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Municipal leaders are pursuing ambitious goals to increase urban tree canopy (UTC), but there is little understanding of the pace and socioecological drivers of UTC change. We analyzed land cover change in Philadelphia, Pennsylvania (United States) from 1970–2010 to examine the impacts of post-industrial processes on UTC. We interpreted land cover classes using aerial imagery and assessed historical context using archival newspapers, agency reports, and local historical scholarship. There was a citywide UTC increase of +4.3 percentage points. Substantial UTC gains occurred in protected open spaces related to both purposeful planting and unintentional forest emergence due to lack of maintenance, with the latter phenomenon well-documented in other cities located in forested biomes. Compared to developed lands, UTC was more persistent in protected open spaces. Some neighborhoods experienced substantial UTC gains, including quasi-suburban areas and depopulated low-income communities, the latter also experienced decreasing building cover. We identified key processes that drove UTC increases, and which imposed legacies on current UTC patterns: urban renewal, urban greening initiatives, quasi-suburban developments, and (dis)investments in parks. Our study demonstrates the socioecological dynamism of intra-city land cover changes at multi-decadal time scales and the crucial role of local historical context in the interpretation of UTC change.

This report provides detailed protocols for urban tree monitoring data collection. Specifically, we discuss the core variables necessary for field-based monitoring projects, including field crew identification, field crew experience level, tree record identifier, location, site type, land use, species, mortality status, crown vigor, and trunk diameter. The intent of this Field Guide is to serve urban forest managers and researchers who collect longitudinal field data on urban trees, as well as interns and citizen scientists. This report is a companion document to Urban Tree Monitoring: A Resource Guide.

Purpose The radiobiology of prostate cancer may favor the extreme hypofractionation inherent in stereotactic body radiation therapy (SBRT); however, data from a large multicenter study are lacking. We therefore examined the hypothesis that dose-escalated SBRT can be safely administered across multiple institutions, with favorable 5-year disease-free survival (DFS) rates compared with historical controls. Methods and Materials Twenty-one centers enrolled 309 patients with prostate adenocarcinoma: 172 with low-risk (LR) and 137 with intermediate-risk (IR) disease. All were treated with a non-coplanar robotic SBRT platform using real-time tracking of implanted fiducials. The prostate was prescribed 40 Gy in 5 fractions of 8 Gy. We assessed toxicities using Common Terminology Criteria for Adverse Events (CTCAE) version 3 and biochemical failure using the “nadir + 2” definition. The study population yielded 90% power to identify excessive (>10%) rates of grade ≥3 genitourinary (GU) or gastrointestinal toxicities and, in the LR group, 80% power to show superiority in DFS over a 93% historical comparison rate. Results At a median follow-up of 61 months, 2 LR patients (1.2%) and 2 IR patients (1.5%) experienced grade 3 GU toxicities, far below the 10% toxicity rate deemed excessive (upper limits of 95% confidence interval, 3.5% and 4.3%, respectively). No grade 4 or 5 toxicities occurred. All grade 3 toxicities were GU, occurring 11 to 51 months after treatment. For the entire group, the actuarial 5-year overall survival rate was 95.6% and the DFS rate was 97.1%. The 5-year DFS rate was 97.3% for LR patients (superior to the 93% DFS rate for historical controls; P = .0008; lower limit of 95% confidence interval, 94.6%) and 97.1% for IR patients. Conclusions Dose-escalated prostate SBRT was administered with minimal toxicity in this multi-institutional study. Relapse rates compared favorably with historical controls. SBRT is a suitable option for LR and IR prostate cancer.

Baroreceptor activation therapy (BAT) has been available for several years for treatment of therapy-refractory hypertension (trHTN). This procedure is currently being carried out in a limited number of centers in Germany, also with the aim of offering a high level of expertise through sufficient experience; however, a growing number of patients who are treated with BAT experience problems that treating physicians are confronted with in routine medical practice. In order to address these problems, a consensus conference was held with experts in the field of trHTN in November 2016, which summarizes the current evidence and experience as well as the problem areas in handling BAT patients.

