescribed insulin between 2009 and 2013 were categorized into either a low- or high-dose insulin user group. Two-sample t test and chi-square test were used for comparison of continuous variables and categorical variables, respectively. A multivariable negative binomial regression analysis with (log) person time as an offset was used to assess the impact of different covariates on incidence of high-dose insulin initiation.Results: Between 2009 and 2013, 19,631 patients with diabetes were treated with insulin (T1DM, 7620; T2DM, 12,011). In 2013, 415 high-dose insulin initiators were identified (T1DM, N = 170; T2DM, N = 245). More than half were male (T1DM/T2DM, 62.4%/56.3%) and 94.1%/83.7% of T1DM/T2DM patients were prescribed an insulin analogue at high-dose insulin initiation. At 6 months, 43.6% of T1DM and 42.6% of T2DM remained to have suboptimal HbA1c level of ≥ 8% (64 mmol/mol). Overall, 15.9%/63.3% of high-dose insulin initiators (HDII) with T1DM/T2DM took oral antidiabetics. From 2009 to 2013, the estimated glomerular filtration rate worsened in both T1DM and T2DM HDII.Conclusion: Despite a number of patients requiring high doses of insulin in the UK, achievement of optimal HbA1c levels remains poor. Early identification of HDII is important in order to plan for alternative/adjuvant antidiabetic and lifestyle strategies to achieve optimal glycemic targets in this patient group.Funding: Eli Lilly and Company. [ABSTRACT FROM AUTHOR]

Eating out has been linked to the current obesity epidemic, but the evaluation of the extent to which out of home (OH) dietary intakes are different from those at home (AH) is limited. Data collected among 8849 men and 14 277 women aged 35-64 years from the general population of eleven European countries through 24-h dietary recalls or food diaries were analysed to: (1) compare food consumption OH to those AH; (2) describe the characteristics of substantial OH eaters, defined as those who consumed 25% or more of their total daily energy intake at OH locations. Logistic regression models were fit to identify personal characteristics associated with eating out. In both sexes, beverages, sugar, desserts, sweet and savoury bakery products were consumed more OH than AH. In some countries, men reported higher intakes of fish OH than AH. Overall, substantial OH eating was more common among men, the younger and the more educated participants, but was weakly associated with total energy intake. The substantial OH eaters reported similar dietary intakes OH and AH. Individuals who were not identified as substantial OH eaters reported consuming proportionally higher quantities of sweet and savoury bakery products, soft drinks, juices and other non-alcoholic beverages OH than AH. The OH intakes were different from the AH ones, only among individuals who reported a relatively small contribution of OH eating to their daily intakes and this may partly explain the inconsistent findings relating eating out to the current obesity epidemic. [ABSTRACT FROM AUTHOR]

In 1914, the Indian Army was deployed against the enemies of the British Empire. This paper analyses the administrative mechanism as well as the imperial assumptions and attitudes which shaped the recruitment policy of the Indian Army during the First World War. From the late nineteenth century, the Martial Race theory (a bundle of contradictory ideas) shaped the recruitment policy. With certain modifications, this theory remained operational to the first decade of the twentieth century. The construction of the ‘martial races’ enabled the British to play-off different communities against each other to prevent the emergence of a unified anti-British sentiment among the colonized. During the Great War, faced with the rising demands of manpower, the army was forced to modify the Martial Race theory. However, a conscript army did not emerge in British-India. This was due to imperial policies, the inherent social divisions of Indian society, and because the demands for military manpower remained relatively low in comparison to India's demographic resources. Due to innovations in the theory and praxis of recruitment, the volume of recruitment showed a linear increase from 1914 to 1918, with maximum intensification of recruitment occurring during 1917 and 1918. But as the war ended in November 1918, despite the entry of several new communities, the bulk of the Indian Army still came from the traditional martial races. [ABSTRACT FROM PUBLISHER]

Towards the end of World War II, the morale of British units stationed in Burma and India was on a downslide. In contrast, the morale of Indian units was quite high. In fact, after the 1943 Arakan Campaign, the morale of Indian units rose slowly but steadily. The morale and discipline of Indian troops are also compared and contrasted with another colonial army: the African troops. By making a comparative study of the Commonwealth troops deployed in Burma and India, this paper attempts to show how and why the contours of morale and discipline changed among the various groups of troops at different times. The study of morale and discipline of the troops deployed in these two regions represents two extreme conditions: while Burma remained a war front, India did not experience any actual warfare except for some skirmishes with Indus tribes at the northwest frontier. In general, bad discipline is partly responsible for bad morale and vice versa, which adversely affects the fighting power of armies. This turns to the issue of ‘why do men fight’? The ‘will to war’ is directly proportional to good discipline and strong morale amongst troops. This paper will look for the causative factors shaping discipline and morale of both metropolitan and colonial soldiers, based mainly on military intelligence reports on morale. We will see that rather than grand ideas like nationalism and anti-fascism, mundane factors like the supply of good rations, access to sex and service conditions, influence the morale and discipline of soldiers, and hence their combat-worthiness. [ABSTRACT FROM AUTHOR]

