A key tool for monitoring breast cancer patients under neoadjuvant treatment is the identification of reliable predictive markers. Ki67 has been identified as a prognostic and predictive marker in ...ER-positive breast cancer. Ninety ER-positive, HER2 negative locally advanced breast cancer patients received letrozole (2.5 mg daily) and cyclophosphamide (50 mg daily) with/without Sorafenib (400 mg/bid daily) for 6 months before undergoing surgery. Ki67 expression and tumor size measured with caliber were determined at baseline, after 30 days of treatment and at the end of treatment. Patients were assigned to a clinical response category according to Response Evaluation Criteria in Solid Tumors, both at 30 days and before surgery and further classified as high-responder and low-responder according to the median variation of Ki67 values between biopsy and 30 days and between biopsy and surgery time. The predictive role of Ki67 and its changes with regard to clinical response and survival was analyzed. No differences in terms of survival outcomes emerged between the arms of treatment, while we observed a higher percentage of women with progression or stable disease in arm with the combination containing Sorafenib (20.5% vs 7.1%, p = 0.06). Clinical complete responders experienced a greater overall variation in Ki67 when compared with partial responders and patients with progressive/stable disease (66.7% vs 30.7%, p = 0.009). High responders showed a better outcome than low responders in terms of both disease-free survival (p = 0.009) and overall survival (p = 0.002). ΔKi67 score evaluated between basal and residual tumor at definitive surgery showed to be highly predictive of clinical complete response, and a potential parameter to be used for predicting disease-free survival and overall survival in luminal breast cancer treated with neoadjuvant endocrine-based therapy.
Integration of renewable sources into Brazil's power mix is desirable and necessary. The main benefit from these energy sources is maintaining greenhouse gas emissions at low levels. Nevertheless, ...high penetration of these energy sources into the power mix can lead to many problems, for instance, intermittency in power generation. There are some mechanisms which can be implemented to mitigate intermittency and allow a higher level of participation of these energy sources in the generation mix. One such mechanism is utilizing Energy Storage Systems (ESS). The goal of this paper is to perform a study to find the best ESS options using Multi-criteria Decision Analysis. Moreover, an examination regarding Hydro Power Plants' reservoirs as an ESS is accomplished through a case study using three of Brazil's significant Hydro Power Plants.
Producing electricity from wind, biomass and solar sources (WBSS) is a promising alternative from a sustainability perspective. Considering that the increasing insertion of WBSS into the Brazilian ...National Grid is an irreversible trend, it is essential to go deeper into the debate on the resulting impacts. Will it be possible to service the growth in load using WBSS and to what extent? Which strategy should be adopted to foster the inclusion of WBSS while retaining security of supply? The main objective of this article is to discuss the problems that surround these questions under the focus of full load servicing.
This paper analyzes the feasibility of the coexistence of telemetry and alarm messages employing Long-Range Wide-Area Network (LoRaWAN) technology in industrial environments. The regular telemetry ...messages come from periodic measurements from the majority of sensors while the alarm messages come from sensors whose transmissions are triggered by rarer (random) events that require highly reliable communication. To reach such a strict requirement, we propose here strategies of allocation of spreading factor, by treating alarm and regular (telemetry) messages differently. The potential of such allocation strategies has also been investigated under retransmission and diversity of gateways. Both indoor industrial plant and open-field scenarios are investigated. We compare the proposed solution with a benchmark scenario—where no alarm is considered—by using system level simulation. Our results show that it is possible to achieve high reliability with reasonably low delay for the alarm messages without significantly affecting the performance of the regular links.