As the collective impact of human activity approaches Earth's biophysical limits, the ethics of food become increasingly important. Hundreds of millions of people remain undernourished, yet only 60 percent of the global harvest is consumed by humans, while 35 percent is fed to livestock and 5 percent is used for biofuels and other industrial products. This essay considers the ethics of such use of edible nutrition for feedstock and biofuel. How humanity uses Earth's land is a reflection of its values. The current land-use arrangements, which divert 40 percent of all food to feed animals or create fuels, suggest that dietary and transportation preferences of wealthier individuals are considered more important than feeding undernourished people, or the stability of the wider biotic community.

Traditional endpoints such as local recurrence, distant recurrence and survival are indisputably valuable endpoints steering to improve care for patients with rectal cancer. Multimodal treatment and auditing has improved rectal cancer care enormously in the past decades. Local recurrence rates are very low and survival is increasing in time.

Blast vibrations are considered among the primary factors in destabilising cemented rockfill (CRF) stopes in open stoping systems with delayed backfill. This destabilisation occurs when the backfill face is subjected to blasting of an adjacent stope. Inadequate cementation, backfilling practices and blasting of adjacent stopes can be the causes of CRF failure and hence ore dilution. Poor blasting practices can cause greater blast vibrations and therefore can initiate fill failure. The magnitude of blast vibrations can be controlled by the powder factor and blast design. This study presents the effects of blast vibrations on CRF backfilled stopes. The effect of different blast loads and profiles are examined. Blast loads corresponding to non-ideal blasting are also simulated.

Background: Non-small-cell lung cancer (NSCLC) is a disease of the elderly. Seeking a tolerable but effective regimen, we tested cetuximab + radiation in elderly and/or poor performance status patients with locally advanced NSCLC. Patients and methods: Older patients [≥65 years with an Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2] or younger patients (performance status of 2) received cetuximab 400 mg/m2 i.v. on day 1 followed by weekly cetuximab 250 mg/m2 i.v. with concomitant radiation of 6000 cGy in 30 fractions. The primary end point was the percentage who lived 11+ months. Results: This 57-patient cohort had a median age (range) of 77 years (60–87), and 12 (21%) had a performance status of 2. Forty of 57 (70%) lived 11+ months, thus exceeding the anticipated survival rate of 50%. The median survival was 15.1 months [95% confidence interval (CI) 13.1–19.3 months], and the median time to cancer progression was 7.2 months (95% CI 5.8–8.6 months). No treatment-related deaths occurred, but 31 patients experienced grade 3+ adverse events, most commonly fatigue, anorexia, dyspnea, rash, and dysphagia, each of which occurred in

This paper examines stope design approaches employed at a metal mining operation in Canada for extraction of transverse primary, transverse secondary, and longitudinal stopes. Variations in stope and slot design, blast design, and blast vibration attenuation are presented in detail. It is shown that the type of blasthole stoping technique employed varies according to stope sequence and ore zone width. Within this range of stopes, blasting design practices have been standardized in terms of drillhole diameter, powder factor, and the type and pattern of the explosives used.

Range images collected from terrestrial laser scanners hold promise for characterizing forest canopies and facilitating research into linkages between forest structure and function. Applications that aim to make plot-level or canopy-level assessments may ultimately require combining range imagery from multiple viewpoints, a procedure of image co-registration that poses numerous challenges. We developed a method for simultaneously registering multiple range images using explicitly-matched, computer-estimated tie points from natural ground and tree-stem surfaces in two stages. Stage I involved registration using tie points estimated from ground-surfaces, while stage II involved tie points estimated from tree-stem centers. Eight range images were simultaneously aligned based on more than 3000 tie point pairs from ground surfaces, and more than 4000 tie point pairs from tree stems. Tie points were widely dispersed throughout the scanned volume, spanning a horizontal area of 750 m 2 and heights up to 22 m above ground. Results showed accurate image alignments at heights well above ground, with an average post-registration error, for tree-stem-based tie point pairs, of 0.16 cm. When linked to automated algorithms for identification and extraction of tree stems from point clouds, the method developed here should be useful for delivering an array of products related to the detailed assessment of forest canopies and stand structure.

