Search

Frequent typhoons are significantly affecting the coastal cities via intensive rainstorms, tidal surges and strong wind. Natural factors such as climate change and global sea-level rise come alongside anthropogenic factors such as rapid urbanisation and land use/land cover change leading to detrimental consequences such as urban floods. This short communication offers various lessons learnt by Ningbo municipality from two strong typhoons that hit the city directly, namely “Fitow” in 2013 and “In-Fa” in 2021. On the one hand, the usage of “Big Data” and “Social Media” for bettering “Preparation” and “Prevention” reduced flood impacts significantly. On the other hand, the implementation of “Flood Insurance” speed up the “Recovery” processes. The successful “Preparation”, “Response” and “Recovery” helped Ningbo to enhance its flood resilience, and thus substantial impacts of injuries, household damages and associated economic loss were avoided. These three key terms should be heeded in typhoon/flood governance in which various stakeholders are involved with, and be incorporated into the city’s long-term strategic development plans to merge with the climate actions towards 2030s and beyond. This will be vitally important in reducing climatic hazards and improving coastal flood resilience under the future climatic uncertainties in Asian coastal cities. (196 words)

The discrete choice experiment (DCE) has been widely employed to examine public preferences for changes in environmental/social welfare brought about by various policy and development propo...

The importance-performance analysis (IPA) has been developed and widely utilized to understand customer satisfaction and prioritize provision strategies based on the assumption that satisfaction is resultant from a preference (perceived importance) for a service and a relevant judgment of its performance. However, little work has been performed to examine to what degree different social groups are satisfied with diverse ecosystem services provided by urban rivers, being a unique yet underinvested public good. This study pioneers the IPA application to systematically analyze local communities' perceived importance of urban rivers' ecosystem services and their perceptions about how well those ecosystem services have been provided by urban rivers in Guangzhou (south China). We found notable importance-performance gaps for 10 out of 12 ecosystem services. The local residents were more dissatisfied with provision performance than the non-locals even though both groups of residents could explicitly recognize the importance of urban rivers' ecosystem services. Enhancement of water purification was ranked first amongst all ecosystem services by all respondents, irrespective of respondents' hukou status (Chinese household registration system) and residing environment. Thus, this ecosystem service should be prioritized in relevant management and restoration initiatives. These data provide an accurate picture of potential approaches for the improvement and prioritization of ecosystem services that would satisfy the respective target groups' needs. The IPA offers a mechanism to help match local residents' needs with ecosystem services provision. The IPA also has promise as a means of helping decision-makers and practitioners to communicate effectively with various social groups holding diverging expectations and levels of satisfaction. Such communication is essential to curate urban spaces enjoyed and appreciated by diverse social groups via inclusive urban ecosystem governance.

Governments worldwide have embraced mandatory environmental information disclosure as a vital and indispensable component of their strategies to improve environmental conditions. However, the pathways through which environmental information disclosure can effectively mobilize public support for environmental management initiatives is not well understood. On the basis of latent class modelling of discrete choice experiment survey data in Shaoguan city (Guangdong province, south China), we investigate the impacts of passive disclosure (public simply receive environmental information) and active disclosure (public purposefully interact with environmental information providers) on residents’ heterogeneous preferences pertaining to an urban river restoration project. We find that passive environmental information transparency could successfully motivate public participation and support, while active environmental information accessibility tends to hinder public participation. Respondents either act as non-supporters, or fail to lucidly convey their preferences, if they have directly contacted local authorities or attended environmental events to purposefully collect environmental information via two-way interactive communications. The positive and favourable effect of passive environmental information disclosure on public environmental participation is notable. Yet, if we fail to enhance the effectiveness of active environmental information disclosure, we will miss a unique opportunity to transform public environmental awareness and interest into a useful catalyst for aligning public support with governmental environmental management goals.

Planning and management of forest parks have been contentious and challenging, as multiple and sometimes conflicting uses must be accommodated, especially in urban and peri-urban areas. Methodologies are thus needed to explore and evaluate development and conservation initiatives as a crucial part of sustainable planning and management process. In China, urban forest parks have been increasingly established aiming at satisfying the recreational demand of citizens in tandem with preserving diverse natural resources to safeguard the ecological resilience and adaptability of urban ecosystems. The transition from the traditional focus on recreational use (emphasizing the improvement of visitors’ visual quality and landscape aesthetics) to multiple uses including ecological and biological preservation (highlighting the minimization of ecological vulnerability) poses an urgent challenge for the planning and management of urban forest parks worldwide. In this study, a geographic information system (GIS) combined with Analytic Hierarchy Process (AHP) approach is explored to objectively quantify and integrate the visual sensitivity and ecological sensitivity of the Tianzhu Mountain National Forest Park, Fujian province, South China. The visual sensitivity is evaluated based on three dimensions: slope, distance and visibility. And the ecological sensitivity is measured with regard to elevation, slope, aspect, forest type, and distance to river. By overlapping of the visual sensitivity and ecological sensitivity maps for the study site, three functional zones are pinpointed, including nature restoration/conservation zone (with high ecological sensitivity and low visual sensitivity or invisible), level 1 development zone (with high visual sensitivity and low/very low ecological sensitivity), as well as level 2 development zone (with moderate visual and ecological sensitivities). Compared with the existing long-term development plan, obvious discrepancies can be identified. Our results can provide scientific decision support for multiple use planning of the study site, and also demonstrate the efficacy of the proposed methodology, which is comprehensive yet convenient, for the sustainable planning of urban and peri-urban forest parks.

