Breast Cancer Subtypes Can Be Determinant in The Decision Making Process to Avoid Surgical Axillary Staging: A retrospective cohort study

Purpose: The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a lowrisk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). Methods: We retrospectively evaluated 612 consecutive women affected by early breast cancer. We considered age, tumour size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o non-sentinel lymph node (NSLN). Chi-square, Fisher’s Exact test and Student’s t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. Results: A significant positive effect of vascular invasion and lymphatic invasion, and a negative effect of TN were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumour presence, but focusing on the number of metastases, also age has a (negative) significant effect. Conclusion: This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary su

Judicial Autonomy v. Executive Authority: Which Prevails in the Case of a Postcommutation Collateral Attack?

An inmate with a commuted sentence will sometimes collaterally attack his already commuted sentence. This raises the question: Does an act of executive clemency divest the courts of authority to hear the collateral attack? In other words, does clemency moot the issues involved in the collateral attack? While multiple circuit courts have weighed in on this question, the Fourth and Sixth Circuits have developed the most robust discussions, disagreeing about whether federal courts may hear these cases. The Fourth Circuit has held that a collateral attack postcommutation is moot as the “President’s commutation order simply closes the judicial door.” In contrast, the Sixth Circuit has held that a commutation does not moot a collateral attack. This Note argues that the Sixth Circuit reached the correct result but has erred in focusing primarily on mootness. Specifically, this Note argues that separation of powers considerations, not mootness, should determine this issue. Part I provides an overview of the split between the Fourth and Sixth Circuits. Part II provides an overview of the justifications for, and development of, presidential commutations. It discusses how the justifications for commutations—and clemency more generally—have shifted from executive mercy to a political gamble. Part III provides an overview of the mootness doctrine and how it is relevant to this issue. Part III also explains the separation of powers and issues involving judicial autonomy and executive authority in the clemency context. Part IV argues that although a collateral attack postcommutation is almost never moot, the federal courts should focus their analysis of whether commutations foreclose judicial review on other separation of powers considerations, including preserving the sanctity of their role in reviewing unconstitutional convictions. Finally, Part IV also argues that the politicization of the pardon power in the modern era necessitates the court’s involvement in postcommutation collateral attacks in order to (1) effectuate the ideals of mercy and justice and (2) protect the power of judicial review

Public Accommodations Originalism’s Inability to Solve the Problems of Online Content Moderation

In response to online platforms’ increasing ability to moderate content in what often seems to be an arbitrary way, Justice Clarence Thomas recently suggested that platforms should be regulated as public accommodations such that the government could prevent platforms from banning users or removing posts from their sites. Shortly thereafter, Florida passed the Transparency in Technology Act, which purported to regulate online platforms as public accommodations and restricted their ability to ban users, tailor content through algorithmic decision-making, and engage in their own speech. Texas followed suit by passing a similar law, and Arizona debated a bill purporting to regulate platforms as public accommodations. Given the obvious First Amendment concerns with regulating an online platform’s ability to publish and control content on its own forum, courts and legislatures must ensure that such regulations comport with the original understanding of how public accommodations could be regulated at the time of the founding (public accommodations originalism for short). As this Article argues, businesses could be regulated as public accommodations at the founding because they either: (1) held themselves out to the public as willing to serve all comers (the holding out theory); or (2) were subject to franchise obligations through legislation often because they were natural monopolies (the franchise theory). Most online platforms exhibit the necessary characteristics of public accommodations under both the holding out theory and the franchise theory and can thus be regulated as public accommodations according to the term’s original meaning. That said, public accommodations originalism is subject to significant limitations as applied to online platforms. Specifically, under the holding out theory, an online platform can evade public accommodations status merely by ceasing to hold itself out as willing to serve all comers. Under the franchise theory, platforms must be given an exclusive government benefit in exchange for the corresponding duty to host content. Even where such a benefit exists, the platform cannot be subject to an absolute duty to host. Furthermore, platforms would largely maintain control over their algorithmic decisions and could not be prevented from engaging in their own speech. Therefore, while public accommodations originalism will limit a platforms ability to moderate content, it will not entirely undermine the platform’s autonomy. Any law purporting to regulate platforms as public accommodations that does not respect these limitations is unconstitutional since it does not comply with the original public meaning of the First Amendment and the law of public accommodations. Notwithstanding the limited ability of public accommodations originalism to remedy some of the abuses associated with content moderation, the normative implications of such regulation cannot be ignored. Public accommodations originalism will require online platforms and their users to tolerate immoral, lewd, and otherwise objectionable content. But it will also prevent platforms from removing content that serves an important public purpose. Balancing these interests are matters that legislatures must contend with when debating whether to impose public accommodations regulations onto online platforms, but the fact of the matter is that such regulations (when appropriately tailored) are constitutional and should be upheld by the courts