The paper presents the results of a study of the factors causing stope wall overbreak or ore dilution in a blasthole stoping environment. A series of three-dimensional numerical models are developed and analyzed to examine the effect of mining depth, in situ stress as well as stope geometry and orientation on stope wall overbreak. A characteristic orebody and mine design configuration is adopted and used as a basis to carry out comprehensive model parametric study, from which a simple, graphical design tool is derived for the prediction of stope overbreak. It is shown that stope overbreak is significantly affected by the stope aspect ratio and the orientation of major principal in situ stresses with respect to the stope. The methodology presented in this paper can be adopted to develop mine-specific design tools for the estimation of ore dilution associated with a proposed mine design. This can be extremely helpful in the process of underground mine planning and optimization.

Objectives. We investigated the health and safety effects of urban green stormwater infrastructure (GSI) installments. Methods. We conducted a difference-in-differences analysis of the effects of GSI installments on health (e.g., blood pressure, cholesterol and stress levels) and safety (e.g., felonies, nuisance and property crimes, narcotics crimes) outcomes from 2000 to 2012 in Philadelphia, Pennsylvania. We used mixed-effects regression models to compare differences in pre- and posttreatment measures of outcomes for treatment sites (n = 52) and randomly chosen, matched control sites (n = 186) within multiple geographic extents surrounding GSI sites. Results. Regression-adjusted models showed consistent and statistically significant reductions in narcotics possession (18%–27% less) within 16th-mile, quarter-mile, half-mile (P Conclusions. Health and safety considerations should be included in future assessments of GSI programs. Subsequent studies should assess mechanisms of this association.

Background: The purpose of this double-blind, prospective, latin-square crossover randomised study was to examine the efficacy of a mouthrinse solution containing a combination of triclosan, amine fluoride and sodium fluoride on supragingival plaque regrowth compared to a placebo and a chlorhexidine solution. Methods: 12 volunteers refrained after professional oral prophylaxis from all mechanical hygiene measures for the following 96 h and rinsed instead cross-over in a randomised order with either chlorhexidine dicluconate (0.2%, positive control), a verum solution (0.5% amine fluoride, 0.028% sodium fluoride, 0.03% triclosan) or a placebo solution. The plaque index was assessed after 24 and 96 h (PI 1, PI 2) and the plaque area (PA) photographed and calculated after 96 h of undisturbed plaque regrowth. Moreover plaque samples were taken after 24 and 96 h and examined with the vital fluorescence technique to assess the vitality of the biofilm microbiota (VF 1, VF 2). Results: The amine-fluoride-triclosan solution reduced the clinical parameters (PI and PA) as well as the vitality of the plaque flora (VF) significantly when compared to the placebo solution. The verum reached a 36.5% (p

This study was performed to evaluate the outcome of patients with gallbladder cancer who received postoperative concurrent chemotherapy and radiation therapy.Curative resection followed by adjuvant combined modality therapy with external beam radiation therapy (EBRT) and chemotherapy was attempted in 21 consecutive gallbladder carcinoma (GBC) patients at the Mayo Clinic from 1985 through 1997. All patients received concurrent 5-fluorouracil during EBRT. EBRT fields encompassed the tumor bed and regional lymph nodes (median dose of 54 Gy in 1.8-2.0-Gy fractions). One patient received 15 Gy intraoperatively after EBRT. A retrospective analysis was performed for the end points of local control, distant failure, and overall survival.After maximal resection, 12 patients had no residual disease on pathologic evaluation, 5 had microscopic residual disease, and 4 had gross residual disease. One patient had Stage I disease, and 20 had Stage III-IV disease. With median follow-up of 5 years (range: 2.6-11.5 years), 5-year survival for the entire cohort was 33%. The 5-year survival rate of patients with Stage I-III disease was 65% vs. 0% for those with Stage IV disease (p0.02). For patients with no residual disease, 5-year survival was 64% vs. 0% for those with residual disease (p = 0.002). The median survival was 0.6, 1.4, and 5.1 years for patients with gross residual, microscopic residual, and no residual disease, respectively (p = 0.02). The 5-year local control rate for the entire cohort was 73%. Two-year local control rates were 0%, 80%, and 88% for patients with gross residual, microscopic residual, or no residual disease, respectively (p0.01). Five-year local control rates were 100% for the 6 patients who received total EBRT doses54 Gy (microscopic residual, 3 patients; gross residual, 1 patient; negative but narrow margins, 2 patients) vs. 65% for the 15 who received a lower dose (3, gross residual; 2, microresidual; 10, negative margins).Patients with completely resected (negative margins) GBC followed by adjuvant EBRT plus 5-fluorouracil chemotherapy had a relatively favorable prognosis, with a 5-year survival rate of 64%. These results seem to be superior to historical surgical controls from the Mayo Clinic and other institutions, which report 5-year survival rates of approximately 33% with complete resection alone. Both tumor stage and extent of resection seemed to influence survival and local control. More aggressive measures using current cancer therapies and integration of new cancer treatment modalities will be required to favorably impact on the poor prognosis of patients with Stage IV or subtotally resected GBC. Additional investigation leading to earlier diagnosis is warranted, because most patients with GBC present with advanced disease.