Background BCP is uncommon; however, the frequency is increasing due to trends in delayed childbearing. Studies have suggested that some systemic therapies, including doxorubicin and cyclophosphamide, can be delivered safely during pregnancy after the first trimester, whereas agents such as trastuzumab and endocrine therapy are contraindicated due to risk to the fetus. Data remain limited on the efficacy and safety of administering taxane chemotherapy or growth factor support during pregnancy. We retrospectively evaluated the safety of systemic therapies, including paclitaxel and GCSF, as well as clinical outcomes, in a multi-institutional cohort of patients (pts) with BCP. Methods Pts treated for BCP from 1996-2018 from 3 large academic institutions were included. Demographic, oncologic treatment, and obstetric/neonatal outcomes data were obtained from medical records. Disease-free survival (DFS) and overall survival (OS) were estimated by Kaplan-Meier; Log-rank test were used to compare different groups/outcomes. Associations were calculated by Fisher's exact test. Results A total of 114 pts diagnosed with BCP were included. The median age was 35 years (range 25-44) and median gestational age at diagnosis was 18 weeks (range 2-38). BCP was predominantly early stage at diagnosis (stage I 28.0%, stage II 53.5%) and ER+/HER2- negative (48.2%). Sixty-three (55.2%) women received chemotherapy, 13 (11.4%) received paclitaxel and 11 (9.6%) GCSF (daily or depot injections) while pregnant. A total of 78% of pts with HER-2-positive BCP (28/36) received trastuzumab after delivery (11% were treated before 2005 and 5.5% were T1a). With median follow-up of 67.7 months, median DFS (stage I-III) was 212.8 months (CI 95% 108.4-317.1), and median OS (stage I-IV) was not reached. Subgroup analysis suggested a higher DFS for pts diagnosed in the 1sttrimester compared to the 3rdtrimester among women with stage II-III (HR 0.25 CI 95% 0.09-0.70, p= 0.03). Among women who received paclitaxel, there was no significant increase in adverse obstetrical/neonatal outcomes: preterm delivery (23.1% vs 13.1%, p 0.39), low weight newborn (7.7% vs 9.1 %, p 1.0), congenital malformations (0% vs 6.1%, p 1.0) or acute neonatal adverse outcomes (7.7% vs 4.0%, p 0.51), which include NICU need and Apgar 5' Conclusion In this multi-institution cohort of BCP pts, despite a small number of pts, exposure to contemporary therapies including paclitaxel was not associated with unfavorable obstetrical/neonatal outcomes and these results suggest it is safe to administer during pregnancy under the care of a multidisciplinary team. Although not statistically significant, GCSF presented numerical worse outcomes and combining data from several cohorts would be helpful to provide confirmation of these findings. Citation Format: Exman P, Freret TS, Economy KE, Chen WY, Parsons HA, Lin NU, Moy B, Tung NM, Partridge AH, Mayer EL. Outcomes and safety of paclitaxel and granulocyte-colony stimulating factor (GCSF) in breast cancer in pregnancy (BCP) - A multi-institutional retrospective analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-02.

Background: Type 2 diabetes (T2D) has been associated with increased risk of breast cancer. However, the role of metformin, the first-line anti-diabetic drug, in breast cancer carcinogenesis has not been elucidated completely. We aimed to examine further the association between the use of metformin and other anti-diabetic medication and breast cancer incidence within two large prospective cohort studies. Methods: We followed 184,437 women who participated in the Nurses’ Health Study (NHS;1994-2016) and the NHSII (1995-2017), with the baseline tied to the date metformin was introduced into the United States market. Information on T2D diagnosis, metformin, and other anti-diabetic medication, and other covariates were self-reported at baseline and repeatedly assessed by follow-up questionnaires every two to four years. Breast cancer cases were self-reported and confirmed by medical record review. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between metformin/other anti-diabetic medication use and breast cancer incidence were estimated using Cox proportional hazards regression models. Results: During 3,412,366 person-years of follow-up, we ascertained 9,442 incident invasive breast cancer cases, of which 720 were among women with T2D. Compared with women without T2D (n=168,498), similar risks of developing breast cancer were observed among those who ever used metformin (HR =0.95; 95%CI=0.79-1.13) and among those who received medications other than metformin (HR =1.11; 95%CI=0.91-1.37). Among women with T2D (n=15,939), compared with never metformin users, ever use of metformin overall was not associated with breast cancer (HR =0.90; 95%CI=0.72-1.13), but a lower risk of breast cancer was observed among past metformin users (HR =0.72; 95%CI=0.52-0.99). Longer duration of metformin use was not associated with risk of breast cancer (each 2-year interval: HR =0.98; 95%CI=0.93-1.03, p-trend=0.32). However, among women with substantial weight increase since age 18 (>25 kg), greater than 5 years of metformin use was associated with a lower risk of breast cancer (HR =0.62; 95%CI=0.43-0.89). Conclusion: Although we observed inverse associations among past metformin users, similar associations were not found among current users. Overall, metformin use was not strongly associated with the risk of developing breast cancer among the general cohort population or among women with T2D. Citation Format: Tengteng Wang, Jae H. Kang, Boyang Chai, Wendy Y. Chen, Michelle D. Holmes, Jennifer Erdrich, Edward L. Giovannucci, Frank B. Hu, Bernard A. Rosner, Rulla M. Tamimi, Walter C. Willett, A. Heather Eliassen. Metformin and other anti-diabetic medication use and breast cancer incidence in the Nurses’ Health Studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5902.

