Background
Brain metastases (BM) are a frequent complication of advanced cancer and are characterized by a variety of neurological symptoms. Although the presence of neurological symptoms is included ...in the response assessment in patients with primary brain tumors, to the authors' knowledge little is known regarding the prognostic impact of neurological symptoms in patients with BM.
Methods
Patients with newly diagnosed BM from non–small cell lung cancer were identified from the Vienna Brain Metastasis Registry and were evaluated according to the incidence, distribution, and prognostic impact of neurological symptoms at the time of diagnosis of BM.
Results
A total of 1608 patients (57.3% male and 42.7% female; median age, 62 years) were available for further analyses. Neurological symptoms including focal deficits (985 patients; 61.3%), signs of increased intracranial pressure (483 patients; 30.0%), epileptic seizures (224 patients; 13.9%), and neuropsychological symptoms (233 patients; 14.5%) were documented in 1186 of the 1608 patients (73.8%). Patients with asymptomatic BM presented with a longer median overall survival after the diagnosis of BM compared with patients with symptomatic BM (11 months vs 7 months; P < .001). In multivariate analysis with a diagnosis‐specific graded prognostic assessment (hazard ratio, 1.41; 95% CI, 1.33‐1.50 P < .001), the presence of neurological symptoms (hazard ratio, 1.39; 95% CI, 1.23‐1.57 P < .001) was found to be independently associated with survival prognosis from the time of diagnosis of BM.
Conclusions
Neurological symptoms at the time of BM diagnosis demonstrated a strong and independent association with survival prognosis. The results of the current study have highlighted the need for the integration of the presence of neurological symptoms into the prognostic assessment of patients with BM from non–small cell lung cancer.
Lay Summary
Neurological symptom evaluation is included regularly in the assessment of patients with primary brain tumors. However, to the authors' knowledge, little is known regarding the prognostic impact in patients with newly diagnosed brain metastases (BM).
The current study has provided a detailed clinical characterization of the incidence, distribution, and prognostic impact of neurological symptoms in a large, real‐life cohort of patients with BM from non–small cell lung cancer.
In this cohort, neurological symptoms at the time of diagnosis of BM demonstrated a strong, independent prognostic impact on the survival prognosis.
The results of the current study have highlighted the need for the integration of neurological symptom burden into the prognostic assessment of patients with BM from non–small cell lung cancer.
Neurological symptoms at the time of diagnosis of brain metastases demonstrate a strong, independent prognostic impact on prognosis. The current study highlights the integration of neurological symptom burden into the prognostic assessment of patients with brain metastases from non–small cell lung cancer.
The rapid uptake of renewable energy technologies in recent decades has increased the demand of energy researchers, policymakers and energy planners for reliable data on the spatial distribution of ...their costs and potentials. For onshore wind energy this has resulted in an active research field devoted to analysing these resources for regions, countries or globally. A particular thread of this research attempts to go beyond purely technical or spatial restrictions and determine the realistic, feasible or actual potential for wind energy. Motivated by these developments, this paper reviews methods and assumptions for analysing geographical, technical, economic and, finally, feasible onshore wind potentials. We address each of these potentials in turn, including aspects related to land eligibility criteria, energy meteorology, and technical developments of wind turbine characteristics such as power density, specific rotor power and spacing aspects. Economic aspects of potential assessments are central to future deployment and are discussed on a turbine and system level covering levelized costs depending on locations, and the system integration costs which are often overlooked in such analyses. Non-technical approaches include scenicness assessments of the landscape, constraints due to regulation or public opposition, expert and stakeholder workshops, willingness to pay/accept elicitations and socioeconomic cost-benefit studies. For each of these different potential estimations, the state of the art is critically discussed, with an attempt to derive best practice recommendations and highlight avenues for future research.
•Review of over 300 studies on large-scale onshore wind potential assessments.•Analysis of geographic, technical, economic and ‘feasible’ potentials.•Identify weaknesses in methods and best practice examples.•Methods could improve transparency, validation, and sensitivities.•Further interdisciplinary research required on ‘feasible’ potentials.
Biofuels are currently the only available bulk renewable fuel. They have, however, limited expansion potential due to high land requirements and associated risks for biodiversity, food security, and ...land conflicts. We therefore propose to increase output from ethanol refineries in a land-neutral methanol pathway: surplus CO
-streams from fermentation are combined with H
from renewably powered electrolysis to synthesize methanol. We illustrate this pathway with the Brazilian sugarcane ethanol industry using a spatio-temporal model. The fuel output of existing ethanol generation facilities can be increased by 43%-49% or ~100 TWh without using additional land. This amount is sufficient to cover projected growth in Brazilian biofuel demand in 2030. We identify a trade-off between renewable energy generation technologies: wind power requires the least amount of land whereas a mix of wind and solar costs the least. In the cheapest scenario, green methanol is competitive to fossil methanol at an average carbon price of 95€ tCO
.