Objective: To evaluate the results of irradiation ± chemotherapy for patients with unresectable gastric carcinoma. Materials and Methods: The records of 60 patients with a gastric or gastroesophageal junction adenocarcinoma and a locally advanced unresectable primary (n = 28), a local or regional recurrence (n = 21), or gross residual disease following incomplete resection (n = 11) were retrospectively reviewed. Patients were treated with external beam irradiation (EBRT) alone or external beam plus intraoperative irradiation (IOERT), and 55 of the 60 (92%) patients received 5-FU based chemotherapy. Results: The median survival for the entire cohort was 11.6 months. There was no significant difference in median survival between each of the three treatment groups. In examining the extent of disease there was a significant difference in survival based on the number of sites involved. Nine patients with disease limited to a single non-nodal site appeared to represent a favorable subgroup compared to the rest of the patients (median survival of 21.8 months vs. 10.2 months, p = 0.03). In the patients with recurrent disease, the number of sites involved (p = 0.05), and total dose adding external beam dose to IOERT dose (> 54 Gy vs. ≤ 54 Gy, p = 0.06) were of borderline significance in regard to survival. Conclusions: In patients with either primary unresectable, locally or regionally recurrent, or incompletely resected gastric carcinoma, the overall survival is similar, and related to the extent of disease based on the number of regional sites involved. The patients with a single non-nodal site of disease represent a favorable subgroup and patients with recurrent disease may benefit from total irradiation doses > 54 Gy.

Summarization: The task of objective perimetry is to scan the visual field and find an answer about the function of the visual system. Flicker-burst stimulation--a physiological sensible combination of transient and steady-state stimulation--is used to generate deterministic sinusoidal responses or visually evoked potentials (VEP's) at the visual cortex, which are derived from the electroencephalogram by a suitable electrode array. In this paper we develop a new method for the detection of VEP's. Based on the periodogram of a time-series, we test the data for the presence of hidden periodic components, which correspond to steady-state VEP's. The method is applied successfully to real data Παρουσιάστηκε στο: IEEE Transactions Biomedical Engineering

This chapter describes advanced transmission technologies and state-of-the-art transmission concepts to improve vehicle performance. Different types of transmission in terms of concept and design have been reflected and evaluated to meet environmental requirements, emission legislation and customers’ demands for driving pleasure in the next generation of vehicles. Since the introduction of the first four-speed automatic transmission at Mercedes-Benz, more than 50 years’ experience in producing and developing automatic and manual transmissions have passed. These transmissions have undergone continuous development since their introduction with six decades of experience in the field of automatic and manual transmission development.

