The impact of loco-regional recurrences on metastatic progression in early-stage breast cancer: a multistate model

To study whether the effects of prognostic factors associated with the occurrence of distant metastases (DM) at primary diagnosis change after the incidence of loco-regional recurrences (LRR) among women treated for invasive stage I or II breast cancer. The study population consisted of 3,601 women, enrolled in EORTC trials 10801, 10854, or 10902 treated for early-stage breast cancer. Data were analysed in a multivariate, multistate model by using multivariate Cox regression models, including a state-dependent covariate. The presence of a LRR in itself is a significant prognostic risk factor (HR: 3.64; 95%-CI: 2.02-6.5) for the occurrence of DM. Main prognostic risk factors for a DM are young age at diagnosis (</=40: HR: 1.79; 95%-CI: 1.28-2.51), larger tumour size (HR: 1.58; 95%-CI: 1.35-1.84) and node positivity (HR: 2.00; 95%-CI: 1.74-2.30). Adjuvant chemotherapy is protective for a DM (HR: 0.66; 95%-CI: 0.55-0.80). After the occurrence of a LRR the latter protective effect has disappeared (P = 0.009). The presence of LRR in itself is a significant risk factor for DM. For patients who are at risk of developing LRR, effective local control should be the main target of therapy

Frequency and Significance of Coronary Artery Disease and Myocardial Bridging in Patients With Hypertrophic Cardiomyopathy

The etiology of chest pain in hypertrophic cardiomyopathy (HC) is diverse and includes coronary artery disease (CAD) as well as HC-specific causes. Myocardial bridging (MB) has been associated with HC, chest pain, and accelerated atherosclerosis. We compared HC patients with age-, gender- and CAD pre-test probability-matched outpatients presenting with chest pain to investigate differences in the presence of MB and CAD using coronary computed tomography angiography (CCTA). We studied 84 HC patients who underwent CCTA and compared these with 168 matched controls (age 54 ± 11 years, 70% men, pre-test probability 12% [5% to 32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls. MB was more often seen in HC patients (50% vs 25%, p <0.001). Calcium score and the presence of obstructive CAD were similar in both groups (9 [0 to 225] vs 4 [0 to 82] and 18% vs 19%; p = 0.22 and p = 0.82). In the HC group, MB was associated with pathogenic DNA variants (p = 0.04), but not with the presence of chest pain (74% vs 76%, p = 0.8), nor with worse outcome (log-rank p = 0.30). In conclusion, the prevalence and extent of CAD was equal among patients with and without HC, demonstrating that pre-test risk prediction using the CAD Consortium clinical risk score performs well in HC patients. MB was twice as prevalent in the HC group compared with matched controls, but was not associated with chest pain or decreased event-free survival in these patients

Meteorological aspects of self‐initiated upward lightning at the Säntis tower (Switzerland)

Interest in exploring the meteorological conditions favoring upward lightning from tall man‐made structures has grown in recent years, largely due to the worldwide expansion of wind energy. To this end, instrumented towers existing around the world are the most suitable places to study upward lightning. In this context, an LMA network was deployed around the Säntis Mountain (northeast Switzerland) during the summer of 2017, in order to complement the long‐term measurements currently held at the Säntis telecommunications tower, a lightning hotspot in Central Europe. This campaign allowed, for the first time, to gather a comprehensive set of observations of self‐initiated upward lightning emerging from the Tower. With the help of C‐band dual‐polarimetric radar data, the present work focuses on the meteorological conditions conductive to self‐initiated upward lightning from the Säntis. The analysis revealed that the upward‐propagating positively‐charged leaders spread mostly horizontal above the melting level, after an initial short vertical path from the tower tip. After this initial stage, the majority of upward leaders were followed by a sequence of negative return strokes. The inception upward lightning under a stratiform cloud shield would be favored by the low height of the charge structure. From the obtained results, it turns out that a key feature favoring self‐initiated upward lightning would be the proximity of the tower tip to the melting level

The effect of assimilating satellite-derived soil moisture data in SiBCASA on simulated carbon fluxes in Boreal Eurasia

Boreal Eurasia is a region where the interaction between droughts and the carbon cycle may have significant impacts on the global carbon cycle. Yet the region is extremely data sparse with respect to meteorology, soil moisture, and carbon fluxes as compared to e.g. Europe. To better constrain our vegetation model SiBCASA, we increase data usage by assimilating two streams of satellite-derived soil moisture. We study whether the assimilation improved SiBCASA's soil moisture and its effect on the simulated carbon fluxes. By comparing to unique in situ soil moisture observations, we show that the passive microwave soil moisture product did not improve the soil moisture simulated by SiBCASA, but the active data seem promising in some aspects. The match between SiBCASA and ASCAT soil moisture is best in the summer months over low vegetation. Nevertheless, ASCAT failed to detect the major droughts occurring between 2007 and 2013. The performance of ASCAT soil moisture seems to be particularly sensitive to ponding, rather than to biomass. The effect on the simulated carbon fluxes is large, 5-10% on annual GPP and TER, tens of percent on local NEE, and 2% on area-integrated NEE, which is the same order of magnitude as the inter-annual variations. Consequently, this study shows that assimilation of satellite-derived soil moisture has potentially large impacts, while at the same time further research is needed to understand under which conditions the satellite-derived soil moisture improves the simulated soil moisture.Peer reviewe

