The Disposal Mode of Maine’s Waste Governance

Maine’s materials management system is stuck in a disposal mode of waste governance. Despite significant investments in programs and policies designed to reduce the amount of waste the state buries each year, recent shocks and uncertainties have resulted in increased waste generation and disposal. This paper analyzes specific ways through which materials management in Maine has become locked in to a disposal mode of waste governance. We build a framework to help understand various forms of lock-in and how they might be unlocked. This framework is applied to the extended producer responsibility packaging law that is presently under the rule-making process in Maine, the first state to adopt such a policy in the United States

Endocrine therapy for hormone receptor-positive metastatic breast cancer: American Society of Clinical Oncology Guideline

PURPOSE: To develop recommendations about endocrine therapy for women with hormone receptor (HR) -positive metastatic breast cancer (MBC). METHODS: The American Society of Clinical Oncology convened an Expert Panel to conduct a systematic review of evidence from 2008 through 2015 to create recommendations informed by that evidence. Outcomes of interest included sequencing of hormonal agents, hormonal agents compared with chemotherapy, targeted biologic therapy, and treatment of premenopausal women. This guideline puts forth recommendations for endocrine therapy as treatment for women with HR-positive MBC. RECOMMENDATIONS: Sequential hormone therapy is the preferential treatment for most women with HR-positive MBC. Except in cases of immediately life-threatening disease, hormone therapy, alone or in combination, should be used as initial treatment. Patients whose tumors express any level of hormone receptors should be offered hormone therapy. Treatment recommendations should be based on type of adjuvant treatment, disease-free interval, and organ function. Tumor markers should not be the sole criteria for determining tumor progression; use of additional biomarkers remains experimental. Assessment of menopausal status is critical; ovarian suppression or ablation should be included in premenopausal women. For postmenopausal women, aromatase inhibitors (AIs) are the preferred first-line endocrine therapy, with or without the cyclin-dependent kinase inhibitor palbociclib. As second-line therapy, fulvestrant should be administered at 500 mg with a loading schedule and may be administered with palbociclib. The mammalian target of rapamycin inhibitor everolimus may be administered with exemestane to postmenopausal women with MBC whose disease progresses while receiving nonsteroidal AIs. Among patients with HR-positive, human epidermal growth factor receptor 2-positive MBC, human epidermal growth factor receptor 2-targeted therapy plus an AI can be effective for those who are not chemotherapy candidates

Concert recording 2017-04-29

[Track 1]. When the children are asleep from Carousel / Richard Rogers & Oscar Hammerstein -- [Track 2]. Quartet from The secret garden / Lucy Simon -- [Track 3]. Agony from Into the woods / Stephen Sondheim -- [Track 4]. Stepsister\u27s lament from Cinderella / Rogers & Hammerstein -- [Track 5]. Only love from The scarlet pimpernel / Frank Wildhorn -- [Track 6]. Schroeder from You\u27re a good man Charlie Brown / Clark Gesner -- [Track 7]. Where in the world from The secret garden [Track 8]. How could I ever know from The secret garden / Lucy Simon -- [Track 9]. Who am I from Peter Pan / Leonard Bernstein -- [Track 10]. Some things are meant to be from Little Women / Jason Howland -- [Track 11]. With you from Ghost / Bruce Joel Rubin -- [Track 12]. When he sees me from Waitress [Track 13]. Never ever getting rid of me from Waitress / Sara Bareilles -- [Track 14]. Sepia life from Grateful / John Bucchino -- [Track 15]. Thank you for the music from Mamma mia / Benny Andersson & Björn Ulvaeus -- [Track 16]. Agony reprise from Into the woods / Stephen Sondheim -- [Track 17]. If I loved you from Carousel / Rodgers & Hammerstein

Attention bias to emotional faces varies by IQ and anxiety in Williams syndrome

Individuals with Williams syndrome (WS) often experience significant anxiety. A promising approach to anxiety intervention has emerged from cognitive studies of attention bias to threat. To investigate the utility of this intervention in WS, this study examined attention bias to happy and angry faces in individuals with WS (N=46). Results showed a significant difference in attention bias patterns as a function of IQ and anxiety. Individuals with higher IQ or higher anxiety showed a significant bias toward angry, but not happy faces, whereas individuals with lower IQ or lower anxiety showed the opposite pattern. These results suggest that attention bias interventions to modify a threat bias may be most effectively targeted to anxious individuals with WS with relatively high IQ

