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Owing to their characteristics like fast charge–discharge rate, very long life, simple geometry and eco-friendly nature, supercapacitor is an emerging technology to fulfil the present and future requirements of the energy. The performance of a supercapacitor is derived from the composition and morphology of the electrode. 2D materials possess various excellent structural properties like surface area, flexibility in the atomic scale dimension and mechanical strength with high electrical conductivity. This makes them an entrusted material to be used as an electrode material. The teaming of 2D materials and layered transition metal dichalcogenides have been of great interest for electrode materials. In this study, the reduction of graphene oxide is done by an environment-friendly synthesis method using cow urine, and then, synthesizing the reduced graphene oxide (rGO) and transition metal dichalcogenides (TMD) composite using the refluxing method. The modified pencil graphite electrode (PGE) was functionalized using the above composite and the performance is comparable to that of glassy carbon electrode. Our main motive was to develop a low-cost, sustainable and highly effective MoS2–rGO/PGE, which is completely based on an environment and eco-friendly method using natural precursors. The prepared MoS2–rGO nanocomposite was characterized by XRD, SEM and EDX, which revealed the formation as well as its morphological scenario. MoS2–rGO/PGE is explored as electrode material by electrochemical characterization with the 3-electrode system through cyclic voltammetry and electrochemical impedance spectroscopy, which exhibit maximum specific capacitance with good cycle stability. [ABSTRACT FROM AUTHOR]

The article discusses the development of core outcome sets (COS) for skin diseases, which are standardized sets of outcomes and measures to be collected in research studies. The lack of uniformity in outcomes for skin diseases hinders the comparison of research findings and optimal patient care. Historically, COS have had limited stakeholder involvement and lacked geographic diversity. However, recent projects have expanded stakeholder involvement and incorporated novel methodologies to ensure more representative COS. The article emphasizes the importance of training materials for patients and patient representatives. Overall, the move towards methodological innovation and broader stakeholder involvement in COS development aims to standardize outcomes and improve their uptake in clinical practice. [Extracted from the article]

Enfortumab vedotin is an antibody–drug conjugate comprised of a human monoclonal antibody directed to Nectin-4 and monomethyl auristatin E (MMAE), a microtubule-disrupting agent. The objectives of this review are to summarize the clinical pharmacology of enfortumab vedotin monotherapy and demonstrate that the appropriate dose has been selected for clinical use. Pharmacokinetics (PK) of enfortumab vedotin (antibody–drug conjugate and total antibody) and free MMAE were evaluated in five clinical trials of patients with locally advanced or metastatic urothelial carcinoma (n = 748). Intravenous enfortumab vedotin 0.5–1.25 mg/kg on days 1, 8, and 15 of a 28-day cycle showed linear, dose-proportional PK. No significant differences in exposure or safety of enfortumab vedotin and free MMAE were observed in mild, moderate, or severe renal impairment versus normal renal function. Patients with mildly impaired versus normal hepatic function had a 37% increase in area under the concentration-time curve (0–28 days), a 31% increase in maximum concentration of free MMAE, and a similar adverse event profile. No clinically significant PK differences were observed based on race/ethnicity with weight-based dosing, and no clinically meaningful QT prolongation was observed. Concomitant use with dual P-glycoprotein and strong cytochrome P450 3A4 inhibitors may increase MMAE exposure and the risk of adverse events. Approximately 3% of patients developed antitherapeutic antibodies against enfortumab vedotin 1.25 mg/kg. These findings support enfortumab vedotin 1.25 mg/kg monotherapy on days 1, 8, and 15 of a 28-day cycle. No dose adjustments are required for patients with renal impairment or mild hepatic impairment, or by race/ethnicity. [ABSTRACT FROM AUTHOR]

Background: Non-valvular atrial fibrillation (AF) is a common heart arrhythmia in the elderly population. AF patients are at high-risk of ischemic strokes, but oral anticoagulant (OAC) therapy reduces such risks. Warfarin had been the standard OAC for AF patients, however its effectiveness is highly variable and dependent on close monitoring of the anticoagulant response. Newer OACs such as rivaroxaban and apixaban address these drawbacks but are more costly. It is uncertain which OAC therapy for AF is cost-saving from the healthcare system perspective. Methods: We followed a cohort of patients in Ontario, Canada, aged ≥ 66 who were newly diagnosed with AF and prescribed OACs between 2012 and 2017. We used a two-stage estimation procedure. First, we account for the patient selection into OACs using a multinomial logit regression model and estimated propensity scores. Second, we used an inverse probability weighted regression adjustment approach to determine cost-saving OAC options. We also examined component-specific costs (i.e., drug, hospitalization, emergency department and physician) to understand the drivers of cost-saving OACs. Results: We found that compared to warfarin, rivaroxaban and apixaban treatments were cost-saving options, with per-patient 1-year healthcare cost savings at $2436 and $1764, respectively. These savings were driven by cost-savings in hospitalization, emergency department visits, and physician visits, outweighing higher drug costs. These results were robust to alternative model specifications and estimation procedures. Conclusions: Treating AF patients with rivaroxaban and apixaban than warfarin reduces healthcare costs. OAC reimbursement policies for AF patients should consider rivaroxaban or apixaban over warfarin as the first-line treatment. [ABSTRACT FROM AUTHOR]

The evolution of Internet and communication systems is exponentially increasing the complexity in communication networks. This paved the way for the incorporation of artificial intelligence (AI), machine learning (ML), and recently deep learning (DL), in various aspects so as to improve the intelligence in communication networks. As DL techniques are superior on finding solutions to complex problems, they are been utilized for optical network applications. This paper aims to review the progress of AI in optical communication and the advancements from ML to DL. The paper also presents a review of nine research papers that utilized conventional DL techniques along with their contribution in optical and wavelength division multiplexing (WDM) networks. Toward the end of this paper, the DL algorithm is studied and its performance parameters are compared to evaluate the simulation outputs of its variants. The comparative analysis shows that in future, improvements in the outputs of WDMs can be made by applying DL-based algorithms. [ABSTRACT FROM AUTHOR]

