Adjuvant chemotherapy and survival among patients 70 years of age and younger with node-negative breast cancer and the 21-gene recurrence score of 26-30

BACKGROUND: The benefits of chemotherapy in node-negative, hormone receptor-positive, and human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients with the 21-gene recurrence score (RS) of 18-30, particularly those with RS 26-30, are not known. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) data, we retrospectively identified 29,137 breast cancer patients with the 21-gene RS of 18-30 diagnosed between 2004 and 2015. Mortality risks according to the RS and chemotherapy use were compared by the Kaplan-Meier method and Cox\u27s proportional hazards model. RESULTS: Among the breast cancer patients with the RS 18-30, 21% of them had RS 26-30. Compared to breast cancer patients with RS 18-25, patients with RS 26-30 had more aggressive tumor characteristics and chemotherapy use and increased risk of breast cancer-specific mortality and overall mortality. In breast cancer patients who were aged ≤ 70 years and had RS of 26-30, chemotherapy administration was associated with a 32% lower risk of breast cancer-specific mortality (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.47-0.99) and a 42% lower risk of overall mortality (HR, 0.58; 95% CI, 0.44-0.76). Survival benefits were most pronounced in breast cancer patients who were younger or had grade III tumor. CONCLUSIONS: The 21-gene RS of 18-30 showed heterogeneous outcomes, and the RS 26-30 was a significant prognostic factor for an increased risk of mortality. Adjuvant chemotherapy could improve the survival of node-negative, hormone receptor-positive, and HER2-negative breast cancer patients with the 21-gene RS 26-30 and should be considered for patients, especially younger patients or patients with high-grade tumors

Integrating Smart Ceiling Fans and Communicating Thermostats to Provide Energy-Efficient Comfort

The project goal was to identify and test the integration of smart ceiling fans and communicating thermostats. These highly efficient ceiling fans use as much power as an LED light bulb and have onboard temperature and occupancy sensors for automatic operationbased on space conditions. The Center for the Environment (CBE) at UC Berkeley led the research team including TRC, Association for Energy Affordability (AEA), and Big Ass Fans (BAF). The research team conducted laboratory tests, installed99 ceiling fans and 12 thermostats in four affordable multifamily housing sites in California’s Central Valley, interviewed stakeholders to develop a case study, developed an online design tool and design guide, outlined codes and standards outreach, and published several papers.The project team raised indoor cooling temperature setpoints and used ceiling fans as the first stage of cooling; this sequencing of ceiling fans and air conditioningreducesenergy consumption, especially during peak periods, while providing thermal comfort.The field demonstration resulted in 39% measured compressor energy savings during the April–October cooling seasoncompared to baseline conditions, normalized for floor area. Weather-normalized energy use varied from a 36% increase to 71% savings, withmedian savings of 15%.This variability reflects the diversity in buildings, mechanical systems, prior operation settings, space types, andoccupants’ schedules,preferences, and motivations. All commercial spaces with regular occupancy schedules (and twoof the irregularly-occupied commercial spaces and one of the homes) showed energy savings on an absolute basis before normalizing for warmer intervention temperatures,and 10 of 13 sites showed energy savings on a weather-normalized basis. The ceiling fans provided cooling for one site for months during hot weather when the coolingequipment failed.Occupants reported high satisfaction with the ceiling fans and improved thermal comfort. This technology can apply to new and retrofit residential and commercial buildings

Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: Guidelines for their use

The Glasgow Outcome Scale (GOS) is the most widely used outcome measure after traumatic brain injury, but it is increasingly recognized to have important limitations. It is proposed that shortcomings of the GOS can be addressed by adopting a standard format for the interview used to assign outcome. A set of guidelines are outlined that are directed at the main problems encountered in applying the GOS. The guidelines cover the general principles underlying the use of the GOS and common practical problems of applying the scale. Structured interview schedules are described for both the five-point GOS and an extended eight-point GOS (GOSE). An interrater reliability study of the structured interviews for the GOS and GOSE yielded weighted kappa values of 0.89 and 0.85, respectively. It is concluded that assessment of the GOS using a standard format with a written protocol is practical and reliable

