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Research question: Is it feasible to conduct a multicentre randomised controlled trial (RCT) to test the long-term efficacy and safety of biological matrices compared with synthetic meshes in women undergoing one-stage mesh and implant breast reconstruction as standard care. Background: The use of biological and synthetic meshes in implant-based breast reconstruction has become standard care and is the most widely used procedure in the UK. However, there is limited evidence on patient outcomes and how safe each type of mesh is in the long-term to guide patient choices and surgeon decision-making. Aims: To assess patient and clinician acceptance, recruitment rate, and compliance with randomly allocated intervention. We will evaluate completeness of data on proposed future main study outcomes. The standard deviation (SD) of patient reported ‘satisfaction with breasts’ score on Breast Q will inform sample size calculations for the main study. To inform economic evaluation of main study, we will evaluate completeness of EQ-5D-5L and recommendation of an alternative preference-based QoL measure to be used in a definitive trial. Methods: Design: Pragmatic, feasibility, randomised controlled trial. Target population: Women undergoing mastectomy for breast cancer or risk reduction and immediate one-stage breast reconstruction using implant and mesh as standard care. Randomisation: Women will be randomised to biological matrix or synthetic mesh in a 1:1 ratio. Measurement of outcomes Complications: such as infection, wound breakdown, readmission, reoperation, unplanned surgery, skin flap necrosis, implant loss, seroma, pain, capsular contracture and haematoma will be recorded at 3- and 6-months post-surgery. Patient reported outcomes: Women will complete Breast Q and EQ-5D-5L questionnaires at randomisation, 3- and 6-months post-surgery. Sample size: By recruiting 60 (out of 120) we will be able to estimate a participation rate of 50% of women offered the trial to within a 95% confidence interval of +/-9% and a completion rate of 90% (54 of 60) within a 95% confidence interval of (80%, 95%). Additionally, 60 participants will be enough to estimate the SD for sample size calculation for the main study. Timelines for delivery: Recruitment start date: 01 September 2022. Anticipated Impact and Dissemination: The BIOSYM research question has been identified as a key research gap by Association of Breast Surgery (UK). If we can demonstrate feasibility, the definitive trial will provide high quality long-term data on patient outcomes and safety of each type of mesh. Results will be published in peer-reviewed high impact journals and, with PPI partners we will produce patient-facing summaries for a lay audience. The results will inform specialist and NICE guidelines. Citation Format: Amit Goyal, Emanuele Garreffa, Robert Newcombe, Helena Harder, Janice Rose, Valerie Jenkins. BIOSYM - A Feasibility Randomised Controlled Trial Comparing Biological Matrices with Synthetic Meshes in Women Undergoing One Stage Implant Based Breast Reconstruction. ClinicalTrials.gov Identifier: NCT05449691 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-13-01.

In contemporary management theory and practice the rise and role of stakeholders as major players in organizational dynamics are widely recognized and recorded. This pluralistic view of the identity of those who have an investment and an interest in an organization extends well beyond the traditional concept of shareholders to include employees, suppliers, customers, trade unions, communities, etc. The concept of stakeholders has been applied to projects in general but has not, to date, been extended to the context of construction projects although it is accepted that the traditional view of the client as a single entity does not reflect the reality of stakeholder configurations for most projects. Different stakeholders have different levels and types of investment and interest in construction projects and can be seen as multiple clients or customers for the project in which they are involved. This paper argues that the concept of client, which has prevailed throughout the twentieth century, is now obsole...

Project managers in the construction industry increasingly seek to learn from other industrial sectors. Knowledge sharing between different contexts is thus viewed as an essential source of competitive advantage. It is important therefore for project managers from all sectors to address and develop appropriate methods of knowledge sharing. However, too often it is assumed that knowledge freely exists and can be captured and shared between contexts. Such assumptions belie complexities and problems awaiting the unsuspecting knowledge-sharing protagonist. Knowledge per se is a problematic esoteric concept that does not lend itself easily to codification. Specifically tacit knowledge possessed by individuals, presents particular methodological issues for those considering harnessing its utility in return for competitive advantage. The notion that knowledge is also embedded in specific social contexts compounds this complexity. It is argued that knowledge is highly individualistic and concomitant with the various surrounding contexts within which it is shaped and enacted. Indeed, these contexts are also shaped as a consequence of knowledge adding further complexity to the problem domain. Current methods of knowledge capture, transfer and, sharing fall short of addressing these problematic issues. Research is presented that addresses these problems and proposes an alternative method of knowledge sharing. Drawing on data and observations collected from its application, the findings clearly demonstrate the crucial role of re-contextualisation, social interaction and dialectic debate in understanding knowledge sharing.