To fulfill the future demand for high data rate, novel research has been carried out which provides high-performance and secured communication from the optical line terminal (OLT) to the optical network unit (ONU). Results have been incorporated with simulations in optical simulation software called Opti-system. Gain and power estimation has been considered for long reach using wavelength division multiplexing passive optical network (WDM-PON). This method evolves with time and extends to mobile, local area, and metro area access networks. Finally, it has been predicted that the system data rate can reach (2.5 × 8) 20 gigabits per second (Gbps) up to a maximum of 80 km (km). The distance limit for larger data speeds (i.e., 5Gbps or 10 Gbps) was 80 km with a power of 30 dBm. A higher data rate of 40 Gbps per channel was achieved successfully at 30 km, i.e., a maximum data rate from 80 Gbps (10 × 8) to 320 Gbps (40 × 8) can be achieved with novel optimized WDM-PON architecture. Bit error rate (BER), quality (Q) factor, and eye height have limited within the acceptable range as per international telecommunication union (ITU) standards to achieve and fulfill the future demand of 5G (generation) or 6G-based applications at the last mile. [ABSTRACT FROM AUTHOR]

Introduction: Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval. Methods: This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12–17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018. Results: Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively). Conclusion: In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS. [ABSTRACT FROM AUTHOR]

In this paper, advanced modulation techniques based on external modulation, such as I-AMI, AMI, and DBRZ, are designed to improve long-haul transmission and lower high power requirements in the FSO communication system. For long-haul 16 × 100 Gbps FSO systems, an alternate mark inversion modulation approach with high-data rate distortion less transmission is possible. The results demonstrate improved performance in terms of performance indicators such as Q-factor (29.62) and BER (3.8e−193), as well as improved data transmission capabilities of up to 100 Gbps over a distance of 9 km in clear weather. Because here, AMI technique uses a low input power of 5 dBm instead of a conventional power of 10 dBm, the achieved findings demonstrate a reasonable reduction in signal degradation, especially nonlinear effects. [ABSTRACT FROM AUTHOR]

Drainage from chronic wounds can significantly negatively impact a patient's quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response. [ABSTRACT FROM AUTHOR]

Machine learning (ML) has attracted researchers to discover numeral solutions in the field associated with optical networking problems. In this paper, ML discipline procedures have been discussed to proficiently execute Routing and Wavelength Assignment (RWA) for contribution in traffic calculation in the Wavelength Division Multiplexing (WDM) optical set-up. The growing demand for data transport through WDM networks has created problems related to the search for routes and the assignment of wavelengths in these networks. In optical networks, RWA is a well-known problem. To address this problem, researchers have proposed simple to complex heuristic machine learning algorithms. This paper describes how machine learning support can be used and shared in optical networks and the assessment of transmission quality (QoT), data traffic patterns, and crosstalk detection to help route and distribute resources. The RWA algorithm assessments rely on performance measures such as the blocking probability, network utilization, etc. The paper summarizes future research trends for the use of routing and distribution of resources in machine learning processes in optical networks with the results obtained. [ABSTRACT FROM AUTHOR]

Introduction: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that affects approximately 0.3–6 out of every 100,000 people worldwide. Clinical trials are scarce but there is growing interest in using newer and more targeted therapeutics to achieve disease remission. However, there are no standardized instruments to measure outcomes in PG and, therefore, future clinical trials are hampered by the absence of established and accurate means of assessment and comparison. Therefore, we aim to produce an internationally accepted core outcome set (COS) that will overcome this obstacle. This protocol outlines our intended approach to achieve the first part of this process, establishing a core outcome domain set. Methods: An international team of PG stakeholders, consisting of physicians, wound care nurses, patients, scientists and industry representatives, has been assembled for the purpose of building a comprehensive and universally established set of core outcome domains. During the first step, we will generate items of relevance using a nominal process from all stakeholders. Items will be distilled and collapsed into potential domains and subdomains. A systematic review of current methods for reporting PG has already been published and domains identified in this work will be considered in the generation of the core domains set. During the second step, after the potential domains and subdomains are identified, stakeholders will participate in an e-Delphi exercise to rate the importance of (sub)domains. A final consensus meeting will be organized with the goal of establishing a core domain set. Conclusion: Pyoderma gangrenosum lacks an established COS and previously published clinical trials have used inconsistent measures established from similarly inconsistent domains. As a first step this study seeks to create a core domain set within the COS, to build the foundation for future core outcome work for PG. [ABSTRACT FROM AUTHOR]

Nowadays, the designing and development of next-generation 5G communication systems are in their infancy stage. The incorporation of survivability, reliability, and transmission latency awareness are the major challenges while designing networks. Passive optical networks (PONs) are considered one of the prominent solutions to support next-generation networks. The paper proposes and demonstrates a hybrid single-mode fiber/free space optics (FSO) wavelength division multiplexed gigabit PON architecture that has the capability of fault protection and can transmit direct internetworking data. The proposed architecture also has the capability to transmit inter-optical distribution network (ODN) and intra-ODN data along with broadcasting, i.e., a particular optical networking unit (ONU) can broadcast its message to all other ONUs residing inside the ODN. The proposed architecture can reduce a minimum of 55% of transmission latency for inter-ODN transmission. Noise tolerance against Rayleigh backscattering is also enhanced by enabling the downstream and upstream transmission only in one direction. Additionally, the proposed architecture is also capable of transmitting high data rates over long distances irrespective of adverse geographical conditions or obstacles like a big mountain, wider river, etc. using a hybrid optical fiber (OF)/FSO link at the distribution network. The received optical power for 200 m of FSO length varies from −25.52 to −24.14 dBm under different atmospheric conditions in moderate and high turbulence regime. For a hybrid fiber-FSO link, the maximum power penalties of 1.5 dB can achieved. Massive high speed and reliability against link failure using a proposed hybrid OF/FSO architecture makes it more attractive for supporting the next generation of communication systems. [ABSTRACT FROM AUTHOR]