Public Accommodations Originalism’s Inability to Solve the Problems of Online Content Moderation

In response to online platforms’ increasing ability to moderate content in what often seems to be an arbitrary way, Justice Clarence Thomas recently suggested that platforms should be regulated as public accommodations such that the government could prevent platforms from banning users or removing posts from their sites. Shortly thereafter, Florida passed the Transparency in Technology Act, which purported to regulate online platforms as public accommodations and restricted their ability to ban users, tailor content through algorithmic decision-making, and engage in their own speech. Texas followed suit by passing a similar law, and Arizona debated a bill purporting to regulate platforms as public accommodations. Given the obvious First Amendment concerns with regulating an online platform’s ability to publish and control content on its own forum, courts and legislatures must ensure that such regulations comport with the original understanding of how public accommodations could be regulated at the time of the founding (public accommodations originalism for short). As this Article argues, businesses could be regulated as public accommodations at the founding because they either: (1) held themselves out to the public as willing to serve all comers (the holding out theory); or (2) were subject to franchise obligations through legislation often because they were natural monopolies (the franchise theory). Most online platforms exhibit the necessary characteristics of public accommodations under both the holding out theory and the franchise theory and can thus be regulated as public accommodations according to the term’s original meaning. That said, public accommodations originalism is subject to significant limitations as applied to online platforms. Specifically, under the holding out theory, an online platform can evade public accommodations status merely by ceasing to hold itself out as willing to serve all comers. Under the franchise theory, platforms must be given an exclusive government benefit in exchange for the corresponding duty to host content. Even where such a benefit exists, the platform cannot be subject to an absolute duty to host. Furthermore, platforms would largely maintain control over their algorithmic decisions and could not be prevented from engaging in their own speech. Therefore, while public accommodations originalism will limit a platforms ability to moderate content, it will not entirely undermine the platform’s autonomy. Any law purporting to regulate platforms as public accommodations that does not respect these limitations is unconstitutional since it does not comply with the original public meaning of the First Amendment and the law of public accommodations. Notwithstanding the limited ability of public accommodations originalism to remedy some of the abuses associated with content moderation, the normative implications of such regulation cannot be ignored. Public accommodations originalism will require online platforms and their users to tolerate immoral, lewd, and otherwise objectionable content. But it will also prevent platforms from removing content that serves an important public purpose. Balancing these interests are matters that legislatures must contend with when debating whether to impose public accommodations regulations onto online platforms, but the fact of the matter is that such regulations (when appropriately tailored) are constitutional and should be upheld by the courts

The accuracy of sentinel lymph-node biopsy in breast cancer after previous excisional biopsy

Scopo: La biopsia del linfonodo sentinella (BLS) nel carcinoma della mammella con linfonodi ascellari clinicamente negativi \ue8 considerato la migliore scelta per stadiare il cavo ascellare. Inizialmente una precedente biopsia escissionale del carcinoma era considerata una controindicazione. Esaminiamo il tasso di successo della BLS e la incidenza della recidiva a livello ascellare in pazienti con carcinoma della mammella precedentemente sottoposti a biopsia escissionale del tumore. Pazienti e metodi: 858 pazienti con carcinoma della mammella sono stati sottoposti a BLS e i pazienti con linfonodi sentinella metastatici a svuotamento del cavo ascellare; 82 pazienti erano stati sottoposti precedentemente a biopsia escissionale del tumore. Risultati: Il linfonodo sentinella \ue8 stato identificato nel 100% dei casi, \ue8 risultato indenne nel 74,4% e metastatico nel 23,1%. La dissezione del cavo ascellare \ue8 stata effettuata in tutti i casi con linfonodi sentinella metastatici e nel 74% dei casi non si sono ritrovati altri linfonodi ascellari metastatici. Il follow-up mediano \ue8 stato di 63,5 mesi e non si sono osservate recidive ascellari. Conclusioni: L\u2019accuratezza del BLS in pazienti con carcinoma della mammella sottoposte precedentemente a biopsia escissionale \ue8 uguale a quella dei pazienti non sottoposti a biopsia.Aim: Sentinel node biopsy (SLNB) is considered to be the standard of care for staging the axilla in clinically node-negative women with breast cancer. A previous breast excisional biopsy has been considered a contraindication to the use of SLNB.We examined the success rate of SLN localization and then the evaluation of the incidence of axillary relapse in patients with breast cancer undergoing excisional biopsy. Patients and Methods: 858 patients with breast carcinoma underwent a SLNB and only positive sentinel nodes were submitted to axillary dissection; 82 patients had undergone an excisional biopsy before. Results: The sentinel node was identified in 100% of cases, it was negative in 74.4% and positive in 23.1%. Complete axillary dissection was performed in all positive cases, and in 74% of cases no other positive nodes were found. The follow-up median was 63.5 months and no axillary recurrence was observed. Conclusions: SLNB accuracy in breast cancer patients who have previously undergone excisional biopsy is comparable with that in patients undergoing no excisional biopsy, so that it may be considered a standard procedure