12089 Background: Metabolic abnormalities may impact breast cancer prognosis, but research has been limited by small samples and assessment of laboratory values at a single time point, often prior to cancer diagnosis and treatment. In a population based cohort, we utilized time-updated laboratory values and adjusted for cancer treatment to assess the association between metabolic risk factors (glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides) and breast cancer survival. Methods: 13,434 women diagnosed with stage I-III breast cancer from 2005-15 at Kaiser Permanente were included. All outpatient fasting glucose, HDL, LDL, and triglyceride values from diagnosis through 2019 or death were extracted from electronic medical records. Lab values were updated a median of 5 times between 1-7 years post-diagnosis. Risk of breast cancer-specific mortality was evaluated with Cox proportional hazards models adjusted for metabolic labs, demographics, body mass index, and diabetes, and then for dyslipidemia and anti-hypertensive medications, tumor characteristics (stage, ER and HER2 receptor status) and cancer treatment (use of chemotherapy, and tamoxifen v. aromatase inhibitors). Results: Mean (SD) age at diagnosis was 62.3 (11.8) years. Over median follow-up of 9 years, 2,876 patients died (1,080 of breast cancer). Patients with low HDL (≤45 vs. >45 mg/dL) had higher breast cancer-specific mortality (HR, 1.87; 95% CI, 1.62-2.16); high levels of glucose, triglycerides, and LDL were not associated. The increased risk associated with low HDL persisted after adjusting for tumor characteristics, cancer treatment, and medications. Conclusions: Low HDL evaluated over time after cancer diagnosis is associated with higher breast cancer mortality independent of cancer treatments and changes in other metabolic risk factors. Cholesterol may play a role in breast cancer due to its role in cell membrane structure, signaling pathways, and steroid hormone synthesis. Future studies should address whether pharmacologic or lifestyle treatment of lipids after breast cancer diagnosis can optimize survival outcomes.[Table: see text]

360922 Background: In-vitro and in-vivo evidence suggests that aspirin may have an anti-tumor effect. Multiple epidemiologic studies have reported improved breast cancer survival among regular aspirin users compared to non-users. Pooled data from randomized trials of aspirin for cardiovascular disease have also reported a decreased risk of metastatic cancer among aspirin users. Thus, we conducted a prospective randomized controlled trial to determine the true benefits and risks of adjuvant aspirin therapy for breast cancer survivors. Methods: The primary objective was to compare the effect of 300 mg aspirin daily versus placebo upon invasive disease-free survival (iDFS) in patients with high-risk, HER2-negative breast cancer. Secondary objectives included effects on overall survival, cardiovascular disease, toxicity, and adherence. Eligible participants included patients aged 18-70 diagnosed with a primary invasive HER2-negative breast cancer. If hormone receptor (HR)–positive, tumors needed to be node positive and diagnosed within the past 10 years. If HR negative, tumors could be node positive or T2-4N0 and diagnosed within the past 18 months. Participants were randomly selected (1:1) to aspirin 300 mg versus placebo daily for 5 years in a double-blinded fashion. Stratification factors include HR status (positive vs. negative), body mass index (< or ≥ 30 kg/m2), and stage (II vs. III). Based upon an accrual goal of 2,936 patients to reach 381 iDFS events, the study was estimated to have 80% power to detect HR 0.75. Results: From January 2017 to December 2020, 3,021 participants were enrolled. Treatment arms were well balanced in terms of key characteristics. In November 2021, the Data Safety and Monitoring Board recommended that the trial be unblinded because the stratified hazard ratio had crossed a pre-specified futility boundary. After 191 iDFS events (aspirin: 107, placebo: 84) and median follow-up of 20 months, the stratified hazard ratio comparing aspirin to placebo was 1.27 (z-score: -1.64), which is greater than the pre-specified hazard ratio of futility 1.03 (z-score < -0.192). There was no difference in the frequency of grade 3/4 adverse events by study arm. Compliance was high and similar across arms. Non-protocol use of aspirin/non-steroidal anti-inflammatory drugs was similar across arms and less than 14%, consistent with prior randomized aspirin trials. Updated results on iDFS events will be provided at presentation. Conclusions: In this double-blinded, placebo-controlled, randomized trial, there was no benefit in breast cancer invasive disease-free survival with the addition of 300 mg aspirin daily. Although inflammation may still play a role in cancer progression, aspirin is not recommended for prevention of breast cancer recurrence. Clinical trial information: NCT02927249.