This article presents results obtained from single-set analysis, and an increase in the SNR is derived and demonstrated by real data. In addition, some aspects of practical signal analysis and detection are discussed. It is concluded that, being a relatively simple method for analyzing biosignals, the bispectrum turns out to be very efficient for the detection of phase-coupled harmonics in background noise. The results obtained so far for steady-state visually evoked potentials suggest that there are nonlinearities of at least seventh order in the conduction and processing of the stimuli. Therefore, future research will be carried out to detect this phenomenon. A necessary condition for using conventional detectors is the whiteness of noise. Since higher-order spectra are used in the analysis of biosignals, an appropriate prewhitening algorithm for higher-order moments needs to be developed.

In ophthalmologic diagnostics well-defined light stimuli are used to study the visual system. Sensor arrays are used in applications where the signal-to-noise ratio is very low or where the spatial structure of the signal is of interest. Since the signal-to-noise ratio can be exponentially increased with the designed function it can be assumed, that the reliability of signal detection will also significantly increase. In other words, for a given false detection probability, the necessary amount of data should significantly decrease. If the preconditions regarding the noise (spatial and temporal noncorrelatedness) and the signal (constant shape over the channels) are fulfilled, a detector could be used as a simple mean-value discriminator. A suitable signal detector based on the desired function and the influence of signal and noise parameters on the detection reliability will be investigated in future work. >

Background: Atopic dermatitis is commonly colonized with Staphylococcus aureus in high densities. Objective: Our purpose was to study the effect of topical corticosteroids on the colonization of S. aureus in atopic dermatitis. Methods: Sixty-six patients were treated with moderately potent, potent, or very potent corticosteroids. Quantification of S. aureus and evaluation of the severity of the eczema was performed before, after 1 week, and after 2 weeks of treatment. Results: Fifty-three patients carried S. aureus in the most pronounced lesion before treatment. The colonization was significantly correlated with the severity of the eczema. The density of S. aureus was reduced by topical corticosteroids. The reduction increased with the potency of the corticosteroid and was most pronounced during the first week. S. aureus was eliminated after a successful 2-week treatment with a very potent corticosteroid. Propylene glycol 25% added to a moderately potent corticosteroid did not significantly increase the reduction of S. aureus. Conclusion: Topical corticosteroids of sufficient potency reduce the density of S. aureus in atopic dermatitis.

VECPs (visual evoked cortical potential) after focal stimulation used in perimetry have weak amplitudes in comparison to the spontaneous EEG, thus the SNR (signal-to-noise ratio) falls off down to -20 dB and less. The shape of the VECP waves depends on several parameters and is unknown in general. Then for SNR enhancement and signal detection shape-independent methods can be used only. The most common of them is the stimulus synchronized averaging, which causes cumulative prolongation of the measurement time corresponding to the averaging order. For online measurements of VECP other ways in signal improvement are needed. In this paper a new method for SNR enhancement based on beam forming is introduced. While the anatomical structures of sources generating the focal VECP are known roughly and the electrode positions have sufficient density over the visual cortex, signal sources can be focused by controlling the channel delay.

In the functional diagnostics of human sensor systems, the analysis of stimulus responses embedded in an electroencephalogram (EEG), e.g. evoked potentials (EPs), is of high relevance for an objective electrophysiological assessment. The aim of this work is to detect weak EPs from highly contaminated signal traces. In principle this can be done using methods of spatiotemporal signal processing, which simultaneously increase the weak SNR (signal-to-noise ratio). However, methods based on any a priori knowledge of spatial or temporal properties as well as the propagation speed and direction are not applicable. Models with adjustable signal properties similar to real cortical activity are necessary for the development and evaluation of new methods of spatiotemporal signal processing. A model is needed which can be used in forward- and inverse-projection calculations. This study aims to develop a signal generator of the background EEG activity with embedded EPs of fully adjustable signal parameters. The study also compares the results of modeled signal analysis by known methods for signal decomposition, SVD (singular value decomposition) and ICA (independent component analysis).

This paper addresses the principles of testing long submarine solid dielectric cables with AC-voltage, using up to date high voltage equipment with frequency tuning. It is shown that lengths up to 100 km or more is possible to test if all parameters affecting such tests are taken into account and treated accurately. Whether an AC or a DC solid dielectric cable is chosen, an successful AC factory test with enhanced phase to ground voltage, give high credibility to the XLPE technologies of today.

