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ObjectiveTo quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment.Setting(1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.Participants485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.Outcome measuresThe shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.MethodsDistances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test.ResultsTARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).ConclusionsThe use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.Trial registration numberISRCTN34086741; Post-results.

The crisis of 2008 was a watershed event for the study of finance and society. There was the boom in financial markets that came to a head with the collapse of Lehman Brothers, and there was the boom in financial scholarship that followed in its wake. But what comes after this second boom? After more than decade of rapid expansion under the shadow of 2008, what comes next for the new finance studies? What are the emerging debates that matter most? Where lies the need for further theorisation and for new empirical work? In this editorial, these questions are pursued under three broad headings, each corresponding to an overarching imperative: first, the need to keep a vigilant watch on the core institutions and logics of finance; second, the need to continue expanding and deepening the field; and third, the need to persist with difficult lines of questioning.

Objective This study combines population changes in hormone therapy (HT) use with reported relative risks to estimate directly the impact of reductions in HT use on US breast cancer incidence. Methods Using breast cancer incidence rates and prevalence estimates of HT use, the breast cancer incidence in HT users and non-users was derived. Attributable fraction calculations used risk data from the Million Women Survey (MWS), Collins' meta-analysis (CMA), and the initial or later data from the Women's Health Initiative (WHI) study. Results Between 2000 and 2005, HT use fell from 25.0 to 11.3%. The reported breast cancer incidence (in women aged 40-79) fell 8.8%. Derived incidence rates among non-users of HT remained unchanged (MWS or later WHI data) or slightly lower (initial WHI and CMA data), suggesting reductions in incidence are almost entirely (MWS or later WHI data) or partially (initial WHI or CMA data) due to reduced HT use. Conclusion Changes in reported breast cancer incidence may be partially or largely explained by changes in HT use in the US population.

The financial crisis of 2007-8 sparked a variety of responses from elites and popular movements across the world. Its legacy also continues to shape capitalist societies through ongoing processes of regulatory reform, state restructuring, and financial innovation. While these processes are open-ended, they are increasingly subject to critical attention from a range of commentators. The usual suspects are out in force - academics, politicians, and pundits - but they are now joined by a wider array of theorists and activists, playwrights, novelists and artists. The financialisation of capitalism, it seems, has finally been met with a blooming of the financial imagination. Finance and Society will provide a space for the further development of this imagination, generating new insights into how money and finance organise social life.

Patients often ask how population risk data apply to them. This analysis will help doctors to answer that question for women considering hormone replacement therapy

Both Meillassoux's admirers and his detractors tend to agree on the scientistic interpretation of his work (an interpretation that reaches an apogee in Matt Spencer's argument that After Finitude can support climate science).4 The flip side of the coin is that Meillassoux's philosophy has been treated to scarcely any attention from a political perspective. Since part of the appeal of speculative realism derives from its promise to disentangle metaphysics from the political determinations evident in much continental philosophy, to read politics into Meillassoux's work seems to run counter to the whole spirit of the enterprise. First was the regime of the cosmological symbol where, after the dissolution of myth by early natural philosophy, Plato tried to reconcile value and being by inscribing justice into the eternal Ideas. [...]was the birth of the romantic symbol in response to the blow dealt to the cosmological symbol by Newton with his description of planetary orbits in a linear, clockwork motion. [...]the overly scientistic reading of Meillassoux's work runs aground on Meillassoux's conspicuous lack of proof for the point which would secure his reputation as a stalwart of scientific realism.

The 2013 Breast Cancer Campaign gap analysis established breast cancer research priorities without a specific focus on surgical research or the role of surgeons on breast cancer research. This Review aims to identify opportunities and priorities for research in breast surgery to complement the 2013 gap analysis. To identify these goals, research-active breast surgeons met and identified areas for breast surgery research that mapped to the patient pathway. Areas included diagnosis, neoadjuvant treatment, surgery, adjuvant therapy, and attention to special groups (eg, those receiving risk-reducing surgery). Section leads were identified based on research interests, with invited input from experts in specific areas, supported by consultation with members of the Association of Breast Surgery and Independent Cancer Patients' Voice groups. The document was iteratively modified until participants were satisfied that key priorities for surgical research were clear. Key research gaps included issues surrounding overdiagnosis and treatment; optimising treatment options and their selection for neoadjuvant therapies and subsequent surgery; reducing rates of re-operations for breast-conserving surgery; generating evidence for clinical effectiveness and cost-effectiveness of breast reconstruction, and mechanisms for assessing novel interventions; establishing optimal axillary management, especially post-neoadjuvant treatment; and defining and standardising indications for risk-reducing surgery. We propose strategies for resolving these knowledge gaps. Surgeons are ideally placed for a central role in breast cancer research and should foster a culture of engagement and participation in research to benefit patients and health-care systems. Development of infrastructure and surgical research capacity, together with appropriate allocation of research funding, is needed to successfully address the key clinical and translational research gaps that are highlighted in this Review within the next two decades.

Leon Wansleben’s new book, The Rise of Central Banks , explains how central banks have emerged as powerful monetary governors over the past half-century. Yet the book’s recognition that central banks cannot extricate themselves from quantitative easing and market bailouts begs the question: what does it mean for central banks to be dominant but captive? In this commentary, I identify the book’s ambiguities with the concept of infrastructural power the book draws from Michael Mann. Unless the dynamics of state-market interdependence are well specified, giving due attention to the sources of both public and private power, it is unclear what kind of agency central bankers are exercising if they lack sufficient autonomy to act in the public interest.

This chapter makes the case for a social studies of financial regulation taking inspiration from science and technology studies. Acknowledging that the regulatory field poses challenges for ethnographic and qualitative research, the chapter presents three methodological lessons to help guide scholarship in this area. First, listen to the actors. While it is tempting to adopt a hermeneutics of suspicion when interpreting the actions and statements of financial regulators, there is more to gain by understanding the practical metaphysics of their work. Second, models matter. It is a well-established principle in finance studies that it is worth attending to non-human \"actors.\" However, following the evolution of modeling and evaluation practices at the regulatory level can loosen up overly rigid categorical distinctions between public and private governance. Third, discover the macro in the micro. Just as the social studies of finance has succeeded in identifying short circuits between technical details and legal minutia with large-scale infrastructural developments, so too should the social studies of financial regulation remain open to interactions within and across a multitude of different \"scales.\"