An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: the guiding principles

Objective: New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. Design: A formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. Results: Twelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test’s ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. Conclusion: New non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Pertuzumab in Combination with Trastuzumab and Chemotherapy in the Treatment of HER2-Positive Metastatic Breast Cancer: Safety, Efficacy, and Progression Free Survival

Tyrosine kinase inhibitors have revolutionized the oncology community and were pioneered by the use in HER2-targeted therapies. Improved outcomes were seen with the advent of trastuzumab, leading investigators to develop newer agents to target the HER2 pathway such as the novel monoclonal antibody pertuzumab. In this paper, we describe the attributes of pertuzumab including: mechanism of action, pharmacokinetics and metabolism, safety/cardiotoxicity, drug interactions, efficacy, and role in HER2-positive breast cancer management. Newly reviewed here versus previously published reviews on pertuzumab oriented therapy are data of pertuzumab monotherapy as it is used in combination with other anti-HER2 agents derived from preclinical research and ongoing clinical trials. Materials and Methods A computer based literature search was carried out using PubMed data reported at international meetings (ASCO) up to September 2013 were included

Effect of Cardiac Autonomic Balance During Sleep on Elite Cycling Performance Following Fatiguing Exercise

Heart-rate variability characterizes cardiac autonomic balance, and provides a useful index of training load exposure, and hence an estimate of cumulative physical fatigue. However, the interaction between HRV and performance is less understood. Purpose: To determine the predictive value of the Root Mean Square of Successive Differences (RMSSD) and Low to High Frequency Ratio (LF/HF) on cycling 4km TT performance following high-intensity (HI) exercise. Methods: Four elite cyclists (mountain bike (F), cyclocross (M), triathlon (M), BMX (M)) performed three successive days of 4x5 min HI cycling bouts at 260W (F), and 375 ± 21.8W (M) separated by 5-7 min of recovery between each bout. Following completion of the HI protocol, athletes rested for 30 min and then performed a 4km TT on a Cyclus 2 ergometer. HRV was recorded the evening before the TT’s between 22:00h and 23:59h using a HealthPatch (Vital Connect, Campbell CA), and areas under the curve were computed for RMSSD and LF/HF ratio. Linear regression was performed to determine the relationship between RMSSD, LF/HF ratio and TT time. Results: 4x5 min HI exercise bouts were sustained in all athletes except BMX where workload was reduced by 14% from day 1 to day 2. Progressive fatigue was evidenced by RPE’s increasing from 1km to 4km by 12.5±3.6% (Day 1) to 20.6±4.5% (Day 3). Day 1 to Day 3 data is shown in the table below; TT time TT Power RMSSD area LF/HF area Mountain bike +2.8% -9.8% -25% +46% Cyclocross +5.2% -2.4% -11% -50% Triathlon -2.9% +6.6% +29% -16% BMX -0.5% +6.5% -4% +3% RMSSD v. TT time R2 for day 1-3 respectively was, -0.39, -0.29, and -0.60 (p=0.03 for grouped days). LF/HF v. TT time R2 for day 1-3 respectively was, 0.09, 0.59, and 0.18 (p=0.06 for grouped days). Conclusion: Early sleep cycle HRV data prior to HI fatiguing cycling explains partially TT cycling performance in elite athletes

Economic Threshold for Soybean Aphid (Hemiptera: Aphididae)

Soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), reached damaging levels in 2003 and 2005 in soybean, Glycine max (L.) Merrill, in most northern U.S. states and Canadian provinces, and it has become one of the most important pests of soybean throughout the North Central region. A common experimental protocol was adopted by participants in six states who provided data from 19 yield-loss experiments conducted over a 3-yr period. Population doubling times for Þeld populations of soybean aphid averaged 6.8 d±0.8 d (mean±SEM). The average economic threshold (ET) over all control costs, market values, and yield was 273 ± 38 (mean ± 95% confidence interval [CI], range 111-567) aphids per plant. This ET provides a 7-d lead time before aphid populations are expected to exceed the economic injury level (EIL) of 674 ± 95 (mean ± 95% CI, range 275-1,399) aphids per plant. Peak aphid density in 18 of the 19 location-years occurred during soybean growth stages R3 (beginning pod formation) to R5 (full size pod) with a single data set having aphid populations peaking at R6 (full size green seed). The ET developed here is strongly supported through soybean growth stage R5. Setting an ET at lower aphid densities increases the risk to producers by treating an aphid population that is growing too slowly to exceed the EIL in 7 d, eliminates generalist predators, and exposes a larger portion of the soybean aphid population to selection by insecticides, which could lead to development of insecticide resistance