The rapid growth of cities and the increasing intensity of human activities in urbanized areas are continuing to modify the physical and social environments of cities worldwide. Open air recreation has long been recognized as a key need for the health and well-being of urban dwellers. Recreation takes many forms, in dissimilar sites, for different purposes, by varied urban dwellers, from children kicking a football in a quiet street in Bogota to old age pensioners practicing tai-chi in a shady park in Hangzhou. Urban nature and associated natural settings close to home are likely to attract people to spend a larger part of their spare time outdoors and be physically more active. A wealth of evidence on the links between urban natural settings, people’s physical activities, and their physical and mental health is now available. The diversity within the urban nature mosaic provides places for solitude and respite, and localities for gathering and socializing.

Preclinical studies support the JAK2-STAT3 signaling pathway as a key driver in CD44+ CD24- "stem-cell-like" breast cancer cells. Ruxolitinib is an orally bioavailable JAK1/2 inhibitor. We aimed to identify the recommended phase 2 dose (RP2D) of ruxolitinib in combination with paclitaxel in patients with HER2-negative metastatic breast cancer (MBC).Eligible patients had HER2-negative MBC and had received ≤ 3 chemotherapy regimens for advanced disease. Patients received oral ruxolitinib (10-25 mg bid) in a 3 + 3 dose escalation design in combination with weekly paclitaxel 80 mg/mNineteen patients received protocol therapy (mean age 52 years). Eight (42%) had triple-negative breast cancer and 11 (58%) had hormone receptor-positive disease; 12 (63%) had visceral disease. Ten (53%) patients had not received prior treatment for advanced disease. Patients received a median number of 5 cycles of combination therapy (range 1-12) and five patients continued single-agent ruxolitinib. The MTD of ruxolitinib was 25 mg bid when combined with paclitaxel, and the RP2D for the combination was 15 mg bid. Thirteen (68%) patients required dose reductions or holds. Most frequent toxicities reported of any grade were neutropenia (50%) and anemia (33%). There were no grade 4/5 toxicities attributed to study drug. Four (21%) patients had PR, 12 (63%) had SD and three (16%) had PD as their best response.The combination of ruxolitinib and weekly paclitaxel was well tolerated with evidence of clinical activity. Further analysis of this combination is ongoing (NCT02041429).NCT02041429. Date of registration: January 22, 2014.

Throughout history, urban rivers have been regarded as valuable natural elements that satisfy various human needs and affect where people reside. With the increasing expansion of modern cities along the vertical dimension, how urban rivers affect housing values and homebuyers' purchasing decisions in a 3-D context has attracted a significant amount of attention from researchers, environmental practitioners, urban planners, and policymakers. In this paper, we attempt to estimate how homebuyers' utilities are affected by various river attributes and their interactions using the vibrant high-rise apartment housing market in Guangzhou (south China) as a case study. An appropriate 3-D weights matrix is identified using ex ante Monte Carlo simulation combined with ex post validation on the basis of information criteria. By using the identified 3-D spatial weights scheme in a multilevel autoregressive modelling framework, an intricate combination of multidimensional spatial heterogeneity and spatial dependence can be sufficiently accounted for. Our analytical results reveal that river view and riverfront location are considered as negative utilities by Guangzhou's homebuyers, showing the significant negative impacts of river pollution. Yet, the proximity to urban rivers is regarded as a positive utility, revealing that homebuyers enjoy a sense of being close to nature and an emotional bond with traditional water culture. The black-odorous river water itself devalues apartment prices and adds the negative utilities of river view and riverfront location. Riparian greening would command a price premium, as well as mitigate the negative utilities of river view and riverfront location. Although the availability of walking paths and sitting benches along river stretches is generally regarded as a positive utility, it may worsen the negative impact of river view, but enhance the positive impact of river proximity. These results provide deeper managerial insights into how different river attributes influence apartment buyers' utilities and thus help environmental managers (in collaboration with housing developers) design urban river restoration initiatives so as to create pleasant and attractive neighbourhoods for prospective homebuyers.

Blastoid and pleomorphic mantle cell lymphomas (MCLs) are variants of aggressive histology MCL (AH-MCL). AH-MCL can arise de novo (AH-DN) or transform from prior classic variant MCL (AH-t). This study is the first integrated analysis of clinical and genomic characteristics of AH-MCL. Patient characteristics were collected from diagnosis (AH-DN) and at transformation (AH-t). Survival after initial diagnosis (AH-DN) and after transformation (AH-t) was calculated. Regression tree analysis was performed to evaluate prognostic variables and in univariate and multivariate analyses for survival. Whole-exome sequencing was performed in evaluable biopsy specimens. We identified 183 patients with AH-MCL (108 were AH-DN, and 75 were AH-t; 152 were blastoid, and 31 were pleomorphic). Median survival was 33 months (48 and 14 months for AH-DN and AH-t, respectively; P = .001). Factors associated with inferior survival were age (≥72 years), AH-t category, Ki-67 ≥50% and poor performance status. AH-t had a significantly higher degree of aneuploidy compared with AH-DN. Transformed MCL patients exhibited KMT2B mutations. AH-MCL patients with Ki-67 ≥50% had exclusive mutations in CCND1, NOTCH1, TP53, SPEN, SMARCA4, RANBP2, KMT2C, NOTCH2, NOTCH3, and NSD2 compared with low Ki-67 (