Introduction: Hidradenitis suppurativa (HS) is a chronic, debilitating, and painful inflammatory skin disease that significantly and negatively impacts patients' quality of life. The prevalence of HS in the USA is estimated to be 0.10%, with worldwide reports suggesting a prevalence closer to 1%. There is limited real-world evidence available on the care of patients with HS. We aimed to evaluate the trends in clinical care and treatment in the patient population with HS in the USA in a real-world setting. Methods: A cohort study was conducted using claims data from IBM MarketScan Databases, including the US Commercial Claims and Encounters with Medicare Supplemental and Coordination of Benefits (CCAE+MDCR) database and IBM US Medicaid database. Results: The annual prevalence of HS increased from 0.06% (2008) to 0.14% (2017), and from 0.17% (2008) to 0.31% (2017) among CCAE+MDCR and Medicaid patients, respectively. Dermatologist visits increased from 31.9% (2008) to 47.8% (2019) in CCAE+MDCR patients, and decreased from 10.9% (2008) to 8.5% (2018) in Medicaid patients. Opioid use decreased from 45.4% (2008) to 25.5% (2019) among CCAE+MDCR patients, and from 71.3% (2008) to 48.1% (2018) among Medicaid patients. Only 8.4% of CCAE+MDCR patients and 5.8% of Medicaid patients were exposed to any biologic in 2018. Conclusions: Improved care and treatment of HS over the last decade, including the emergence of new treatments, have been accompanied by an increase in awareness and reported prevalence of the disease. However, there are still gaps in access to dermatologic care and low utilization of biologic therapies among patients with HS. Infographic: [ABSTRACT FROM AUTHOR]

Dengue virus (DENV) infection has increased worldwide, with over 400 million infections annually, and has become a serious public health concern. Several drug candidates, new and repurposed, have failed to meet the primary efficacy endpoints. We have recently shown that Aqueous Extract of the stem of Cocculus hirsutus (AQCH) was effective in vitro and in vivo against DENV and was safe in humans. We now report that an active ingredient of AQCH, Sinococuline, protects against the antibody-mediated secondary-DENV infection in the AG129 mouse model. DENV infection markers were assessed, viz. serum viremia and vital organs pathologies-viral load, proinflammatory cytokines and intestinal vascular leakage. The treatment with Sinococuline at 2.0 mg/kg/day; BID (twice a day), was the most effective in protecting the severely DENV-infected AG129 mice. Also, this dose effectively reduced serum viremia and tissue-viral load and inhibited the elevated expression levels of proinflammatory cytokines (TNF-α and IL-6) in several vital organs. Based on these findings, it could be explored further for pre-clinical and clinical developments for the treatment of dengue. [ABSTRACT FROM AUTHOR]

There has been an increase in demand of optical networks over the recent years due to which they have become sources of heterogeneous data. Several other challenges such as failure management, power optimization and low-margin optical netting have also been highlighted. However, with the use of machine learning (ML) techniques such support vector machine (SVM), k-NN (k-nearest neighbors), back-propagation, etc. most of these challenges have been overcome. The paper reviews the various optical network based applications in which ML-techniques have been used. Furthermore, the paper highlights the approach of using Wavelength Division Multiplexing (WDM) in optical networks as they provide huge bandwidth to the optical fibers. As a result, traffic can be transmitted simultaneously on several non-overlapping channels. This paper presents a comparative analysis of the existing approaches with the aim of attaining a future direction toward better outcomes. [ABSTRACT FROM AUTHOR]

Novel coding and modulation methods are required for fulfilling the demands of 5G and beyond cellular communication systems. In this paper, an innovative time diversity non-orthogonal multiple access (TD-NOMA) approach is proposed for 5G applications. The suggested system uses time diversity (TD) in conjunction with NOMA to improve the system bit error rate (BER) performance. The NOMA technique basically employes data transmission based on non-orthogonal basis functions. The data pass through the channel, and the desired signal can be obtained by a successive interference cancelation (SIC) receiver. Using different subcarriers and channel models, different modulation schemes such as QPSK and BPSK are investigated. When compared to conventional methodologies, the simulation results reveal that the proposed system outperforms them; it reduces the effect of fading for the multipath channel and enhances the BER. [ABSTRACT FROM AUTHOR]

To support high bandwidth demands, optical networks are widely used for the past few decades. In this manuscript, the author proposes the pure fiber Bragg Grating (FBG) based remote node architecture that is responsible for realizing the flexible, energy-efficient, and reliable optical access network. The architecture can transmit the data to the user end with better reliability and improved bit error rate (BER) performance. The proposed architecture can support point-to-point (P2P) dedicated, point to multipoint broadcasted data transmission. The architecture can broadcast the downstream data to all the available users in the network or within a group of specific users associated with a particular optical distribution network (ODN). The architecture also provides an excellent feature of scaling and/or extending the legacy network as it grows shortly. The proposed architecture can transmit data at a very high speed (up to 40 Gbps) for transmission distances up to 20 km without the use of any amplifier for handling various internet applications in a smart city with higher reliability, least complexity, lower power, and cost consumption. The architecture can reduce the energy consumption of upto ~ 30% of the total energy consumption. For the considered conditions, it can save average energy of up to 42 Wh per day, accumulating to upto 15.33 KWh for the entire year. The proposed architecture may be useful for the realization of the concept of smart cities and for supporting the next generation of access networks. [ABSTRACT FROM AUTHOR]