Electrical potentials generated by movement of the eye dipoles or by slow potential shifts over the retinal pigment epithelium can cause strong contamination of the electroencephalogram or the event related potentials. An efficient method, which compromises between the signal quality after the ocular artifact correction and the computation load, is developed. The method can be applied for the artifact correction of the data containing both DC and AC components, and thus, is convenient for the analysis of electrophysiological signals such as P300, event related synchronisation /desynchronisation, contingent negative variation (CNV) and other slow potentials. A modification of the method can be utilized for online applications such as brain computer interface (BCI).

In this contribution different technologies connecting conventional medical software with modules for supporting the patient informing process are represented. The authors lay the emphasis here on the design of the user interface and the realization of need driven informing as a requirement for the acceptance of these systems. The metabolism disease diabetes mellitus serves as an example of the doctor patients relation as basis of a successful prevention and therapy of chronic diseases.

The phase of visual evoked responses (VERs) is one of the basic parameters in functional diagnostics of the visual system. A new method for phase estimation of VERs based on the observer model in system identification is introduced. Simulated data show significantly less variance of estimation than actual estimators do. By means of the new estimator, the dynamics of the visual system according to selected optical stimuli has been analyzed.

The authors discuss the system concept of a fiber-in-the-loop (FITL) system, factors involved in network planning, and give a specific example of operations in the city of Brandenburg. Depending on the complexity of the respective optical line terminal (OLT) area, more or less optimization steps are necessary to find the most cost effective realization. This solution is a compromise between three major aspects; i.e., short cable length, low number of active parts, and high flexibility to install new services.

Using time-frequency representation based on the Wigner distribution gives an window-independent formulation of the signal's energy localized in time and frequency. Thus a time-frequency region of interest can be found for transient visual evoked responses. The information is used to construct a linear time-varying filter for post-processing of visual evoked responses. The filter is constructed via the window-independent Weyl correspondence.

The DIABCARE Working Group was launched to further the target of establishing monitoring and control systems using state of the art information technology for quality assurance of diabetes health care provision. For this purpose the group developed the standards of a data set and of the relevant quality indicators. The clinical partners of the DIABCARE Consortium are, in their own countries, responsible for the evaluation and dissemination of the developed tools (DIABCARE Data for Windows, DIABCARE Fax System and others). The adaptation of each tool and the fine-tuning of them have to meet the needs of their own country. The implementation will be in clearly defined patient and practically orientated stages taking into account the different health care environments in different European countries, and the different levels of health care. The Q-NET application is a telematic network in health care, consisting of several interdependent elements: local application, network application, and telemedicine application.

The knowledge of the properties of an EEG signal related to a visual stimulus is of fundamental importance for reliable signal detection. The procedure described in this paper is based on a local stimulation of the retina by a linear frequency-modulated on-off sequence. The resulting deterministic response is analyzed by means of the Wood-Barry (1994) algorithm for the detection of linear frequency-modulated signals using the Radon-Wigner transform. Perimetric measurements are carried out up to an eccentricity of 30.

DIABCARE Q-Net is a European project founded by the EU Telematics Applications Programme. The implementation of the basic information sheet (BIS) for the evaluation of diabetes related data, containing a fixed data set, will assist the health care professional in structured data collection. Specifications for collection and transfer of data to the DIABCARE data software and transfer of information for evaluation purposes via a telematic communication channel is implemented. A methodology for data evaluation and the identification of performance gaps (quality circles) will be used to reduce those gaps, putting data entry and evaluation to its intended use, i.e. improvement of quality of care.

Various efficient finite element modelling packages are available commercially. However, for applications in biomedical engineering which require the use very complex models, the limits of most of these program packages will be reached quickly or they can only be applied with strong restrictions in terms of functionality. An image acquisition/modelling/analysis system has been developed, which considerably reduces the time consumed in the creation of finite element models of human body parts taking into account the real patient's anatomy. The system covers the following components: (1) an image processing system for the direct creation of 3D geometric data of biological objects; (2) software translating 3D geometric data into CAD-related geometric models; and (3) coupling of the created CAD models with mesh generation and mesh refinement techniques for the creation of realistic finite element models.