High-dosage motor practice can significantly contribute to achieving functional recovery after a stroke. Performing rehabilitation exercises at home and using, or attempting to use, the ...stroke-affected upper limb during Activities of Daily Living (ADL) are effective ways to achieve high-dosage motor practice in stroke survivors. This paper presents a novel technological approach that enables 1) detecting goal-directed upper limb movements during the performance of ADL, so that timely feedback can be provided to encourage the use of the affected limb, and 2) assessing the quality of motor performance during in-home rehabilitation exercises so that appropriate feedback can be generated to promote high-quality exercise. The results herein presented show that it is possible to detect 1) goal-directed movements during the performance of ADL with a c-statistic of 87.0% and 2) poorly performed movements in selected rehabilitation exercises with an F-score of 84.3%, thus enabling the generation of appropriate feedback. In a survey to gather preliminary data concerning the clinical adequacy of the proposed approach, 91.7% of occupational therapists demonstrated willingness to use it in their practice, and 88.2% of stroke survivors indicated that they would use it if recommended by their therapist.
This paper presents new analytical results for evaluating the ALOHA-like multi-class random access wireless network’s performance. The proposed model is motivated by the growth of low-power wireless ...networks that employ random access protocols. In particular, we compare our analytical formulation with system-level simulations of Long Range (LoRa) technology. We show that the proposed formulation provides an accurate approximation of LoRaWAN performance capturing its main trade-offs. The main contributions are (i) an extensive analysis of the impact of different LoRa spreading factors (SFs) allocation strategies, including area intersection among SFs, which is little explored in the literature and represents the optimal approach under some conditions; and (ii) the optimal proportion of users that maximizes the network throughput for each class and for each allocation strategy considered in the paper.
ObjectivesTo assess the feasibility and change in clinical outcomes associated with continuous glucose monitoring (CGM) use among a rural population in Malawi living with type 1 diabetes.DesignA 2:1 ...open randomised controlled feasibility trial.SettingTwo Partners In Health-supported Ministry of Health-run first-level district hospitals in Neno, Malawi.Participants45 people living with type 1 diabetes (PLWT1D).InterventionsParticipants were randomly assigned to Dexcom G6 CGM (n=30) use or usual care (UC) (n=15) consisting of Safe-Accu glucose monitors and strips. Both arms received diabetes education.OutcomesPrimary outcomes included fidelity, appropriateness and severe adverse events. Secondary outcomes included change in haemoglobin A1c (HbA1c), acceptability, time in range (CGM arm only) SD of HbA1c and quality of life.ResultsParticipants tolerated CGM well but were unable to change their own sensors which resulted in increased clinic visits in the CGM arm. Despite the hot climate, skin rashes were uncommon but cut-out tape overpatches were needed to secure the sensors in place. Participants in the CGM arm had greater numbers of dose adjustments and lifestyle change suggestions than those in the UC arm. Participants in the CGM arm wore their CGM on average 63.8% of the time. Participants in the UC arm brought logbooks to clinic 75% of the time. There were three hospitalisations all in the CGM arm, but none were related to the intervention.ConclusionsThis is the first randomised controlled trial conducted on CGM in a rural region of a low-income country. CGM was feasible and appropriate among PLWT1D and providers, but inability of participants to change their own sensors is a challenge.Trial registration numberPACTR202102832069874.
A two-iris waveguide-probe technique is introduced for measuring the electromagnetic properties of a lossy conductor-backed material layer. A flanged open-ended rectangular waveguide is applied to ...the material under test, and the reflected signal is measured under two conditions. The reflection is first measured when the aperture of the waveguide is unobstructed; then, the reflection is measured with an iris placed in the aperture of the guide. These two measurements allow the extraction of both the permittivity and permeability of the material. The theoretical reflection coefficient necessary to perform the extraction is obtained using a rigorous full-wave approach combining a modal expansion in the waveguide and iris regions with a magnetic-field integral equation formed using equivalent currents at the waveguide aperture. The optimum iris size is determined by minimizing the propagated error due to instrumentation uncertainty and by comparing the extracted parameters to those found using a two-thickness method. Measurements of a commercially available magnetic radar-absorbing material demonstrate the feasibility of the two-iris approach.
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