Introduction: Effective communication between patients with psoriatic arthritis (PsA) and their physicians is important for optimizing treatment outcomes. We assessed the quality of patient–physician communication in terms of awareness and impact of PsA symptoms, their levels of satisfaction, and their perceptions of communications. Methods: A global online survey was conducted by The Harris Poll in adult patients with PsA and physicians managing patients with PsA in eight countries. Participating physicians were either rheumatologists or dermatologists seeing ≥ 10 and ≥ 5 patients with PsA per month, respectively. Patient and physician groups were unmatched. Patient–physician communication was assessed with 35–60 questions regarding discussion topics during consultations, levels of satisfaction with communication, and specific communication issues. Results: A total of 1286 patients with PsA (983 and 303 whose primary treating physician was a rheumatologist or dermatologist, respectively) and 1553 physicians (795 rheumatologists and 758 dermatologists) completed the survey. Regardless of whether they were primarily treated by a rheumatologist or dermatologist, most patients reported a social (84% and 81%, respectively) or work (81% and 80%, respectively) impact of PsA, and a major/moderate negative impact on their physical activity levels (79% and 74%, respectively) or emotional/mental wellbeing (69% and 68%, respectively). Physician responses were generally consistent with this; however, physicians often appeared to under-recognize the extent to which PsA affects patients. Most (≥ 85%) patients and physicians were very/somewhat satisfied with their patient–physician communication, and most (≥ 86%) patients were comfortable raising their concerns/fears with their physician. However, > 40% of patients were identified as being at risk of suboptimal communication. These patients were significantly less likely to report their PsA symptoms even when asked, were less comfortable discussing the impacts of PsA with their physician, and were more likely to experience major/moderate impacts of PsA on their health-related quality of life (HRQoL). Conclusions: Physicians often underestimate the impacts of PsA, compared with patients, and some patients may be at risk of suboptimal communication with their attending physician, which may worsen the HRQoL impacts of PsA. These findings highlight a need for ways to improve communication between patients with PsA and their healthcare providers. Plain Language Summary: Psoriatic arthritis (PsA) is a disease that can cause swollen and painful joints, as well as skin psoriasis. To effectively treat PsA, it is important that doctors and patients communicate well. We used a survey to ask patients with PsA and doctors from around the world about their communications about PsA. We also asked how PsA affects patients' quality of life. In total, 1286 patients and 1553 doctors took the survey. Most patients said that PsA affected their social and work lives. Similarly, PsA had a negative impact on physical activity and on emotional and/or mental wellbeing in most patients who answered the survey. Doctors answered similarly, but they were generally less likely to recognize how severely PsA can impact patients, compared with patients themselves. Most patients and doctors were happy with their patient–doctor communication, and most patients felt comfortable talking about their worries and/or fears with their doctor. However, some patients (about four out of 10) felt that communication with their doctors was not good; these patients were less likely/comfortable to talk about their PsA symptoms and the impacts of PsA with their doctor. PsA was also more likely to negatively impact these patients' quality of life. This survey shows that it is important to find ways to improve communication between patients with PsA and their doctors. [ABSTRACT FROM AUTHOR]

To handle the massive high-speed internet traffic, free space optics (FSO) or single-mode fiber (SMF) based fiber optic communication is being used everywhere across the world. These technologies are capable of providing huge bandwidth and transmitting the data at very high speed with low energy consumption. FSO is a very convenient technology to quickly expand the legacy network in the adverse geographical areas. However, its link performance is highly dependent of inconsistent weather conditions. SMF based fiber optic link has a very low loss and its performance is almost independent on the weather conditions. Though, the installation and maintenance of fibers are quite complex and costly. Individually, FSO or SMF links have their limitations and have to be integrated to leverage their benefits. In this paper, we integrated FSO/SMF links and compared the performance of the proposed architecture which is capable of providing high-speed dual-rate data transmission. The proposed architecture transmits data over either FSO or SMF or both links simultaneously and has 100% more reliability against any one of the link failures. In case of operational link failure (FSO/SMF), data may be switched to the alternative working link (SMF/FSO), simply by tuning the transmitted signal by 50 GHz. The proposed architecture is also reliable against the optical line terminal transceiver (TRx) failure as each user located in the network can be served by two transceivers (1 Gbps and 10 Gbps). The proposed architecture also supports the wavelength division multiplexing overlay transmission for broadcasting the common signal to all the available users in the networks. The architecture reduces ~ 27% of the energy consumption by utilizing the appropriate link of hybrid architecture and TRx according to weather conditions and traffic load. The integrated architecture looks attractive for providing energy-efficient, high speed, and reliable internet coverage to the areas where there is a difficulty of laying fibers and has frequent fiber faults. The architecture is useful for strengthening and boosting rural and urban development. [ABSTRACT FROM AUTHOR]

This paper aims to improve the traffic system through an imaging receiver. Different modulation schemes for visible light communication (VLC) are investigated, including On–Off Keying (OOK), L-Pulse Position Modulation (L-PPM), and Inverse L-Pulse Position Modulation (I-L-PPM) schemes. Considering a road with three lanes, the received information changes according to many factors such as the communication distance and the number of pixels for the imaging receiver. A simple traffic model has been proposed and analyzed for optimizing several remarkable characteristics, including signal to noise ratio (SNR), required average power, bit error rate (BER), and modulation scheme. The simulation results show that, an imaging receiver with 64 × 64 pixels is a good choice for a communication distance in the range 10–50 m between vehicle and traffic light. Also, in the three lanes, the received information increases with the number of pixels. The replacement of a photodiode with an imaging receiver enhances the SNR and reduces both required transmitter power and BER. It is found that 10 dB less power is required in 16-PPM scheme requires than that required by the 16-I-PPM, but in the expense of bandwidth used. [ABSTRACT FROM AUTHOR]

