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The addition of olanzapine to a neurokinin receptor blocker, a serotonin receptor blocker, and dexamethasone markedly improved the control of nausea and vomiting in previously untreated patients receiving highly emetogenic chemotherapy. Chemotherapy-induced nausea and vomiting are associated with a significant deterioration in quality of life and are perceived by patients as major adverse effects of cancer treatment. 1 The use of 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists, 2 dexamethasone, 2 and neurokinin-1 (NK 1 ) receptor antagonists 3 – 9 has significantly improved the control of this troublesome side effect. International guidelines 10 – 12 recommend combinations of these agents to prevent chemotherapy-induced nausea and vomiting in patients receiving moderately or highly emetogenic chemotherapy. Nonetheless, nausea remains a major problem for many patients. 1 , 2 Olanzapine is approved by the Food and Drug Administration (FDA) as an . . .

Background Reoperations occur frequently after initial lumpectomy for breast cancer. The authors hypothesized that the receipt of neoadjuvant chemotherapy (NAC) is associated with fewer reoperations. Methods The association between timing of chemotherapy and reoperation rates (ROR) after lumpectomy was investigated for patients with stages 1–3 breast cancer in the National Cancer Database (NCDB) from 2010 to 2013 by multivariable logistic regression modeling. Then propensity score-matching was performed. Results The unadjusted ROR for 71,627 stages 1–3 patients was 11.4% for those who had NAC compared with 20.3% for those who had postoperative chemotherapy ( p < 0.001) (odds ratio [OR] 0.53; 95% confidence interval [CI] 0.49–0.57; p < 0.001). The ORs for the reoperations performed for patients with stages 1, 2, and 3 cancers who received NAC were respectively 0.65 (95% CI 0.56–0.75), 0.50 (95% CI 0.45–0.56), and 0.27 (95% CI 0.19–0.38) The p values for all were lower than 0.001. Conclusion For a population of patients receiving chemotherapy, the receipt of chemotherapy before instead of after surgery was associated with fewer reoperations after initial lumpectomy for breast cancer.

The purpose of this study was to determine if receipt of chemotherapy was associated with utilization of the 21-gene recurrence score assay (RS assay) or with recurrence score (RS) in eligible patients. Using the National Cancer Data Base (NCDB), we identified female patients eligible for RS assay based on National Comprehensive Cancer Network (NCCN) guidelines: age 18–70, ER-positive and HER2-negative early-stage breast cancer diagnosed during 2010–2013. We excluded patients not meeting testing guidelines. Inclusion required result of RS in patients who underwent RS assay and status for receipt of chemotherapy. Multivariable logistic regression models and propensity matched analysis were used to determine associations between RS assay and RS with receipt of chemotherapy. Among 129,765 patients who were eligible, 74,778 underwent RS assay and had results available. Of these, 59.5 % (44,505) had low-risk, 32.0 % (23,920) had intermediate-risk, and 8.5 % (6353) had high-risk RS. Patients with intermediate- and high-risk RS were more likely to receive chemotherapy [OR 12.9 (CI 12.2–13.6), p  <0.001 and OR 87.2 (CI 79.6–95.6), p  <0.0001], respectively. In both low- and intermediate-risk groups, increasing RS score was significantly associated with increasing odds of receiving chemotherapy [OR 1.10 (CI 1.09–1.12), p <0.0001 and OR 1.26 (CI 1.25–1.27), p <0.0001, respectively, for each point increase in RS]. Receipt of chemotherapy was more likely in patients who did not undergo RS assay compared to those who did, OR 1.21 (CI 1.175–1.249) p  <0.0001. The utilization of RS assay and the RS were both strongly associated with chemotherapy receipt. Patients eligible for chemotherapy, based on NCCN criteria, were more likely to receive chemotherapy if they did not undergo RS assay or they had a high RS.

National Comprehensive Cancer Network (NCCN) guideline compliance for breast cancer was determined in a breast center. A retrospective study of 200 new breast cancer patients seen in 2004 was performed. NCCN guideline compliance rates for preoperative evaluation, breast surgery, lymph node surgery, radiation treatment, and systemic adjuvant therapy were 87%, 97%, 97%, 77%, and 63%, respectively. The most common reasons for noncompliance were partial breast radiation, no radiation, limited life expectancy, and patient choice to defer systemic treatment. The investigation of quality of breast cancer care requires measurement of compliance and reasons for noncompliance with established guidelines. A review that focuses only on percentage compliance has the potential to penalize institutions that (1) practice informed consent detailing absolute risks of survival with and without systemic therapy, (2) practice evidence-based medicine before the standardized guideline is changed to reflect it, and (3) serve populations with limited life expectancy.