We evaluated the relation of fruit and vegetable consumption, including specific fruits and vegetables, with incident breast cancer characterized by menopausal status, hormone receptor status and molecular subtypes. Fruit and vegetable consumption, cumulatively averaged across repeated, validated questionnaires, was examined in relation to risk of invasive breast cancer among 182,145 women initially aged 27-59 years in the Nurses' Health Study (NHS, 1980-2012) and NHSII (1991-2013). Cox proportional hazards regression, adjusted for known risk factors, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) and assessed tumors by hormone receptor status and molecular subtypes. We prospectively documented 10,911 invasive breast cancer cases. Greater intake of total fruits and vegetables, especially cruciferous and yellow/orange vegetables, was associated with significantly lower breast cancer risk (>5.5 vs. ≤2.5 servings/day HR = 0.89, 95% CI = 0.83-0.96; ptrend = 0.006). Intake of total vegetables was especially associated with lower risk of estrogen receptor negative tumors (HR per 2 additional servings/day as a continuous variable = 0.84, 95%CI = 0.77-0.93; pheterogeneity = 0.02). Among molecular subtypes, higher intake of total fruits and vegetables (HR per 2 additional servings/day as a continuous variable) was most strongly associated with lower risk of human epidermal growth factor receptor 2 (HER2)-enriched (HR = 0.79, 95%CI = 0.67-0.93), basal-like (HR = 0.84, 95%CI = 0.72-0.97) and luminal A (HR = 0.94, 95%CI = 0.89-0.99), but not with luminal B tumors (pheterogeneity = 0.03). In conclusion, our findings support that higher intake of fruits and vegetables, and specifically cruciferous and yellow/orange vegetables, may reduce the risk of breast cancer, especially those that are more likely to be aggressive tumors.

The discrete choice experiment approach has been widely applied in developed nations to examine individual preferences and associated heterogeneity regarding the provision of ecosystem services, and thereby a wealth of empirical evidence has been generated. Knowledge about how to inform and benefit the DCE studies in developing countries remains limited due to a lack of direct cross-country comparisons between developed and transitional nations. Using two duplicate DCE surveys executed in Brussels (the capital city of Belgium) and Guangzhou (the capital city of Guangdong province in southern China), where local municipal governments are intending to restore heavily modified and polluted river stretches in densely-populated urban settings, this study provides an in-depth analysis and comparison between two groups of respondents’ preferences and influencing factors. The DCE data are analyzed using an advanced generalized multinomial logit model with attribute interactions to explore and account for observed preference heterogeneity and unobserved scale heterogeneity simultaneously, and also latent class models to highlight the presence of divergent preferences within the sample and construct the linkage between preference heterogeneity and individual characteristics, including respondents’ perceptions of urban river’s ecosystem services and socio-economic characteristics. While fairly similar preference heterogeneity regarding various attributes are found between respondents from the two cities, there exists a highly significant scale heterogeneity and hence a large degree of uncertainty amongst Guangzhou respondents when making their choice decisions in a DCE exercise. Another significant finding shared by respondents from the two cities is that those who could not appreciate urban river’s ecosystem services adequately were not in favor of moving away from the status quo. Contributing to the growing literature that recognizes and explores residents’ preference heterogeneity, as well as the scale heterogeneity in environmental and ecological goods, this comparative study provides information for policy-makers and practitioners for optimizing strategies to restore impaired urban river ecosystems.

Integrated urban blue-green spaces (UBGS) represent a new global strategic initiative in the construction of ecologically multifunctional and socially inclusive cities. A common challenge is to integrate social preferences and values into UBGS planning and management. Using a 3-D spatial multilevel autoregressive model, this study attempts to differentiate and decompose the impacts of four UBGS attributes (including river water quality, detectable black-odorous problem, riparian greening, and provision of recreational facilities) on apartment prices in Guangzhou (China), so as to elicit homebuyers’ preferences and associate their preferences with higher hierarchical level (district) socioeconomic characteristics. Our modelling results reveal that homebuyers are insensitive to a relatively good water quality (Grade IV) of UBGS, but strongly dislike UBGS with black-odorous phenomenon. Both riparian greening and recreational facilities could command premiums, showing homebuyers’ significant preferences. At the aggregated level, district average income level plays a moderating role: homebuyers’ positive preferences (for riparian greening) and negative preference (for black-odorous river) become weakened when district income level increases. And district population density plays an enhancing role: homebuyers’ positive preferences (for riparian greening and recreational facilities) and negative preference (for black-odorous UBGS) become stronger when population density increases. These findings help optimizing UBGS design and establishing UBGS restoration priorities differently in divergent urban contexts, so as to improve environmental welfare and social equity.

