Meat: a natural symbol

In Britain, and in cultures around the world, meat's significance extends beyond what might be anticipated from its nutritional utility. By looking at the academic and popular literature, and through a series of loosely structured interviews, this study investigates the range of ideas that people hold about meat in modem Britain for evidence as to what it is that makes animal flesh such an esteemed foodstuff. The principle conclusion is that meat's pre-eminence derives from its being a "natural" choice for human societies to use to express their control over the natural environment -a value which has long been important in Western culture. It is for this reason, for example, that we commonly relate the origins of "civilised" humanity to the beginnings of hunting or of farming, and this is likewise why meat has been a symbol of affluence, strength, and virility. Our proscription of cannibalism, our unwillingness to eat pets, and the common reference to meat in sexual symbolism, are all shown to conform to this analysis. The principle of environmental control is also shown to be a significant factor underpinning our more usual explanations of trends in the meat system. Economics; health and nutrition; ethical and religious influences; and ecological concerns, are all shown to have a significant symbolic component in addition to their overtly practical meaning

Buddhist Vegetarian Restaurants and the Changing Meanings of Meat in Urban China

This article charts the changing meanings of meat in contemporary urban China and explores the role played by Buddhist vegetarian restaurants in shaping these changes. In Kunming, meat has long been a sign of prosperity and status. Its accessibility marked the successes of the economic reforms. Yet Kunmingers were increasingly concerned about excessive meat consumption and about the safety and quality of the meat supply. Buddhist vegetarian restaurants provided spaces where people could share meat-free meals and discuss and develop their concerns about meat-eating. While similar to and influenced by secular, Western vegetarianisms, the central role of Buddhism was reflected in discourses on karmic retribution for taking life and in a non-confrontational approach that sought to accommodate these discourses with the importance of meat in Chinese social life. Finally, the vegetarian restaurants spoke to middle-class projects of self-cultivation, and by doing so potentially challenged associations between meat-eating and social status

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusion: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Cost-effective clinical pathways at The Alfred Hospital: international lessons from Bayside Health, Australia

The paper "Caring about carepaths" by Pearson and Macintosh (2001) is an interesting article for those considering the implementation of clinical pathways. The authors have attempted to describe the experiences and lessons learned in trying to introduce clinical pathways at Cairns Base Hospital (CBH). The paper is not a research report. Rather, it is a story of what was hoped to be achieved versus what actually was achieved. Hence, the term "experiment" was used in a non-technical sense. In our commentary of that paper below, we also outline our own experience in clinical pathways at The Alfred by way of comparison, drawing upon lessons learnt that may be of interest to other hospitals.</jats:p

Meat, Cannibalism and Humanity in Paul du Chaillu’s Explorations and Adventures in Equatorial Africa, or, What Does a Gorilla Hunter Eat for Breakfast?

The Victorian gorilla was the most Gothic of animals. Described by Western science only in 1847, it was brought spectacularly to public attention in 1861 by the French-American gorilla hunter Paul du Chaillu's Explorations and Adventures in Equatorial Africa. As du Chaillu described his quest for this ‘hellish dream creature’, his narrative devotes a considerable amount of space to the struggles he endured in obtaining sufficient food. Particularly, du Chaillu is obsessed with meat: how to get it, what species to eat, how, indeed, to avoid being eaten himself. This essay explores the ways in these dietary anxieties become entwined with the monstrous figure of the gorilla, and, most significantly, how du Chaillu's narrative destabilises established conceptions of the relation between meat-eating and identity