Summary This Review assesses the relevant data and controversies regarding the use of radiotherapy for, and locoregional management of, women with triple-negative breast cancer (TNBC). In view of the ...strong association between BRCA1 and TNBC, knowledge of baseline mutation status can be useful to guide locoregional treatment decisions. TNBC is not a contraindication for breast conservation therapy because data suggest increased locoregional recurrence risks (relative to luminal subtypes) with breast conservation therapy or mastectomy. Although a boost to the tumour bed should routinely be considered after whole breast radiation therapy, TNBC should not be the sole indication for post-mastectomy radiation, and accelerated delivery methods for TNBC should be offered on clinical trials. Preliminary data implying a relative radioresistance for TNBC do not imply radiation omission because radiation provides an absolute locoregional risk reduction. At present, the integration of subtypes in locoregional management decisions is still in its infancy. Until level 1 data supporting treatment decisions based on subtypes are available, standard locoregional management principles should be adhered to.
ABSTRACT We present a study of the spatial distribution and kinematics of star-forming galaxies in 30 massive clusters at 0.15 < z < 0.30, combining wide-field Spitzer 24 m and GALEX near-ultraviolet ...imaging with highly complete spectroscopy of cluster members. The fraction (fSF) of star-forming cluster galaxies rises steadily with cluster-centric radius, increasing fivefold by 2r200, but remains well below field values even at 3r200. This suppression of star formation at large radii cannot be reproduced by models in which star formation is quenched in infalling field galaxies only once they pass within r200 of the cluster, but is consistent with some of them being first pre-processed within galaxy groups. Despite the increasing fSF-radius trend, the surface density of star-forming galaxies actually declines steadily with radius, falling ∼15× from the core to 2r200. This requires star formation to survive within recently accreted spirals for 2-3 Gyr to build up the apparent over-density of star-forming galaxies within clusters. The velocity dispersion profile of the star-forming galaxy population shows a sharp peak of 1.44 at 0.3r500, and is 10%-35% higher than that of the inactive cluster members at all cluster-centric radii, while their velocity distribution shows a flat, top-hat profile within r500. All of these results are consistent with star-forming cluster galaxies being an infalling population, but one that must also survive ∼0.5-2 Gyr beyond passing within r200. By comparing the observed distribution of star-forming galaxies in the stacked caustic diagram with predictions from the Millennium simulation, we obtain a best-fit model in which star formation rates decline exponentially on quenching timescales of 1.73 0.25 Gyr upon accretion into the cluster.
Thermal stress is an important factor in many industrial situations, athletic events and military scenarios. It can seriously affect the productivity and the health of the individual and diminish ...tolerance to other environmental hazards. However, the assessment of the thermal stress and the translation of the stress in terms of physiological and psychological strain is complex. For over a century attempts have been made to construct an index, which will describe heat stress satisfactorily. The many indices that have been suggested can be categorized into one of three groups: "rational indices", "empirical indices", or "direct indices". The first 2 groups are sophisticated indices, which integrate environmental and physiological variables; they are difficult to calculate and are not feasible for daily use. The latter group comprises of simple indices, which are based on the measurement of basic environmental variables. In this group 2 indices are in use for over four decades: the "wet-bulb globe temperature" (WBGT) index and the "discomfort index" (DI). The following review summarizes the current knowledge on thermal indices and their correlates to thermal sensation and comfort. With the present knowledge it is suggested to adopt the DI as a universal heat stress index.
The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it ...becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.
Linguistic diversity, now and in the past, is widely regarded to be independent of biological changes that took place after the emergence of
We show converging evidence from paleoanthropology, speech ...biomechanics, ethnography, and historical linguistics that labiodental sounds (such as "f" and "v") were innovated after the Neolithic. Changes in diet attributable to food-processing technologies modified the human bite from an edge-to-edge configuration to one that preserves adolescent overbite and overjet into adulthood. This change favored the emergence and maintenance of labiodentals. Our findings suggest that language is shaped not only by the contingencies of its history, but also by culturally induced changes in human biology.
The goal of the current study is to examine the direct and indirect influences of parenting styles, math self-efficacy, and the participants' sex on math anxiety. The research population (
= 204) ...included randomly selected participants, whose native language is Hebrew and were born in Israel. The participants were surveyed about four measures that served as the research tools. They answered questions about demographics, math anxiety, and the parenting style of the child's mother and about math self-efficacy. The research data concluded that there were strong correlations between the authoritarian parenting style and math anxiety. The authoritative parenting style had both a direct positive correlation and an indirect negative correlation on math anxiety. This is in contrast to the permissive parenting style which was exclusively found to have a small positive correlation on math anxiety. The participant's sex had both direct and indirect influences on math anxiety. Math anxiety levels, as well as the negative effects of self-efficacy on the level of math anxiety, were higher in females compared to males. These findings are relevant when considering methods of diagnosis and intervention surrounding math anxiety.
To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute ...complications of labour or birth, or severe acute adverse maternal outcomes.
Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors.
Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified.
Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
The atmospheres of late M stars represent a significant challenge in the characterization of any transiting exoplanets because of the presence of strong molecular features in the stellar atmosphere. ...TRAPPIST-1 is an ultracool dwarf, host to seven transiting planets, and contains its own molecular signatures that can potentially be imprinted on planetary transit lightcurves as a result of inhomogeneities in the occulted stellar photosphere. We present a case study on TRAPPIST-1g, the largest planet in the system, using a new observation together with previous data, to disentangle the atmospheric transmission of the planet from that of the star. We use the out-of-transit stellar spectra to reconstruct the stellar flux on the basis of one, two, and three temperature components. We find that TRAPPIST-1 is a 0.08 M*, 0.117 R*, M8V star with a photospheric effective temperature of 2400 K, with ∼35% 3000 K spot coverage and a very small fraction, <3%, of ∼5800 K hot spot. We calculate a planetary radius for TRAPPIST-1g to be Rp = 1.124 R⊕with a planetary density of p = 0.8214 ⊕. On the basis of the stellar reconstruction, there are 11 plausible scenarios for the combined stellar photosphere and planet transit geometry; in our analysis, we are able to rule out eight of the 11 scenarios. Using planetary models, we evaluate the remaining scenarios with respect to the transmission spectrum of TRAPPIST-1g. We conclude that the planetary transmission spectrum is likely not contaminated by any stellar spectral features and are able to rule out a clear solar H2/He-dominated atmosphere at greater than 3 .
There are few data on the quality of cancer treatment information available on social media. Here, we quantify the accuracy of cancer treatment information on social media and its potential for harm. ...Two cancer experts reviewed 50 of the most popular social media articles on each of the 4 most common cancers. The proportion of misinformation and potential for harm were reported for all 200 articles and their association with the number of social media engagements using a 2-sample Wilcoxon rank-sum test. All statistical tests were 2-sided. Of 200 total articles, 32.5% (n = 65) contained misinformation and 30.5% (n = 61) contained harmful information. Among articles containing misinformation, 76.9% (50 of 65) contained harmful information. The median number of engagements for articles with misinformation was greater than factual articles (median interquartile range = 2300 1200-4700 vs 1600 819-4700, P = .05). The median number of engagements for articles with harmful information was statistically significantly greater than safe articles (median interquartile range = 2300 1400-4700 vs 1500 810-4700, P = .007).
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