Objectives: To study whether a trained convolutional neural network (CNN) can be of assistance to radiologists in differentiating Coronavirus disease (COVID)–positive from COVID-negative patients using chest X-ray (CXR) through an ambispective clinical study. To identify subgroups of patients where artificial intelligence (AI) can be of particular value and analyse what imaging features may have contributed to the performance of AI by means of visualisation techniques. Methods: CXR of 487 patients were classified into [4] categories—normal, classical COVID, indeterminate, and non-COVID by consensus opinion of 2 radiologists. CXR which were classified as "normal" and "indeterminate" were then subjected to analysis by AI, and final categorisation provided as guided by prediction of the network. Precision and recall of the radiologist alone and radiologist assisted by AI were calculated in comparison to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. Attention maps of the CNN were analysed to understand regions in the CXR important to the AI algorithm in making a prediction. Results: The precision of radiologists improved from 65.9 to 81.9% and recall improved from 17.5 to 71.75 when assistance with AI was provided. AI showed 92% accuracy in classifying "normal" CXR into COVID or non-COVID. Analysis of attention maps revealed attention on the cardiac shadow in these "normal" radiographs. Conclusion: This study shows how deployment of an AI algorithm can complement a human expert in the determination of COVID status. Analysis of the detected features suggests possible subtle cardiac changes, laying ground for further investigative studies into possible cardiac changes. Key Points: • Through an ambispective clinical study, we show how assistance with an AI algorithm can improve recall (sensitivity) and precision (positive predictive value) of radiologists in assessing CXR for possible COVID in comparison to RT-PCR. • We show that AI achieves the best results in images classified as "normal" by radiologists. We conjecture that possible subtle cardiac in the CXR, imperceptible to the human eye, may have contributed to this prediction. • The reported results may pave the way for a human computer collaboration whereby the expert with some help from the AI algorithm achieves higher accuracy in predicting COVID status on CXR than previously thought possible when considering either alone. [ABSTRACT FROM AUTHOR]

India's commitment to Paris Climate Change Agreement through its Nationally Determined Contribution (NDC) will require the energy system to gradually move away from fossil fuels. The current energy system is witnessing a transformation to achieve these through renewable energy targets and enhanced energy efficiency (EE) actions in all sectors. More stringent global GHG mitigation targets of 2 °C and well below 2 °C regimes would impose further challenges and uncertainties for the Indian energy systems. This paper provides a quantitative assessment using bottom-up optimization model (AIM/Enduse) to assess these until 2050 for meeting carbon mitigation commitments while achieving the national sustainable development goals. Energy transformation trajectories under five scenarios synchronized with climate mitigation regimes are explored—Business As Usual scenario (BAU), NDC scenario, 2 °C scenarios (early and late actions), and well below 2 °C scenario. The key results from the study include (a) coal-based power plants older than 30 years under NDC and older than 20 years for deeper CO2 mitigation will be stranded before their lifetime, (b) increase in renewables of up to 225–280 GW by 2050 will require battery storage with improved integrated smart grid infrastructure, (c) growth in nuclear to 27–32 GW by 2050 is dependent on nuclear supply availability, (d) gradual shift towards electrification in industry, building, and transport sectors, and (e) installation of CCS technologies in power and industry sectors. Cumulative investments of up to 6–8 trillion USD (approximately) will be required during 2015–2030 to implement the actions required to transform the current energy systems in India. [ABSTRACT FROM AUTHOR]

This study looks into the development of multi-level classification approach for land use change mapping in Indian cities using Landsat imageries. In this study, we mapped 47 Indian cities at different time frames 1990, 2000, 2010, and 2017. We started with traditional classification methods, but results provided unsatisfactory accuracy levels. Thus, we employed multiple classification techniques to achieve results with higher accuracy. The paper captures the evaluation of different classification techniques—hybrid, unsupervised, decision tree classification (DTC), and object-based image analysis (OBIA). The results suggest improvement in accuracy levels by using multi-level classification for different cities at different stages of the classification process. The most prominent is the hybrid classification technique; 14 cities out of 47 reached to accuracy above 72% through hybrid classification. For problematic classes, we used DTC, OBIA, and unsupervised classification techniques after masking the datasets. DTC was used in cities with a greater number of problems in datasets. For example, in the case of Kochi City, the accuracy at the initial level was reported 51% through unsupervised classification which improved to 77% (supervised classification), and finally, it reached 90% by DTC technique. The overall accuracy achieved through the multi-level classification approach described in this paper for the 47 Indian cities ranges from 81 to 93%. [ABSTRACT FROM AUTHOR]