In this article, we demonstrate the fabrication of thin and macroporous carbon coatings that adhere to various metal substrates such as nickel- or aluminum-based foils or meshes. The coating process ...is a combination of emulsion-templating and the doctor-blade method, which allows to prepare up to 350 µm thick poly(dicyclopentadiene) membranes with a polyHIPE (polymerized high internal phase emulsions) architecture. Carbonization of these poly(dicyclopentadiene) membranes directly on the metal substrates resulted in up to 30-µm-thick foamy carbon coatings that retain the highly porous architecture and flexibility. Subsequently, carbon foam-coated Ni-foils were filled with elemental sulfur by a melt diffusion technique. A macroporous carbon coating supported sulfur loadings up to 65 wt%, obtaining cathodes for galvanostatic cycling experiments in Li–S cells. The latter revealed discharge capacities higher than 800 mA h
−1
according to the sulfur mass. With our approach, the final assembly of the electrodes is greatly simplified because no binders or conductive fillers are required.
Graphical abstract
Abstract
US wind power generation has grown significantly over the last decades, in line with the number and average size of operating turbines. However, wind power density has declined, both ...measured in terms of wind power output per rotor swept area as well as per spacing area. To study this effect, we present a decomposition of US wind power generation data for the period 2001–2021 and examine how changes in input power density and system efficiency affected output power density. Here, input power density refers to the amount of wind available to turbines, system efficiency refers to the share of power in the wind flowing through rotor swept areas which is converted to electricity and output power density refers to the amount of wind power generated per rotor swept area. We show that, while power input available to turbines has increased in the period 2001–2021, system efficiency has decreased. In total, this has caused a decline in output power density in the last 10 years, explaining higher land-use requirements. The decrease in system efficiency is linked to the decrease in specific power, i.e. the ratio between the nameplate capacity of a turbine and its rotor swept area. Furthermore, we show that the wind available to turbines has increased substantially due to increases in the average hub height of turbines since 2001. However, site quality has slightly decreased in this period.
A compelling amount of animal and human research has shown that perceived maternal stress during pregnancy can affect the neurodevelopment of the offspring. Prenatal maternal cortisol is frequently ...proposed as the biological key mechanism underlying this link; however, literature that investigates the effects of prenatal cortisol on subsequent neurodevelopment in humans is scarce. By using longitudinal data from a relatively large community sample of mother–child dyads (
N
= 73), this pre-registered study prospectively examined the role of maternal prenatal cortisol concentrations on subsequent individual differences in gray matter volume (GMV) and hippocampal subfield volumes at the onset of puberty of the offspring (12 years of age). Two markers of cortisol, that is, evening cortisol and circadian decline over the day, were used as indicators of maternal physiological stress during the last trimester of pregnancy. The results indicate that prenatal maternal cortisol levels were not associated with GMV or hippocampal subfield volumes of the children. These findings suggest that late pregnancy maternal cortisol may not be related to the structural development of the offspring’s brain, at least not in healthy community samples and at the onset of puberty. When examining the influence of prenatal stress on offspring neurodevelopment, future investigations should delineate gestational timing effects of the cortisol exposure, cortisol assessment method, and impact of additional biomarkers, as these were not investigated in this study.
Context:
Despite overwhelming evidence for endovascular therapy in anterior circulation ischemic stroke due to large-vessel occlusion, data regarding the treatment of acute basilar artery occlusion ...(BAO) are still equivocal. The BASICS trial failed to show an advantage of endovascular therapy (EVT) over best medical treatment (BMT). In contrast, data from the recently published BASILAR registry showed a better outcome in patients receiving EVT.
Objective:
The aim of the study was to investigate the safety and efficacy of EVT plus BMT vs. BMT alone in acute BAO.
Methods:
We analyzed the clinical course and short-term outcomes of patients with radiologically confirmed BAO dichotomized by BMT plus EVT or BMT only as documented in a state-wide prospective registry of consecutive patients hospitalized due to acute stroke. The primary endpoint was a favorable functional outcome (mRS 0–3) at hospital discharge assessed as common odds ratio using binary logistic regression. Secondary subgroup analyses and propensity score matching were added. Safety outcomes included mortality, the rate of intracerebral hemorrhages, and complications during hospitalization.
Results:
We included 403 patients with acute BAO (2017–2019). A total of 270 patients (67%) were treated with BMT plus EVT and 133 patients (33%) were treated with BMT only. A favorable outcome (mRS 0–3) was observed in 33.8% of the BMT and 26.7% of the BMT plus EVT group OR.770, CI (0.50–1.2). Subgroup analyses for patients with a NIHSS score > 10 at admission to the hospital revealed a benefit from EVT OR 3.05, CI (1.03–9.01).
Conclusions:
In this prospective, quasi population-based registry of patients hospitalized with acute BAO, BMT plus EVT was not superior to BMT alone. Nevertheless, our results suggest that severely affected BAO patients are more likely to benefit from EVT.
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