Optimizing Radiant Systems for Energy Efficiency and Comfort

Radiant cooling and heating systems provide an opportunity to achieve significant energy savings, peak demand reduction, load shifting, and thermal comfort improvements compared to conventional all-air systems. As a result, application of these systems has increased in recent years, particularly in zero-net-energy (ZNE) and other advanced low-energy buildings. Despite this growth, completed installations to date have demonstrated that controls and operation of radiant systems can be challenging due to a lack of familiarity within the heating, ventilation, and air-conditioning (HVAC) design and operations professions, often involving new concepts (particularly related to the slow response in high thermal mass radiant systems). To achieve the significant reductions in building energy use proposed by California Public Utilities Commission’s (CPUC’s) Energy Efficiency Strategic Plan that all new non-residential buildings be ZNE by 2030, it is critical that new technologies that will play a major role in reaching this goal be applied in an effective manner. This final report describes the results of a comprehensive multi-faceted research project that was undertaken to address these needed enhancements to radiant technology by developing the following: (1) sizing and operation tools (currently unavailable on the market) to provide reliable methods to take full advantage of the radiant systems to provide improved energy performance while maintaining comfortable conditions, (2) energy, cost, and occupant comfort data to provide real world examples of energy efficient, affordable, and comfortable buildings using radiant systems, and (3) Title-24 and ASHRAE Standards advancements to enhance the building industry’s ability to achieve significant energy efficiency goals in California with radiant systems. The research team used a combination of full-scale fundamental laboratory experiments, whole-building energy simulations and simplified tool development, and detailed field studies and control demonstrations to assemble the new information, guidance and tools necessary to help the building industry achieve significant energy efficiency goals for radiant systems in California

Axial Disease in Psoriatic Arthritis study:defining the clinical and radiographic phenotype of psoriatic spondyloarthritis

OBJECTIVES: To compare the prevalence, clinical and radiographic characteristics of psoriatic spondyloarthritis (PsSpA) in psoriatic arthritis (PsA), with ankylosing spondylitis (AS).METHODS: A prospective single-centre cross-sectional observational study recruited consecutive PsA and AS cases. Participants completed outcome measures, and underwent clinical examination, axial radiographic scoring and HLA-sequencing. Multivariable analyses are presented.RESULTS: The 402 enrolled cases (201 PsA, 201 AS; fulfilling classification criteria for respective conditions) were reclassified based upon radiographic axial disease and psoriasis, as: 118 PsSpA, 127 peripheral-only PsA (pPsA), and 157 AS without psoriasis (AS) cases. A significant proportion of patients with radiographic axial disease had PsSpA (118/275; 42.91%), and often had symptomatically silent axial disease (30/118; 25.42%). Modified New York criteria for AS were fulfilled by 48/201 (23.88%) PsA cases, and Classification of Psoriatic Arthritis criteria by 49/201 (24.38%) AS cases. pPsA compared with PsSpA cases had a lower frequency of HLA-B*27 (OR 0.12; 95% CI 0.05 to 0.25). Disease activity, metrology and disability were comparable in PsSpA and AS. A significant proportion of PsSpA cases had spondylitis without sacroiliitis (39/118; 33.05%); they less frequently carried HLA-B*27 (OR 0.11; 95% CI 0.04 to 0.33). Sacroiliac joint complete ankylosis (adjusted OR, ORadj 2.96; 95% CI 1.42 to 6.15) and bridging syndesmophytes (ORadj 2.78; 95% CI 1.49 to 5.18) were more likely in AS than PsSpA. Radiographic axial disease was more severe in AS than PsSpA (Psoriatic Arthritis Spondylitis Radiology Index Score: adjusted incidence risk ratio 1.13; 95% CI 1.09 to 1.19).CONCLUSIONS: In a combined cohort of patients with either PsA or AS from a single centre, 24% fulfilled classification criteria for both conditions. The pattern of axial disease was influenced significantly by the presence of skin psoriasis and HLA-B*27.</p