Urban forests are important landscape components in cities around the world that offer multiple functionality, thereby serve as a nature-based solution to offsetting negative social-ecological effects brought by urbanization. While the recreational function, as a traditional focus of urban forests, has been primarily emphasized in Chinese cities, the emerging ecological civilization, as a national guiding institution, has gradually brought ecological dimension into urban forest construction and management. By combining statistical data and satellite image data covering 31 key-cities in mainland China, we attempt to quantitatively analyze the transition of urban forests with regard to two intertwined, critical dimensions: recreational potential (proxied by public park space per capita) and habitat potential (proxied by the percentage of core habitat that is not subject to significant disturbances and thus able to effectively maintain the ecological functionality of urban forest patches), to unveil possible synergies or tradeoffs between these two critical aspects for the period of 2011−2018. We found that overall urban forests’ recreation potential has increased, but their habitat potential has decreased. Economic growth is positively associated with recreation potential, but negatively associated with habitat potential. Results of this study revealed that the institutionalization of “ecological civilization” paradigm in China has not yet been successfully taken into urban forest domain. This calls for urban landscape policy and planning directed towards fostering synergistic effects between urban forests’ recreational function and habitat potential in order to essentially reconcile citizens’ recreational uses and the resilience of cities as complex socioecological systems. In this vein, the development of urban forest, as a visualized form of the mainstream yet subtle ecological civilization, can be further geared towards multi-functionality.

This research examined the psychological (perceived restoratives, emotion, stress, and mood) and physiological (blood pressure readings) effects of short-range visits to urban environments. Ninety participants visited two urban areas; Bukit Jalil Urban Park (a green space) and Bukit Jalil Urban Street (an urban a built-up city centre as a controlled environment) located in a tropical city Kuala Lumpur. Participants took a 20-minute leisure walk along the given routes in both the study areas. The findings indicate that the urban park has had an overall rehabilitative impact in contrast to the built-up environment. Overall, the positive emotion has increased, and mood disturbance has decreased in the metropolitan green area after the field experiment. The findings demonstrate that even short-term visits to urban parks decidedly influence stress reduction compared to an urban built-up city centre. However, both systolic and diastolic blood pressures decreased insignificantly after walking in the park. Similar variables such as their mental and physiological measures on other urban societies (i.e., working adults, population with hypertension, and their encounters) concerning the effect of a short walk with green ecology should be studied further.

A wide range of benefits can be provided by urban green spaces to enhance urban dwellers' social, economic and environmental welfare, and secure urban ecosystem resilience. With the increasing recognition of these benefits, municipal governments might provide urban public green spaces (UPGS) in a strategic manner to upgrade local landscape amenities so as to make their cities more attractive compared with their neighbors and boost economic growth. Based on a panel dataset of China's cities at the prefecture-level and above over the period of 2002 to 2014, this study explores the strategic interaction amongst municipal governments in providing green spaces for the general public. A novel and powerful econometric tool, the dynamic spatial Durbin model with city and time-period fixed effects, is applied to test for spatial interaction effects. The results depict a confirmative picture of the strategic interactions amongst China's municipal governments. Specifically, cities tend to mimic their neighbors and provide more UPGS as a response to the increase of UPGS provision in their neighboring cities across the whole country. Economic development, average income level, urban population growth, and urban land availability exhibit strong positive direct effects on UPGS provision in a short time-span, suggesting that municipal governments' decisions regarding UPGS provision tend to be myopic. Regional variations indicate that municipal governments in the eastern and central regions are actively involved in strategic interaction in providing UPGS, while those in the western region are not. The results illustrate that UPGS provision serves as a metric for evaluating local officials' performance complementary to the overwhelmingly-believed economic-performance based political competition, which reasonably benefits urban residents' environmental welfare in transitional China. However, a general lack of far-sighted greening perspective and inter-city synergy might engender some risks regarding the long-term resilience and stability of urban ecosystems and broad social efficiency. This study sheds light on the co-evolutionary dynamics of social and bio-physical systems, and specifically provides a scientific basis for region-specific policy making to achieve socially optimal UPGS provision in China.

To evaluate the association between alcohol consumption and breast cancer risk in younger women, overall and by family history of breast cancer and folate intake, we prospectively followed 93,835 US women aged 27–44 years in Nurses’ Health Study II who had alcohol consumption data in 1991. Alcohol consumption and folate intake were measured by food frequency questionnaire every 4 years. We documented 2,866 incident cases of invasive breast cancer between 1991 and 2011. Alcohol consumption was not associated with breast cancer risk overall (for intake of ≥10 g/day vs. nondrinking, multivariate hazard ratio = 1.07, 95% confidence interval: 0.94, 1.22). When the association was stratified by family history and folate intake, a positive association between alcohol consumption and breast cancer was found among women with a family history and folate intake less than 400 μg/day (multivariate hazard ratio = 1.82, 95% confidence interval: 1.06, 3.12; P-trend = 0.08). Alcohol consumption was not associated with breast cancer in other categories of family history and folate intake (P-interaction = 0.55). In conclusion, in this population of younger women, higher alcohol consumption was associated with increased risk of breast cancer among those with both a family history of breast cancer and lower folate intake.