Britain and the Government of India embarked on the campaign in Mesopotamia for several reasons. The discovery of oil in south Persia in 1901 resulted in the formation of the Anglo-Persian Oil Company. The oil produced from this company was supplied to the Royal Navy. Germany's plan to construct a railway from Constantinople to Baghdad and Basra send tremors at London and Delhi. Germany's attempt to operate behind the facade of Turkish and Persian intrigues threatened the Anglo-Persian Oil Company's pipeline at the island of Abadan, the oilfields and the refineries. Britain was afraid that the Germans might instigate the Arab tribes to revolt. Further, capture of Basra by a hostile power would threaten Britain's sea lines of communication between Egypt and India. Logistics to a great extent had determined the texture of campaign in Mesopotamia. The logistical aspect of the Mesopotamia campaign during the Great War is yet to be studied thoroughly. The issue of supplying the British and Indian units in Mesopotamia proved crucial in shaping the course of the campaign. The first half of the paper shows how the problems of maintaining the units accelerated the disaster at Kut in April 1916. And the next section highlights the organizational restructuring of the logistical affairs which enabled the British and the Indian authorities to maintain larger number of troops with greater effectiveness from late 1916 onwards. [ABSTRACT FROM AUTHOR]

In 2019, 585 000 children in England were homeless or at risk of becoming homeless. The pressure of the COVID-19 pandemic on the health-care delivery system has amplified the inequalities faced by marginalised children. Although the UK has had a series of successful health sector reforms, few have designed or implemented strategies that target reach, access, and use of public health services for marginalised children. This project aims to identify such strategies by exploring solutions used in low-income and middle-income countries (LMICs), through reverse-innovation. We undertook a systematic review of the literature published in English from PubMed, MEDLINE, and SCOPUS between Jan 1, 2010, and March 31, 2021. We explored the literature focusing on policy, strategy, intervention, and services, using keywords and Medical Subject Headings corresponding to the target population, and medical, health, and nutrition services including preventive and immunisation services, and outcomes. Our target population included homeless and marginalised children. We defined marginality in terms of social distances following Braun and Gatzweiler (2013). We included in our search homelessness, temporary accommodation (eg, makeshift accommodation, emergency shelter, and feral), the conditions that put a child at risk of homelessness (eg, war, battle, conflict, refugee, displaced, and migrant), and the general conditions of social distances (eg, poverty, and financial catastrophe) that do not belong to discrimination. We used the Arksey O'Malley framework with Levene's extension in the aforementioned databases and Google Scholar to improve inclusivity. The primary outcomes included access, coverage, and utilisation of child health and nutrition services. The impact measurements included morbidity, mortality, and economic outcomes (return on investment, cost, and efficiency). We applied natural language processing for thematic analysis of qualitative evidence. The analysis was assisted by Python (v3.7.12). We found 53 final articles (47 quantitative and six qualitative) from LMICs. Community-focused and financial interventions were successful in different settings. Financial interventions such as user-fee removal increased health care and service use between 15–309%. Cash transfers increased immunisation coverage, financial security, and nutrition. Mobile health services and the individualised tactics of community midwives and volunteers improved the coverage and use of child health and nutrition services. Community-based savings groups, user-fee removal, and cash transfer policies improved access and utilisation. mHealth applications and capacity building of health workforce increased coverage and quality of these services and improved clinic attendance. UK policy makers could adapt and adopt targeted and conditional cash transfer policies to provide greater financial security to homeless families and make child health care more affordable and inclusive. Volunteer and mobile-clinic-based community services would increase access and use of these services in the COVID-19 recovery phase. Our review may have missed matured strategies published before 2010. We were unable to estimate a pooled effect. ESRC, UK Research and Innovation rapid response COVID 19. [ABSTRACT FROM AUTHOR]

Both radioactive and magnetic nodes identified in 103 patients; only hot nodes in 3 patients; magnetic only in 2 patients. Overall LN retrieval rate was 1.86 nodes per patient; 1.75 and 1.79 nodes per patient with magnetic and standard techniques respectively. Concordance rate per patient was 97.1% (CI 91.85-99.38%; P<0.0001); reverse concordance per patient was 98% (CI93.14-99.74%; P<0.0001). [Extracted from the article]

The ordnance establishment of British India was rightly regarded as the fourth arm of defence by the British. Especially after the 1857 mutiny, they understood that fire-power generated by the artillery and advanced small arms actually led to victory against numerically superior 'rebels'. Instead of depending on imports from Britain, which were not only time-consuming, but costly and also intermittent, the colonial state decided to lay the foundation of an industrial base for manufacturing military stores. This was in anticipation of future military threats. Neverthless, several factors hampered the expansion and modernization of the arms and munitions factories. This article, based on some hitherto unused sources, is the first attempt to chart the evolution of the ordnance factories until the Great War. [ABSTRACT FROM AUTHOR]

Explores how museums deal with the chapter of disability and disabled people. Museum professionals' tendency to do whatever is the bare minimum to make themselves appear consistent with the prevailing social norms; Hastily prepared package of measures to boost disability rights in Great Britain; Disabled-access provisions; Observations about museum accessibility in India, Denmark and Great Britain.

