Understanding decision-making for and against oncoplastic breast-conserving surgery as an alternative to a mastectomy in early breast cancer: UK ANTHEM qualitative study.

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.

Consumer characteristics and preferences for mobulid gill plates in China.

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.

Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire.

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.

Axillary sentinel lymph node identification using superparamagnetic iron oxide versus radioisotope in early stage breast cancer: The UK SentiMag trial (SMART study).

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.

Can Substitutes Reduce Future Demand for Wildlife Products: A Case Study of China's Millennial Generation.

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.

Compassionate Conservation and the Challenge of Sustainable Wildlife Management: A Survey of the Urban Public of China.

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.

The Impact of Information on Attitudes toward Sustainable Wildlife Utilization and Management: A Survey of the Chinese Public.

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.

Wildlife-friendly food requires a multi-stakeholder approach to deliver landscape-scale biodiversity conservation in the Satoyama landscape of Japan.

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.

Protocol for a mixed-method study to inform the feasibility of undertaking a large-scale multicentre study comparing the clinical and patient-reported outcomes of oncoplastic breast conservation as an alternative to mastectomy with or without immediate breast reconstruction in women unsuitable for standard breast-conserving surgery (the ANTHEM Feasibility Study).

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.

What determines the success and failure of environmental crowdfunding?

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.