Background and Objective: The International Dermatology Outcome Measures (IDEOM) has defined a core set of domains to be measured in all psoriasis clinical trials. This set comprises the following domains: skin manifestations, psoriasis and psoriatic arthritis symptoms, health-related quality of life, investigator global, patient global, and treatment satisfaction. The next step is to define how to measure these domains. The objective of this article was to evaluate the quality of available instruments to assess 'investigator global' and 'patient global' domains to identify the most appropriate instruments. Methods: Reviewers conducted a systematic literature review to retrieve studies on the measurement properties of instruments including either an investigator global assessment or a patient global assessment. Following the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, three independent reviewers rated the quality of each study. We then performed a qualitative synthesis of the evidence. Results: We identified nine investigator global assessments and three patient global assessments, reflecting substantial variability in global assessment instruments. Overall, most measures lacked evidence for content validity and feasibility. The Lattice System-Physician Global Assessment, Product of the Investigator Global Assessment and Body Surface Area, and the professional-Simplified Psoriasis Index had higher levels of evidence for validity, reliability, and/or responsiveness than the 5- and 6-point investigator global assessments. The self-assessment-Simplified Psoriasis Index was the only patient global assessment with evidence for validity, reliability, and responsiveness. Conclusions: The 5- and 6-point investigator global assessments, which are the most widely used investigator global assessments in registered clinical trials, have less evidence for measurement properties as compared with the Lattice System-Physician Global Assessment, professional-Simplified Psoriasis Index, and the Product of the Investigator Global Assessment and Body Surface Area. However, all instruments lack evidence for content validity and feasibility. Further validation studies of investigator global assessments and patient global assessments are required to recommend the best global measure for psoriasis clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: To study the various pain assessment tools based on their psychometric properties and ease of use.Methods: Published articles on psychometric properties of pain tools were accessed and data collected for low back pain (LBP)-specific tools, generic tools, neuropathic LBP tools, tools for cognitively impaired patients, and tools for acute LBP.Results: Among the LBP-specific tools, Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) have good construct validity and reliability, and responsiveness over short intervals. Quebec Back Pain Disability Scale (QBPDS) gauges only disability and sleep. Among the generic tools, McGill Pain Questionnaire (MPQ), West Haven-Yale Multidimensional Pain Inventory (MPI), and Brief Pain Inventory (BPI) show good responsiveness, but BPI is the only tool validated for LBP. Neuropathic Pain Scale (NPS) and Short Form-MPQ-2 (SF-MPQ-2) are both reliable tools for neuropathic LBP. For cognitively impaired patients, Pain Assessment in Advanced Dementia (PAINAD), Abbey Pain Scale (APS), and Doloplus-2 are all reliable tools, but PAINAD has good construct validity. For acute pain, Clinically Aligned Pain Assessment (CAPA) is reliable and responsive, but presently, unidimensional tools and SF-MPQ-2 are the tools most preferred.Conclusion: Based on psychometric properties and ease of use, the best tools for LBP seem to be RMDQ/ODI (among LBP-specific tools), BPI (among generic tools), SF-MPQ-2/NPS (for neuropathic LBP), PAINAD (for cognitively impaired patients), and unidimensional tools and SF-MPQ-2 (for acute pain). Overall, BPI seems to be a tool that can be relied upon the most. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the pharmacokinetics (PK) of pertuzumab and trastuzumab in patients with HER2-positive metastatic gastric or gastroesophageal junction cancer in the randomized, double-blind, phase III JACOB study (NCT01774786), and to evaluate the appropriateness of the pertuzumab regimen in these patients.Methods: Patients received 840 mg intravenous pertuzumab or placebo plus trastuzumab q3w and chemotherapy. Pertuzumab and trastuzumab were administered until disease progression or unacceptable toxicity. Chemotherapy was administered for up to six cycles or disease progression or unacceptable toxicity. Serum concentrations of pertuzumab and trastuzumab were measured. Pertuzumab PK was characterized across treatment cycles. The impact of anti-drug antibodies (ADAs) on pertuzumab PK and the impact of pertuzumab on trastuzumab PK were assessed. An exploratory exposure-efficacy analysis was also conducted.Results: In total, 374 patients in the pertuzumab arm had evaluable PK data. The mean observed pertuzumab steady-state serum trough (minimum) concentration (Cmin,ss) ± standard deviation was 114 ± 51.8 μg/mL. The target pertuzumab Cmin,ss of ≥ 20 μg/mL was reached in 99.3% of patients at Cycle 5 (steady state) and beyond. Greater than 90% of patients were above the PK target right after the first pertuzumab dose. There was no apparent impact of ADAs on pertuzumab PK nor of pertuzumab on trastuzumab PK. There were no differences in overall survival across Cycle 1 pertuzumab (Cmin) or Cycle 5 pertuzumab (Cmin,ss) exposure quartiles.Conclusions: Pertuzumab exposure in JACOB was consistent with prior studies in advanced gastric cancer and breast cancer. The 840 mg q3w dose allowed the majority of patients in JACOB to achieve target pertuzumab concentrations and appears to be an appropriate dose selection. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the pharmacokinetics (PK) of, and perform an exploratory exposure-response (E-R) analysis for, pertuzumab in patients with HER2-positive early breast cancer (EBC) within the APHINITY study (NCT01358877, BIG 4-11/BO25126/TOC4939G).Methods: A previously developed pertuzumab two-compartment linear population pharmacokinetic (popPK) model was subjected to external validation to examine appropriateness for describing pertuzumab concentrations from the APHINITY study. Pharmacokinetic drug-drug interactions (DDIs) between pertuzumab, trastuzumab, and chemotherapy were assessed by comparing observed serum or plasma Cmax, Cmin, and AUClast geometric mean ratios with 90% CIs. Predictions of pertuzumab Cmax,ss, Cmin,ss, and AUCss were derived from individual parameter estimates and used in an exploratory E-R analysis.Results: Using data from 72 patients, based on goodness-of-fit, the popPK model was deemed appropriate for predictions of individual exposures for subsequent comparisons to historical data, assessment of DDIs, and E-R analyses. No evidence of DDIs for pertuzumab on trastuzumab, trastuzumab on pertuzumab, or pertuzumab on chemotherapy PK was observed. Analyses of differences in exposure between patients with and without invasive disease-free survival events did not indicate improved efficacy with increased exposure. Overall Grade ≥ 3 diarrhea prevalence was higher with pertuzumab versus placebo, but was not greater with increasing pertuzumab exposure. No apparent E-R relationship was suggested with respect to other grade ≥ 3 AEs.Conclusion: Overall, the limited available data from this exploratory study suggest that no dose adjustments are needed for pertuzumab when administered in combination with trastuzumab and an EBC chemotherapy regimen. [ABSTRACT FROM AUTHOR]