Heavy metals are prevalent in urban settings due to many legacy and modern pollution sources, and are essential to quantify because of the adverse health effects associated with them. Of particular importance is lead (Pb), because there is no safe level of exposure, and it especially harms children. Through our partnership with community scientists in the Marion County (Indiana, United States) area ( n = 162 households), we measured Pb and other heavy metal concentrations in soil, paint, and dust. Community scientists completed sampling with screening kits and samples were analyzed in the laboratory via x-ray fluorescence by researchers to quantify heavy metal concentrations, with Pb hazards reported back to participants. Results point to renters being significantly ( p ≤ 0.05) more likely to contain higher concentrations of Pb, zinc (Zn), and copper (Cu) in their soil versus homeowners, irrespective of soil sampling location at the home. Housing age was significantly negatively correlated with Pb and Zn in soil and Pb in dust across all homes. Analysis of paired soil, dust, and paint samples revealed several important relationships such as significant positive correlations between indoor vacuum dust Pb, dust wipe Pb, and outdoor soil Pb. Our collective results point to rental status being an important determinant of metal pollution exposure in Indianapolis, with housing age being reflective of both past and present Zn and Pb pollution at the household scale in dust and soil. Thus, future environmental pollution work examining renters versus homeowners, as well as other household data such as home condition and resident race/ethnicity, is imperative for better understanding environmental disparities surrounding not just Pb, but other heavy metals in environmental media as well.

Methane (CH4) emissions from coal production amount to roughly one-third of European anthropogenic CH4 emissions in the atmosphere. Poland is the largest hard coal producer in the European Union with the Polish side of the Upper Silesian Coal Basin (USCB) as the main part of it. Emission estimates for CH4 from the USCB for individual coal mine ventilation shafts range between 0.03 and 20 kt a−1, amounting to a basin total of roughly 440 kt a−1 according to the European Pollutant Release and Transfer Register (E-PRTR, http://prtr.ec.europa.eu/, 2014). We mounted a ground-based, portable, sun-viewing FTS (Fourier transform spectrometer) on a truck for sampling coal mine ventilation plumes by driving cross-sectional stop-and-go patterns at 1 to 3 km from the exhaust shafts. Several of these transects allowed for estimation of CH4 emissions based on the observed enhancements of the column-averaged dry-air mole fractions of methane (XCH4) using a mass balance approach. Our resulting emission estimates range from 6±1 kt a−1 for a single shaft up to 109±33 kt a−1 for a subregion of the USCB, which is in broad agreement with the E-PRTR reports. Three wind lidars were deployed in the larger USCB region providing ancillary information about spatial and temporal variability of wind and turbulence in the atmospheric boundary layer. Sensitivity studies show that, despite drawing from the three wind lidars, the uncertainty of the local wind dominates the uncertainty of the emission estimates, by far exceeding errors related to the XCH4 measurements themselves. Wind-related relative errors on the emission estimates typically amount to 20 %.

Lead (Pb) is a neurotoxicant that particularly harms young children. Urban environments are often plagued with elevated Pb in soils and dusts, posing a health exposure risk from inhalation and ingestion of these contaminated media. Thus, a better understanding of where to prioritize risk screening and intervention is paramount from a public health perspective. We have synthesized a large national data set of Pb concentrations in household dusts from across the United States (U.S.), part of a community science initiative called “DustSafe.” Using these results, we have developed a straightforward logistic regression model that correctly predicts whether Pb is elevated (>80 ppm) or low (<80 ppm) in household dusts 75% of the time. Additionally, our model estimated 18% false negatives for elevated Pb, displaying that there was a low probability of elevated Pb in homes being misclassified. Our model uses only variables of approximate housing age and whether there is peeling paint in the interior of the home, illustrating how a simple and successful Pb predictive model can be generated if researchers ask the right screening questions. Scanning electron microscopy supports a common presence of Pb paint in several dust samples with elevated bulk Pb concentrations, which explains the predictive power of housing age and peeling paint in the model. This model was also implemented into an interactive mobile app that aims to increase community‐wide participation with Pb household screening. The app will hopefully provide greater awareness of Pb risks and a highly efficient way to begin mitigation. Plain Language Summary Community science has been gaining traction in many locales throughout the United States, particularly in the field of urban pollution. While this has helped with science education and informing communities of potential hazards and mitigation tools, little has been done to effectively assimilate this information in a useful way to help people in other communities throughout the country. Thus, we utilized a large data set of household dust samples provided by community scientists across the United States to build a simple predictive model that lets users know if their dust is likely to be high in a toxic metal, lead. Additionally, we built this model into an interactive mobile app that we plan to use as a recruitment tool for usage of lead screening kits. Ultimately, we plan to assess whether this mobile app improves user knowledge of household lead risks and increases participation from start to finish for free lead screening services. Key Points Community science sampling can provide national‐level insight Mobile apps can be utilized as a lead intervention tool Elevated lead in house dust can be reasonably predicted with a simple statistical model and two variables