Aim: To evaluate the safety, usefulness, and outcome of Magseed localisation for surgery of non-palpable breast lesions in a non-experimental setting.Materials and Methods: An audit was undertaken of a prospectively maintained database of patients who had undergone breast surgery under Magseed guidance in two high-volume institutions in the UK. Patients were selected for Magseed localisation depending on service convenience. Wire localisations were used in other patients in accordance with previous normal practice. One hundred and thirty-nine Magseed localisaton procedures were performed between September 2017 and March 2019. Data were collected on age, body mass index, size, bra cup size, weight of specimen, surgery, histology, re-excision rate, and time and mode of insertion of seeds.Results: A total of 137 patients had Magseed localisation with a total of 139 seeds. Sixteen patients had a diagnostic procedure and 121 had therapeutic surgery. The distribution of procedures were similar between the two institutes (n=63 and n=74). Mean age was 60 (range 28-81) years. The majority of seeds were placed under ultrasound guidance (n=112) and 25 lesions were targeted under stereo guidance. Mean size of the lesions was 15.2 (range 1-85) mm. The mean weight of the specimen was 75.5 (range 2-1,900) g. The mean body mass index was 30.56 (range 18.1-48.3). All Magseeds and index lesions were retrieved. The re-excision rate for patients who underwent therapeutic surgery was 14.8% (n=18).Conclusion: The Magseed localisation technique of non-palpable breast lesions is a safe, easy procedure, and comes with the advantage of better utilisation of theatre and radiology resources. The re-excision rate in this series is lower than the national average. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • SLNB is a robust technique for assessment of lymphatic spread in early breast cancer • The standard technique uses radioisotope (Tc-99), blue dye or a combination of both • It has limitations like legislation, radiation exposure and allergy to the blue dye • Our study shows that the magnetic technique is a feasible method for SLNB • The SLN identification rate is not inferior to the standard technique [ABSTRACT FROM AUTHOR]

The article features Panchanan Mitra, the first professor of anthropology in India. He was born in Kolkata on May 24, 1892. He had received many distinctions in his life including being the first Indian to obtain a degree in Philosophy from Yale University in Connecticut. Several works published by Mitra include "Prehistoric India," "History of American Anthropology" and "Indo-Polynesian Memories." He also won the Fellowship of the Royal Anthropological Institute of Great Britain and Ireland.

Evidence shows that yoga has several health benefits including the management of stress and possibly hypertension. The popularity of yoga is growing in the UK, but it is mostly unregulated with little information available about yoga providers and their sessions and students. This study aimed to explore who is providing yoga; what sessions are available, where and at what cost; and who attends these sessions in the UK. A web-based, anonymous, cross-sectional survey was undertaken, using Jisc Online Surveys, in March 3–Sept 3, 2020, among yoga providers in the UK. Participants were eligible if they were at least 18 years old and delivered a yoga session at least once in a fortnight during the past 6 months in the UK. Participants were approached through four major yoga associations in the UK. 407 yoga providers (335 teachers and 67 therapists) participated. Most providers were female (93%, n=379), White (93%, n=378), and aged 45–64 years (69%, n=280). Providers delivered a mean of 4·5 (SD 3·34) group sessions and 2·8 (2·58) one-to-one sessions per week, and the mean group size was 12·2 (7·94). 80% (n=326) of providers delivered evening sessions, and 25% (n=104) weekend sessions. The most common styles reported were Hatha (28%, n=172) and Iyengar (26%, n=162). Sessions had a varying emphasis on different yogic practices, but 59% (n=242) of providers allocated most time to yogic poses, 18% (n=72) to breathing practices, and 12% (n=50) to meditation and relaxation practices. Sessions were available in all the Office for National Statistics regions of the UK. The mean cost was £7·64 (SD £3·46) per group session and £39·71 (14·78) per one-to-one session. 73% (n=299) of providers reported that students disclosed their health conditions; the most common was mental health issues (41%, n=166) followed by hypertension (25%, n=103). 87% (n=356) of providers received training on hypertension and 46% (n=186) reported a need for further training. To the best of our knowledge, this is the first study in the UK providing information about yoga providers and their sessions and students. Yoga sessions are heterogeneous in the UK but there is more focus on yogic poses. People with hypertension attend these sessions, and there is a perceived need for more training on hypertension among providers. GN is a PhD student, funded by the Ministry of National Education of Turkey. This research is a part of her PhD project. [ABSTRACT FROM AUTHOR]

Two letters to the editor in response to an article presenting a case report of yew tree poisoning by Jones et al. published in the April 2011 issue and a reply by the authors to this are presented.