Urban streams could concurrently bring about both positive amenities accruing to the view of waterscape and negative disamenities associated with water pollution. In this paper, we focus on a specific question that has not yet been explicitly answered in the extant literature: how to estimate the cumulative impacts of urban streams (which refer to the combined impacts of amenities and disamenities of multiple sources) in high density and high-rise urban contexts. A typical residential apartment complex (comprised of a number of apartment units located in dozens of mid- to high-rise commercial apartment buildings on a contiguous land parcel) in Guangzhou, south China, is used as a case study. A detailed palette of natural amenities and environmental disamenities of two bifurcated streams are quantified via the generalized spatial two-stage least squares (GS2SLS) model. In this model, an originally constructed 3-D spatial connectivity matrix, cube contiguity, is applied to address, in a sophisticated manner, an array of endogenous, exogenous, and error interactions along both horizontal and vertical dimensions that inherently exist in the spatial context of high-rise housing markets. Our results from spatial hedonic models at the micro-neighborhood level demonstrate that homebuyers tend to evaluate urban streams’ chemical, physical, and ecological features holistically. A cumulative impact is also found, as homebuyers would like to pay an extra premium for an apartment located farther away from both polluted streams. This study advances the extant literature by contributing to a novel and effective extension of the conventional two-dimensional spatial matrix which can capture the long-ignored spatial correlation existing amongst apartment units located on contiguous floors, as well as a robust estimation of the demand of urban natural and environmental amenities in the gradually rising mid- and high-rise housing market in both developing and developed countries.

One of the major challenges facing river restoration in densely populated urban areas has been the disparity between the expectations of policy-makers and societal preferences. This study aimed to elicit public preferences and elucidate underlying sources of preference heterogeneity, using the Zenne River in central Brussels, Belgium, as a case study. A discrete choice experiment was administered to a representative sample of the Brussels population. Five attributes were specified, including water quality, ecological status, hydromorphological features of channels, recreational opportunities, and monetary cost. Our econometric analysis based on mixed logit models revealed that overall public would like to have a more natural river (open and naturalized channel, good water quality, and with rich species diversity), while achieving good water quality was the most preferred attribute. Respondents categorized as male, non-Belgian citizen, or not being a member of an environmental organization constituted an inclination to prefer the status quo. Belgian citizens showed a pronounced preference for good biodiversity, and being a member of an environmental organization could moderate the strong preference for good water quality. This study provided insights into the relative attractiveness of key attributes pertaining to river restoration, in general, and served as a useful input to the ongoing discussion concerning the future plan for the Zenne River in Brussels, specifically. Possible implications also exist for other urban river restorations in the rest of Europe, where the Water Framework Directive has become a major impetus for the expansion of freshwater ecosystem restoration from rural and peri-urban areas to densely populated urban areas. Particularly, the cultural heterogeneity of societal preferences should be tested and accounted for to compare the welfare impacts of river restoration and to facilitate benefit transfer, within and between river basins, in the Water Framework Directive implementation.

There is an increasing recognition of ecosystem services provided by urban trees and their importance to urban resilience and sustainability through the preservation and enhancement of biological diversity so as to withstand disturbances and retain ecosystem functions as well as guarantee the well-being of current and future urban dwellers. However, the heterogeneous perceptions that urban residents may hold towards various ecosystem services have seldom been investigated. This study made a unique contribution to the growing body of literature on urban ecosystem services by examining the unobserved heterogeneity in resident perceptions of ecosystem services provided by a distinctive bio-cultural asset, urban heritage trees, in Hong Kong, via a novel application of latent class factor analysis which allows for considering the multidimensionality of latent factors and increases model parsimony. A total of 1075 face-to-face interviews were conducted with a stratified sample of residents about their perceived importance of two categories of distinctive ecosystem services provided by urban heritage trees: biological benefits and cultural benefits. The results indicated that, on average, both biological and cultural benefits of urban heritage trees were perceived to be important. Nevertheless, six classes were identified on the basis of different levels of two latent class factors, which differed markedly with respect to individual’s perceived importance of ecosystem services provided by urban heritage trees, from fairly balanced to very divergent perceptions of biological services and cultural services. This heterogeneity was explained with covariates describing respondents’ sociodemographic characteristics and activities at heritage tree sites. The results have implications for optimally tailoring promoting and participatory approaches, fostering improved communications with the general public, and nurturing overall support for urban heritage tree conservation from heterogeneous resident groups in order to achieve urban resilience and sustainability.

Obesity is a well-established cause of postmenopausal breast cancer. However, early life adiposity is inversely associated with breast cancer incidence. To understand these conflicting relations, we use validated measures to assess adiposity in childhood and late adolescence, as well as weight change, in relation to total invasive breast cancer incidence and receptor subtypes. We conducted a prospective observational study among 74,177 women from the Nurses' Health Study from 1980-2012, with updated risk factors every 2 years during which 4965 incident invasive breast cancers occurred. Overall, weight at age 18 was inversely associated with both premenopausal (HR per 30 kg = 0.52, 95% CI = 0.39 – 0.71) and postmenopausal (HR per 30 kg = 0.81, 95% CI = 0.72 – 0.92) breast cancer which was largely explained by adiposity at age 10. Long-term weight gain from age 18 both during premenopause and postmenopause were positively associated with postmenopausal breast cancer risk. However, premenopausal weight gain was not related to premenopausal breast cancer risk. Furthermore, weight gain since age 18 was positively associated with ER+/PR+ postmenopausal breast cancer (HR per 30 kg = 1.50, 95% CI = 1.36 – 1.65) but not ER+/PR- (HR per 30 kg = 0.96, 95% CI = 0.78 – 1.19) or ER-/PR- (HR per 30 kg = 1.16, 95% CI = 0.95 – 1.42) postmenopausal breast cancer. Overall, 17% of ER+/PR+ postmenopausal breast cancer and 14% of total postmenopausal breast cancer are attributable to weight gain of > 5 kg since age 18. This article is protected by copyright. All rights reserved.