Graphene oxide (GO), a precursor to graphene, contains sp2 as well as sp3 hybridized carbon atoms because of its covalently attached oxygen functional groups. This functionalization makes it hydrophilic and gives room for band-gap tuning, making it pertinent for optical and electronic applications. This extraordinary characteristic of GO has resulted in several GO synthesis mechanisms reported in the literature, but still the meagreness of tailoring of optical properties of chemically derived GO for opto-electronic applications persists. This article is an effort to discuss the pros and cons of oxidation strategies with a focus on characterisation details for non-linear optic (NLO) applications. In this review, advancement of graphene in non-linear optics is shown by several recent results employing a 532-nm laser with 4-ns pulses and correlation between ID/IG and La (sp2 crystallite size) established to predict a better oxidation mechanism for NLO devices. The established correlation analysis of suggests the mild oxidation method is the best GO synthesis technique that will result in the best rGO oxidation–reduction route specifically for NLO applications. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to characterize the population pharmacokinetics (PK) of the intravenous formulation of trastuzumab, assess the impact of patient and pathological covariates on trastuzumab PK, and perform simulations to support dosing recommendations in special situations.Methods: Serum trastuzumab concentrations were obtained from 1582 patients with metastatic breast cancer (MBC), early breast cancer (EBC), advanced gastric cancer (AGC), or other tumor types/healthy volunteers in 18 phase I, II, and III trials and analyzed by nonlinear mixed-effects modeling.Results: A two-compartment model with parallel linear and nonlinear elimination best described the data. During treatment, linear clearance (CL) dominated, resulting in a total CL of 0.173-0.337 L/day, which is similar to other IgG1 monoclonal antibodies. Covariates influencing CL were baseline body weight, aspartate aminotransferase, albumin, gastric cancer, and the presence of liver metastases. MBC and EBC had similar PK parameters, while CL was higher in AGC. Simulations indicated that at least 95% of patients with BC reach concentrations < 1 µg/mL (~ 97% washout) by 7 months. A dose delay in BC or AGC patients of > 1 week would take approximately 6 weeks to get back within steady-state exposure range.Conclusions: Trastuzumab PK for the intravenous formulation was well-described across cancer types, disease status, and regimens. No dose adjustment is required for any of the identified patient covariates. A 7-month serum washout period for trastuzumab is recommended. A reloading dose is required if a maintenance dose is missed by > 1 week. [ABSTRACT FROM AUTHOR]

Psoriatic arthritis (PsA) is rarely assessed in psoriasis randomized controlled trials (RCT); thus, the effect of psoriasis therapy on PsA is unknown. The International Dermatology Outcome Measures (IDEOM) has included “PsA Symptoms” as part of the core domains to be measured in psoriasis RCT. This study aimed to achieve consensus about screening for PsA and how to measure for “PsA Symptoms” in psoriasis RCT. At the IDEOM 2017 Annual Meeting, stakeholders voted on the role of PsA screening in psoriasis RCT. To select measures for “PsA Symptoms”, we adapted the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Three potential measures were selected. At the meeting, stakeholders voted on the validity, feasibility, and responsiveness of these measures. Of the 47 stakeholders, 93% voted that all psoriasis trial participants should be screened for PsA. “PsA Symptoms” measures included Patient Global (PG)-arthritis, Routine Assessment Patient Index Data (RAPID)-3, and Psoriatic Arthritis Impact of Disease (PsAID)-9. During the voting, more than 50% of the voters agreed that RAPID3 and PsAID9 were good measures for PsA Symptoms, able to capture all its essential elements. PsAID9 was considered the most feasible instrument, followed by RAPID3 and PG-arthritis, respectively. Finally, most participants agreed that RAPID3 and PsAID9 were responsive measures. Most study participants voted that all subjects in a psoriasis clinical trial should be screened for PsA. RAPID3 and PsAID9 outperformed PG-arthritis in measuring PsA Symptoms. This will be followed by a Delphi survey involving a larger stakeholder group. [ABSTRACT FROM AUTHOR]

This paper proposes a resilient, bandwidth scalable and energy efficient WDM-TDM passive optical network (PON) architecture that provides network access services to the end user at very high data rates and reduces the power consumption of access network significantly in the presence of low traffic/underutilized network. The proposed power saving technique includes the efficient use of proper line cards (LC) and adaptive link rate (ALR) mechanism at optical line terminal located at the central office. In the presence of low traffic, ALR switches link rate from 10 to 1 Gbps depending on the particular threshold value of traffic load. In the presence of narrowband traffic, a significant amount of energy is saved. Proposed architecture also saves capital expenditure (CAPEX) at remote node and reduces significant CAPEX for larger networks. This architecture also provides network resiliency against LC/TRx or module failure and bandwidth scalability to support future generation PON architectures without any service interruption. [ABSTRACT FROM AUTHOR]

This paper reviews various energy efficient approaches in existence and proposes a Hybrid WDM-TDM PON architecture that allows the adaptive bandwidth allocation mechanism to reduce central office power consumption with acceptable performance. Our proposed architecture allows sending two signals, one broadband and other narrowband to each optical networking unit so an appropriate signal can be utilized according to the traffic demand. In case of very low traffic, only narrowband signal is used and a significant amount of energy consumption and OPEX is reduced. By using $$2\times \hbox {N}$$ power splitter and interleaver, proposed architecture provides broadcasting at both broadband and narrowband signal depending on the required link rate. This further reduces energy consumption and OPEX by avoiding the transmission of same signal from multiple sources. Offered data rates to the optical distribution networks (ODNs) may also be varied by doubling the wavelength spacing of remote node AWG so that two contiguous wavelengths can be transmitted at each port or ODN. This provides the geographical dynamic bandwidth allocation. Proposed architecture also support simultaneous transmission of both broadband and narrowband signals to the ODN to provide bandwidth scalability and network extensibility for supporting future access network in terms of new users and data rates. As two signals are reaching to any ODN, resiliency against OLT TRx and line card failure is also achieved. The performance of the proposed design is verified by simulation results in terms of bit error rate and receiver sensitivity to demonstrate its feasibility for the next-generation optical access network. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis. Study Design: Prospective cohort study. Setting: A tertiary-care center at a public hospital. Participants: 475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015. Intervention: Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis. Main outcome measures: Increase in culture-positivity rate with use of two blood cultures. Results: 475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) ( n=10) and Candida spp. ( n=15) in either of the two cultures. Conclusion: Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture. [ABSTRACT FROM AUTHOR]