Lead exposure has blighted communities across the United States (and the globe), with much of the burden resting on lower income communities, and communities of color. On 17 January 2024, the US Environmental Protection Agency (USEPA) lowered the recommended screening level of lead in residential soils from 400 to 200 parts per million. Our analysis of tens of thousands of citizen‐science collected soil samples from cities and communities around the US indicates that nearly one quarter of households may contain soil lead that exceed the new screening level. Extrapolating across the nation, that equates to nearly 30 million households needing to mitigate potential soil lead hazards, at a potential total cost of 290 billion to $1.2 trillion. We do not think this type of mitigation is feasible at the massive scale required and we have instead focused on a more immediate, far cheaper strategy: capping current soils with clean soils and/or mulch. At a fraction of the cost and labor of disruptive conventional soil mitigation, it yields immediate and potentially life‐changing benefits for those living in these environments. Plain Language Summary The US Environmental Protection Agency recently lowered the recommended screening levels for soil lead, dropping it by one half to 200 parts per million. Based on a wide network of citizen‐science collected household soil samples, we find that nearly one in four households may now contain a soil lead hazard based on this new, more protective standard. This finding challenges the current expensive approach, sometimes termed “dig and dump” to mitigation. Key Points The US Environmental Protection Agency recently reduced its soil lead screening recommendations We find that nearly one in four households may now contain a soil lead hazard based on the new recommendations This finding challenges the current expensive approach, sometimes termed \"dig and dump,\" to mitigation at this scale

Plants can acclimate by using tropisms to link the direction of growth to environmental conditions. Hydrotropism allows roots to forage for water, a process known to depend on abscisic acid (ABA) but whose molecular and cellular basis remains unclear. Here we show that hydrotropism still occurs in roots after laser ablation removed the meristem and root cap. Additionally, targeted expression studies reveal that hydrotropism depends on the ABA signalling kinase SnRK2.2 and the hydrotropism-specific MIZ1, both acting specifically in elongation zone cortical cells. Conversely, hydrotropism, but not gravitropism, is inhibited by preventing differential cell-length increases in the cortex, but not in other cell types. We conclude that root tropic responses to gravity and water are driven by distinct tissue-based mechanisms. In addition, unlike its role in root gravitropism, the elongation zone performs a dual function during a hydrotropic response, both sensing a water potential gradient and subsequently undergoing differential growth. Roots bend towards water. The root cortex in the elongation zone is the site of perception during hydrotropism but also the site of differential root growth, which is different from gravitropism.

Methane (CH4) emissions from coal production amount to roughly one-third of European anthropogenic CH4 emissions in the atmosphere. Poland is the largest hard coal producer in the European Union with the Polish side of the Upper Silesian Coal Basin (USCB) as the main part of it. Emission estimates for CH4 from the USCB for individual coal mine ventilation shafts range between 0.03 and 20 kt a−1, amounting to a basin total of roughly 440 kt a−1 according to the European Pollutant Release and Transfer Register (E-PRTR, http://prtr.ec.europa.eu/, 2014). We mounted a ground-based, portable, sun-viewing FTS (Fourier transform spectrometer) on a truck for sampling coal mine ventilation plumes by driving cross-sectional stop-and-go patterns at 1 to 3 km from the exhaust shafts. Several of these transects allowed for estimation of CH4 emissions based on the observed enhancements of the column-averaged dry-air mole fractions of methane (XCH4) using a mass balance approach. Our resulting emission estimates range from 6±1 kt a−1 for a single shaft up to 109±33 kt a−1 for a subregion of the USCB, which is in broad agreement with the E-PRTR reports. Three wind lidars were deployed in the larger USCB region providing ancillary information about spatial and temporal variability of wind and turbulence in the atmospheric boundary layer. Sensitivity studies show that, despite drawing from the three wind lidars, the uncertainty of the local wind dominates the uncertainty of the emission estimates, by far exceeding errors related to the XCH4 measurements themselves. Wind-related relative errors on the emission estimates typically amount to 20 %.