The effect of assimilating satellite derived soil moisture in SiBCASA on simulated carbon fluxes in Boreal Eurasia

Boreal Eurasia is a region where the interaction between droughts and the carbon cycle may have significant impacts on the global carbon cycle. Yet the region is extremely data sparse with respect to meteorology, soil moisture and carbon fluxes as compared to e.g. Europe. To better constrain our vegetation model SiBCASA, we increase data usage by assimilating two streams of satellite derived soil moisture. We study if the assimilation improved SiBCASA's soil moisture and its effect on the simulated carbon fluxes. By comparing to unique in situ soil moisture observations, we show that the passive microwave soil moisture product did not improve the soil moisture simulated by SiBCASA, but the active data seem promising in some aspects. The match between SiBCASA and ASCAT soil moisture is best in the summer months over low vegetation. Nevertheless, ASCAT failed to detect the major droughts occurring between 2007 and 2013. The performance of ASCAT soil moisture seems to be particularly sensitive to ponding, rather than to biomass. The effect on the simulated carbon fluxes is large, 5-10% on annual GPP and TER, and tens of percent on local NEE, and 2% on area-integrated NEE, which is the same order of magnitude as the inter-annual variations. Consequently, this study shows that assimilation of satellite derived soil moisture has potentially large impacts, while at the same time further research is needed to understand under which conditions the satellite derived soil moisture improves the simulated soil moisture

Adverse Drug Reactions Related Hospital Admissions in Persons Aged 60 Years and over, The Netherlands, 1981–2007: Less Rapid Increase, Different Drugs

Background: Epidemiologic information on time trends of Adverse Drug Reactions (ADR) and ADR-related hospitalizations is scarce. Over time, pharmacotherapy has become increasingly complex. Because of raised awareness of ADR, a decrease in ADR might be expected. The aim of this study was to determine trends in ADR-related hospitalizations in the older Dutch population. Methodology and Principal Findings: Secular trend analysis of ADR-related hospital admissions in patients ≥60 years between 1981 and 2007, using the National Hospital Discharge Registry of the Netherlands. Numbers, age-specific and age-adjusted incidence rates (per 10,000 persons) of ADR-related hospital admissions were used as outcome measures in each year of the study. Between 1981 and 2007, ADR-related hospital admissions in persons ≥60 years increased by 143%. The overall standardized incidence rate increased from 23.3 to 38.3 per 10,000 older persons. The increase was larger in males than in females. Since 1997, the increase in incidence rates of ADR-related hospitalizations flattened (percentage annual change 0.65%), compared to the period 1981-1996 (percentage annual change 2.56%). Conclusion/Significance: ADR-related hospital admissions in older persons have shown a rapidly increasing trend in the Netherlands over the last three decades with a temporization since 1997. Although an encouraging flattening in the increasing trend of ADR-related admissions was found around 1997, the incidence is still rising, which warrants sustained attention to this problem

Afrikaans as Standaard Gemiddelde Europees:Wanneer ‘n lid uit sy taalarea beweeg

A recent trend in the study of Standard Average European is the extraterritorial perspective of examining the extent to which non-European languages have converged with this Sprachbund as a result of contact with one or more of its members. The present article complements this line of research in that it investigates the extent to which a European language has diverged from Standard Average European after leaving the linguistic area. The focus is on Dutch, a nuclear member of the Sprachbund, and Afrikaans, its colonial offshoot. The two languages are compared with respect to twelve of the most distinctive linguistic features of Standard Average European. Afrikaans is found to share ten of them with Dutch, including anticausative prominence and formally distinguished intensifiers and reflexives, and could therefore still be considered a core member of the Sprachbund, despite deviations in the expression of negative pronouns and the grammaticality of external possessor constructions. This relatively low degree of divergence may be attributed to the continuity from Settler Dutch to at least the variety of Afrikaans on which the standard language is based and to the important role that Dutch continued to play in the history of Afrikaans

Response of the Amazon carbon balance to the 2010 drought derived with CarbonTracker South America

Two major droughts in the past decade had large impacts on carbon exchange in the Amazon. Recent analysis of vertical profile measurements of atmospheric CO2 and CO by Gatti et al. [2014] suggests that the 2010 drought turned the normally close-to-neutral annual Amazon carbon balance into a substantial source of nearly 0.5 PgC/yr, revealing a strong drought response. In this study, we revisit this hypothesis and interpret not only the same CO2/CO vertical profile measurements, but also additional constraints on carbon exchange such as satellite observations of CO, burned area, and fire hotspots. The results from our CarbonTracker South America data assimilation system suggest that carbon uptake by vegetation was indeed reduced in 2010, but that the magnitude of the decrease strongly depends on the estimated 2010 and 2011 biomass burning emissions. We have used fire products based on burned area (GFED4), satellite-observed CO columns (IASI), fire radiative power (GFASv1) and fire hotspots (FINNv1), and found an increase in biomass burning emissions in 2010 compared to 2011 of 0.16 to 0.24 PgC/yr. We derived a decrease of biospheric uptake ranging from 0.08 to 0.26 PgC/yr, with the range determined from a set of alternative inversions using different biomass burning estimates. Our numerical analysis of the 2010 Amazon drought results in a total reduction of carbon uptake of 0.24 to 0.50 PgC/yr and turns the balance from carbon sink to source. Our findings support the suggestion that the hydrological cycle will be an important driver of future changes in Amazonian carbon exchange