DIABCARE Q-Net is a European project with a consortium of partners in healthcare, industry, and research, which has the overall target of improvement in diabetes care by aggregation, evaluation, and feedback of anonymized patient data with the tools of modern telematics, resulting from the initiative of the St. Vincent-Declaration, St. Vincent, Italy. Based on standardized tools for quality improvement in diabetes care, i.e., the Basic Information Sheet (BIS) and recently developed data entry and feedback software (DIABCARE Data for Windows), DIABCARE Q-Net as a part of the Telematics Applications Program of the European Commission will improve diabetes care and disease management by the implementation of a quality network. Therefore, the project implements regional, national, and central nodes for processing of diabetes quality indicators. All participating centers (GP's and clinics in Europe) get feedback by standardized benchmarking. The pilot testing and the state of implementation of our network confirm the importance of improving the quality of life of diabetic patients in all participating countries.

Purpose: To evaluate the results of postoperative irradiation ± chemotherapy for carcinoma of the stomach and gastroesophageal junction. Methods and Materials: The records of 63 patients who underwent resection for stomach cancer were retrospectively reviewed. Twenty-five patients had complete resection with no residual disease but with high-risk factors for relapse. Twenty-eight had microscopic residual and 10 had gross residual disease. Doses of irradiation ranged from 39.6 to 59.4 Gy with a median dose of 50.4 Gy in 1.8 Gy fractions. Fifty-three of the 63 (84%) patients received 5-fluorouracil (5-FU)-based chemotherapy. Results: The median duration of survival was 19.3 months for patients with no residual disease, 16.7 months for those with microscopic residual disease, and 9.2 months for those with gross residual disease ( p = 0.01). The amount of residual disease also significantly impacted locoregional control ( p = 0.04). Patients with linitis plastica did significantly worse in terms of survival, locoregional control, and distant control than those without linitis plastica. The use of 4 or more irradiation fields was associated with a significant decrease in the rate of Grade 4 or 5 toxicity when compared to the patients treated with 2 fields ( p = 0.05). Conclusions: There was a significant association between survival and extent of residual disease after resection as well as the presence of linitis plastica. Distant failures are common and effective systemic therapy will be necessary to improve outcome. The toxicity of combined modality treatment appears to be reduced by using greater than 2 irradiation fields.

observed in 16% of the patients at a median of 36 months (range 6-60 months). The median bounce magnitude was 0.505 ng/mL (range 0.2-5.29 ng/mL). For the 335 cases with a minimum of 4 years of follow-up (median 53 months), the 5-year bRFS rates for low-risk and intermediaterisk cases were 97% and 89%, respectively. Conclusions: With a large cohort of patients treated with stereotactic body radiation therapy, with a reasonably long follow-up period, excellent efficacy was demonstrated at 5 years. For high-risk cases, the results are preliminary, given the small number of cases treated. However, for low and intermediate risk cases, these results compare favorably with other modalities. These results support a low alpha beta ratio for prostate cancer. Author Disclosure: A. Katz: F. Honoraria; Accuray. D. Freeman: F. Honoraria; Accuray. J. Aronovitz: None. D. Fuller: None. G. Bolzicco: None. R. Meier: None. S. Collins: G. Consultant; Accuray. J. Wang: None. M. Steinberg: None. C. King: None.

A primary contribution of this essay is to provide a survey of the human and environmental impacts of livestock production. We will find that the mass consumption of animals is a primary reason why humans are hungry, fat, or sick and is a leading cause of the depletion and pollution of waterways, the degradation and deforestation of the land, the extinction of species, and the warming of the planet. Recognizing these harms, this essay will consider various solutions being proposed to "shrink" livestock's long shadow, including proposed "technical" or "market" solutions, a transition to "new agrarian" methods, and a vegetarian or vegan diet. Though important and morally relevant qualitative differences exist between industrial and non-industrial methods, this essay will conclude that, given the present and projected size of the human population, the morality and sustainability of one's diet are inversely related to the proportion of animals and animal products one consumes.