Purpose: The NeoSphere trial evaluated pertuzumab in the neoadjuvant setting [early breast cancer (EBC)] with pathological complete response (pCR) as the primary efficacy end point. This analysis of pertuzumab aimed to (1) compare its pharmacokinetics (PK) in patients with EBC versus advanced cancers, (2) to further evaluate PK drug-drug interactions (DDIs) when given in combination with trastuzumab, and (3) to assess the relationship between exposure and efficacy to assess the clinical dosing regimen in the EBC patients.Methods: Pertuzumab serum concentration data from 180 patients in NeoSphere were compared to historical observations and potential DDI was assessed, by applying simulation techniques using a population PK model. The impact of pertuzumab exposure on pCR rate was evaluated using a logit response model (n = 88).Results: The observed PK matched the population PK model simulations, confirming that the PK in neoadjuvant EBC appear to be in agreement with the historical observations. No evidence of a DDI effect of trastuzumab or docetaxel on pertuzumab was observed supporting the doses when given in combination. In NeoSphere >90% of EBC patients achieved the non-clinical target serum concentration. There was no association between the pertuzumab serum concentration and pCR within the range observed in this study (20-100 μg/mL) supporting no dose adjustments needed for patients with lower exposure.Conclusions: This analysis further supports the lack of DDI between the two therapeutic proteins and the appropriateness of the approved fixed non-body-weight-adjusted pertuzumab dose in the treatment of neoadjuvant EBC with pertuzumab in combination with trastuzumab and docetaxel. [ABSTRACT FROM AUTHOR]

The article presents several case studies of diseases among children. Topics include a 7-month-old girl who was diagnosed with severe hyponatremia with urinary malformation and pyelonephritis, a 6-year-old child who was successfully treated for the child's isolated splenic rupture with severe hemophilia A, and a 9-year-old boy who develops Staphylococcus xylosus meningitis after being bitten by a dog.

Unlabelled: The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on hematological parameters (serum ferritin and hemoglobin) at 6 weeks of life in term neonates. It was a randomized controlled trail conducted at a teaching hospital in North India during August 2012 to August 2013. Babies born at >36 weeks of gestation were randomized in two groups, UCM and DCC (100 in each group). Umbilical cord milking was done after cutting and clamping the cord at 25 cm from the umbilicus. In DCC group, clamping was delayed by 60 to 90 s before cutting the cord. The baseline characteristics were comparable in the two groups. Mean serum ferritin (134.0 ng/ml [89.8]) and mean hemoglobin (11.0 gm/dl [2.4]) in umbilical cord milking group was comparable to mean serum ferritin (142.7 ng/ml [87.1]) and hemoglobin (11.3 gm/dl [2.6]) in DCC group at 6 weeks of age. There was no difference in hemodynamic status, cranial Doppler indices, and adverse neonatal outcomes among the two groups.Conclusion: In term neonates, the DCC and UCM had comparable effect on hematological parameters at 6 weeks of life.What Is Known: • Delayed cord blood clamping improves certain hematologic parameters for neonates, which is potentially important in populations with high rates of neonatal and childhood anemia, but that delayed cord blood clamping may not be feasible in clinical situations when neonatal resuscitation is urgent.What Is New: • There is no significant difference in ferritin and hemoglobin levels at 6 weeks among term, Indian neonates who had UCM and DCC and that this study may give support to the practice of UCM in term deliveries when DCC is not feasible. [ABSTRACT FROM AUTHOR]

Background: Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of the inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. Methods: This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children ranging in age from 1 month to 18 years undergoing CPB. Plasma IL-6 and IL-10 concentrations were measured preoperatively and postoperatively [day 1 (within 6 h after surgery) and day 3]. Results: Stage 2/3 AKI, defined by at least a doubling of the baseline serum creatinine concentration or dialysis, was diagnosed in 24 (23 %) patients. The preoperative IL-6 concentration was significantly higher in patients with stage 2/3 AKI [median 2.6 pg/mL, interquartile range (IQR) 2.6 0.6-4.9 pg/mL] than in those without stage 2/3 AKI (median 0.6 pg/mL, IQR 0.6-2.2 pg/mL) ( p = 0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a sixfold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted odds ratio 6.41, 95 % confidence interval 1.16-35.35). IL-6 and IL-10 levels increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 measurements did not significantly differ between patients with stage 2/3 AKI and those without stage 2/3 AKI. The elevated IL-6 level on day 3 was associated with longer hospital stay ( p = 0.0001). Conclusions: Preoperative plasma IL-6 concentration is associated with the development of stage 2/3 AKI and may be prognostic of resource utilization. [ABSTRACT FROM AUTHOR]

Neoadjuvant chemotherapy is a standard treatment option for patients with locally advanced operable breast cancer and is increasingly used in early breast cancer. Initial randomized trials of neoadjuvant chemotherapy established equivalency to adjuvant chemotherapy in terms of survival, but they also demonstrated improved rates of breast conservation and the ability to modify the risk of locoregional recurrence after a favorable response to chemotherapy. High-quality nonrandomized data have helped to tailor radiotherapy treatment recommendations after neoadjuvant chemotherapy and breast-conserving surgery or mastectomy. Results from an ongoing phase 3 randomized trial (NSABP B-51/RTOG 1304) will help to clarify the value of locoregional radiotherapy for patients with clinical N1 disease that becomes node negative after neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

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