Item does not contain fulltext BACKGROUND: Current models of the medical consultation emphasize shared decision-making (SDM), whereby the expertise of both the doctor and the patient are recognised and seen to equally contribute to the consultation. The evidence regarding the desirability and effectiveness of the SDM approach is often conflicting. It is proposed that the conflicts are due to the nature of assessment, with current assessments from the perspective of an outside observer. AIMS: To empirically assess perceived involvement in the medical consultation using the dyadic OPTION instrument. METHOD: 36 simulated medical consultations were organised between general practitioners and standardized- patients, using the observer OPTION and the newly developed dyadic OPTION instruments. RESULTS: SDM behaviours observed in the consultations were seen to depend on both members of the doctor and patient dyad, rather than each in isolation. Thus a dyadic approach to measurement is supported. CONCLUSIONS: This current study highlights the necessity for a dyadic approach to assessment and introduces a novel research instrument: the dyadic OPTION instrument.

This paper traces the evolution of two contrasting construction projects from conception to completion. The projects are presented in tandem stages, interleaved with comparative analysis of key components and contextual factors. The five components forming the basis for comparison are the purpose of the project, the project process, the people involved, the organisation structure and the project management system. The three contextual factors are the parent organisation, the project environment and the general environment. The value of comparative analysis as a technique for enhancing learning is demonstrated. The use of a global project approach with vignettes selected from various stages is also shown to be instructive.

Although reasonably well developed in the general management literature, the source and use of power in organizations has received little attention in relation to its effect on the management of construction projects. This paper reviews the literature on power and its relationship to both formal and informal authority, and its manifestation as organizational politics, and relates them to construction projects in general. Reward, coercive, expert and referent (prestige) power and the role of resources are covered in this general review. A closer examination is then made of power through a case study of the development of the Hong Kong University of Science and Technology, which identifies the positive use of power and its implications for the outcome of the project.

Theoretical concepts from the literature on organisational power are used to analyse project organisations in the construction industry which result from the adoption of different project management approaches. Two procurement paths, traditional and construction management, are compared in terms of the power bases and processes used by the project manager. It is postulated that legitimate power is weak in both cases, resulting in a power gap between the power that is given under the contract and the power needed to ensure action. The power gap is bridged under the traditional system by a sophisticated system of exchange and reciprocity using a range of ‘currencies’ which are valued by the parties. The more egalitarian atmosphere of the construction management project organisation encourages the greater use of expertise and charisma as power bases to bridge the power gap, coupled with the modern management concept of empowerment of all the parties involved, especially the newly-named specialist trades contractors. The implications of this theory of power and procurement paths for clients, project managers, project teams and researchers is hypothesised.

Glucocorticoids (GCs) compromise the ability of hippocampal neurons to survive various insults, and do so, at least in part, by exacerbating steps in the glutamate/N-methyl-D-aspartate (NMDA)/calcium cascade of damage. As evidence, GCs impair uptake of glutamate by hippocampal astrocytes, the GC endangerment of the hippocampus is NMDA receptor dependent, and GCs exacerbate kainic acid (KA)-induced calcium mobilization. These observations predict that GCs should also exacerbate KA-induced accumulation of extracellular glutamate and aspartate. To test this, adrenalectomized rats were given replacement GCs in either the low or high physiological range. Three days later, rats were anesthetized and 1 mM KA was infused through a dialysis probe placed in the dorsal hippocampus. Extracellular amino acid concentrations in the dialysate were then assessed by HPLC. After KA infusion, high-GC rats (30 ± 3 μg/dl) had significantly elevated concentrations of glutamate and aspartate compared with low-GC rats (all

Abstract —Homocysteine is a risk factor for coronary artery disease (CAD). Folic acid lowers homocysteine and may improve endothelial function in CAD, although the mechanism is unclear. We investigated the effect of folic acid on endothelial function, homocysteine, and oxidative stress in patients with CAD. We also examined the acute effect of 5-methyltetrahydrofolate (5-MTHF), the principal circulating folate, on endothelial function in vivo and on intracellular superoxide in cultured endothelial cells. A randomized crossover study of folic acid (5 mg daily) for 6 weeks was undertaken in 52 patients with CAD. Ten further patients were given intra-arterial 5-MTHF. Endothelial function was assessed by flow-mediated dilatation (FMD). Folic acid increased plasma folate ( P P P P P =0.47). In vitro, 5-MTHF abolished homocysteine-induced intracellular superoxide increase ( P

We studied data on firstborn singleton infants born to primiparous Cardiff residents during the decade 1965-1974. Both mean birth weight and gestational age at delivery fell appreciably during 1965-74. Changes in maternal age, height, smoking habits, or history of abortion did not explain these findings. The increased proportion of infants weighing less than 2500 g may be explained by the overall reduction in gestational age at delivery, which, in turn, may have resulted from increased use of elective delivery during the second quinquennium.