A probabilistic approach to stormwater runoff control through permeable pavements beneath urban trees

: One of the most current and urgent challenges is making cities sustainable and resilient to climate change. From this perspective, Nature-Based Solutions (NBSs) are well-recognized strategies for stormwater control and water cycle restoration. Urban trees are an example of NBS. However, the high degree of soil sealing typically found in urban environments limits natural processes such as infiltration and hinders the water and nutrient supply for proper root development, which weakens tree stability. Permeable pavements at the base of urban trees, on the one hand, facilitate infiltration, which helps runoff control, and on the other hand, improve stormwater retention and soil humidity, which enhance root feeding. This paper proposes an analytical-probabilistic approach to estimate the contribution of permeable pavements to stormwater management. The equations developed in this study relate the runoff probability to the storage volume, the infiltration rate into the underlying soil, and the average values of the hydrological variables in the input. The model allows us to select different runoff thresholds and considers the possibility that residual volume from previous rainfall events prefills the storage capacity. An application to a case study in Sao Paulo (Brazil) has been presented. It investigates the influence of the different parameters used in the model on the results. The comparison of the outcomes obtained using the developed equations with those obtained from the continuous simulation of measured data confirmed the effectiveness of the proposed analytical-probabilistic approach and the suitability of using permeable pavements at the base of urban trees for improving stormwater retention

Diversity in the US Infectious Diseases Workforce: Challenges for Women and Underrepresented Minorities

Research documents significant gender-based salary inequities among physicians and ongoing inadequacies in recruitment and promotion of physicians from underrepresented minority groups. Given the complexity of the social forces that promote these disparities, their elimination will likely require quantitative and qualitative research to understand the pathways that lead to them and to develop effective solutions. Interventions to combat implicit bias will be required, and structural interventions that hold medical school leadership accountable are needed to achieve and maintain salary equity and racial and gender diversity at all levels

A new in situ test for the assessment of the rock-burst alarm threshold during tunnelling

Rock-burst is one of the most serious risks associated with hard rock tunnelling and mining at high depths. Monitoring of acoustic emissions emitted by the rock-mass during excavation and their interpretation now permits the early assessment of failure events and makes the safe management of the construction works possible. A reliable set-up of the alarm threshold is thus fundamental for the correct implementation of the procedures planned to minimise rock-burst related risk. This paper focuses on a novel in situ test specifically developed to provide an experimental basis for a more accurate assessment of the alarm threshold during tunnelling, representative of the local geomechanical conditions. The test, thanks to the compression induced by two flat jacks at the tunnel side wall, produces an artificial failure process during which acoustic emissions are measured and correlated to the mechanical response of the rock-mass, without the typical limitations of scale that characterised the laboratory experiments. The new methodology, named the Mules method, was successfully tested during the excavation of some stretches of the Brenner Base Tunnel in the Brixner granite, affected by mild spalling episodes. The case-history is fully described in the paper to illustrate the practical application of the proposed approach

1-Phenyl-3-azabicyclo[3.1.0]hexane derivatives as new ligands for sigma receptors

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Cesarean Delivery in Women With Genital Herpes in Washington State, 1989–1991

Objective: The purpose of this study was to determine whether the proportion of cesarean deliveries in pregnant women with a history of genital herpes and no active lesions at birth is higher than that in women with no history of genital herpes, and to determine whether this risk was modified by birth facilities' underlying prevalence of cesarean delivery