A Manual for the Glasgow Outcome Scale-Extended Interview

The Glasgow Outcome Scale-Extended (GOSE) has become one of the most widely used outcome instruments to assess global disability and recovery after traumatic brain injury. Achieving consistency in the application of the assessment remains a challenge, particularly in multi-center studies involving many assessors. We present a manual for the GOSE interview that is designed to support both single- and multi-center studies and promote inter-rater agreement. Many patients fall clearly into a particular category; however, patients may have outcomes that are on the borderline between adjacent categories, and cases can present other challenges for assessment. The Manual includes the general principles of assessment, advice on administering each section of the GOSE interview, and guidance on “borderline” and “difficult” cases. Finally, we discuss the properties of the GOSE, including strengths and limitations, and outline recommendations for assessor training, accreditation, and monitoring

Next-Generation Comprehensive Data-Driven Models of Solar Eruptive Events

Solar flares and coronal mass ejections are interrelated phenomena that together are known as solar eruptive events. These are the main drivers of space weather and understanding their origins is a primary goal of Heliophysics. In this white paper, we advocate for the allocation of sufficient resources to bring together experts in observations and modeling to construct and test next generation data-driven models of solar eruptive events. We identify the key components necessary for constructing comprehensive end-to-end models including global scale 3D MHD resolving magnetic field evolution and reconnection, small scale simulations of particle acceleration in reconnection exhausts, kinetic scale transport of flare-accelerated particles into the lower solar atmosphere, and the radiative and hydrodynamics responses of the solar atmosphere to flare heating. Using this modeling framework, long-standing questions regarding how solar eruptive events release energy, accelerate particles, and heat plasma can be explored. To address open questions in solar flare physics, we recommend that NASA and NSF provide sufficient research and analysis funds to bring together a large body of researchers and numerical tools to tackle the end-to-end modeling framework that we outline. Current dedicated theory and modeling funding programs are relatively small scale and infrequent; funding agencies must recognize that modern space physics demands the use of both observations and modeling to make rapid progress.Comment: White paper submitted to the Decadal Survey for Solar and Space Physics (Heliophysics) 2024-2033; 9 pages, 4 figure

Switching the stereochemical outcome of 6-endo-trig cyclizations; Synthesis of 2,6-Cis-6-substituted 4-oxopipecolic acids

A base-mediated 6-endo-trig cyclization of readily accessible enone-derived α-amino acids has been developed for the direct synthesis of novel 2,6-cis-6- substituted-4-oxo-L-pipecolic acids. A range of aliphatic and aryl side chains were tolerated by this mild procedure to give the target compounds in good overall yields. Molecular modeling of the 6-endo-trig cyclization allowed some insight as to how these compounds were formed, with the enolate intermediate generated via an equilibrium process, followed by irreversible tautomerization/neutralization providing the driving force for product formation. Stereoselective reduction and deprotection of the resulting 2,6-cis-6-substituted 4-oxo-L-pipecolic acids to the corresponding 4-hydroxy-L-pipecolic acids was also performed

The Unusually Long Duration Gamma-ray Burst GRB 000911: Discovery of the afterglow and host galaxy

Of all the well-localized gamma-ray bursts, GRB 000911 has the longest duration (T90 = 500 s) and ranks in the top 1% of BATSE bursts for fluence. Here we report the discovery of the afterglow of this unique burst. In order to simultaneously fit our radio and optical observations, we are required to invoke a model involving a hard electron distribution, p ∼ 1.5, and a jet-break time less than 1.5 days. A spectrum of the host galaxy taken 111 days after the burst reveals a single emission line, interpreted as [011] at a redshift z = 1.0585, and a continuum break that we interpret as the Balmer limit at this redshift. Despite the long 790, the afterglow of GRB 000911 is not unusual in any other way when compared to the set of afterglows studied to date. We conclude that the duration of the GRB plays little part in determining the physics of the afterglow.P. A. P. gratefully acknowledges an Alex Rodgers Travelling Scholarship. J. S. B. gratefully acknowledges the fellowship support from the Fannie and John Hertz Foundation. K. H. is grateful for Ulysses support under JPL contract 958056, and for IPN support under the NEAR Participating Scientist program, NAG 5-9503, and under the LTSA, NAG 5-3500. The Konus/Wind experiment was supported by RFBR grant 99-02-017031 and CRDF grant RPI-2260