BACKGROUND Studies of obesity and survival among patients with breast cancer produce conflicting results, possibly because of heterogeneity by molecular subtype. METHODS This study examined whether the association of body mass index (BMI) at diagnosis with breast cancer recurrence and survival varied across subtypes defined by PAM50 (Prediction Analysis of Microarray 50) gene expression. Included were 1559 Kaiser Permanente Northern California members ages 18 to 79 years who had PAM50 assays and were diagnosed with American Joint Committee on Cancer stage I through III breast cancer from 1996 to 2013. Patients reported weight and height. Cox regression models were adjusted for age, menopause, race/ethnicity, stage, and chemotherapy. RESULTS Over a median of 9 years (maximum, 19 years), 378 women developed recurrent disease, and 312 died from breast cancer. Overall, BMI was not associated with breast cancer recurrence or survival when controlling for subtype (eg, the hazard ratio per 5 kg/m2 of BMI was 1.05 [95% confidence interval, 0.95-1.15] for breast cancer-specific death). However, associations varied by subtype. Among women with luminal A cancers, those who had class II/III obesity, but not class I obesity or overweight, had worse outcomes. When women who had a BMI ≥35 kg/m2 were compared with those who had a BMI from 18.5 to

Background: Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied. Methods: Breast cancer patients (N=3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration (n=1949) and post-diagnosis sleep difficulties (n=1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality. Results: At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ⩾9 h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10–1.71), breast cancer (MV-HR=1.46, CI=1.02–2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01–1.79), compared to women sleeping 8 h per night. Increased sleep duration post diagnosis (vs unchanged) and regular sleep difficulties (vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HRincreased duration=1.35, CI=1.04–1.74; MV-HRregular difficulties=1.49, CI=1.02–2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality. Conclusions: Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients' sleep duration and difficulties to identify those at risk for poorer outcomes.

This abstract was not presented at the symposium.

PurposeGreater protein intake has been associated with better breast cancer survival in several prospective studies, including among 1,982 women in the Nurses’ Health Study. We proposed to extend this previous finding. We hypothesized that protein, essential amino acid, branched-chain amino acid, and leucine intakes are associated with improved survival and that these associations are stronger in tumors expressing insulin receptor (IR).Patients and MethodsWe included 6,348 women diagnosed with stage I to III breast cancer between 1976 and 2004. There were 1,046 distant recurrences. Relative risks (RRs) and 95% CIs were calculated according to quintiles of updated postdiagnostic diet using adjusted Cox proportional hazards models based on follow-up until 2010.ResultsThere was an inverse association between energy-adjusted protein intake and recurrence. Multivariable RRs for increasing quintiles of intake compared with the lowest were 0.95 (95% CI, 0.79 to 1.15), 0.92 (95% CI, 0.76 to 1.11), 0.75 (95% CI, 0.61 to 0.91), and 0.84 (95% CI, 0.69 to 1.03; trend P = .02). For animal protein intake, the RRs were 0.88 (95% CI, 0.73 to 1.06), 0.85 (95% CI, 0.70 to 1.02), 0.75 (95% CI, 0.62 to 0.92), and 0.78 (95% CI, 0.63 to 0.95; trend P = .003). Neither essential amino acids, branched-chain amino acids, nor any individual amino acid stood out as being the source of the association. The association also did not differ by IR status. There was no clear association with any protein-containing foods.ConclusionWe found a modest survival advantage with higher intake of protein, regardless of IR status. There was no clear mechanism for this association, although it is consistent with prior studies. Our data suggest that there is likely no advantage for women with a history of breast cancer in restricting protein intake or protein-containing foods.

Background: Achieving a healthy weight is recommended for all breast cancer survivors. Previous research on postdiagnosis weight change and mortality had conflicting results. Methods: We examined whether change in body weight in the 18 months following diagnosis is associated with overall and breast cancer–specific mortality in a cohort of n = 12,590 stage I–III breast cancer patients at Kaiser Permanente using multivariable-adjusted Cox regression models. Follow-up was from the date of the postdiagnosis weight at 18 months until death or June 2015 [median follow-up (range): 3 (0–9) years]. We divided follow-up into earlier (18–54 months) and later (>54 months) postdiagnosis periods. Results: Mean (SD) age-at-diagnosis was 59 (11) years. A total of 980 women died, 503 from breast cancer. Most women maintained weight within 5% of diagnosis body weight; weight loss and gain were equally common at 19% each. Compared with weight maintenance, large losses (≥10%) were associated with worse survival, with HRs and 95% confidence intervals (CI) for all-cause death of 2.63 (2.12–3.26) earlier and 1.60 (1.14–2.25) later in follow-up. Modest losses (>5%– Conclusion: Large postdiagnosis weight loss is associated with worse survival in both earlier and later postdiagnosis periods, independent of treatment and prognostic factors. Impact: Weight loss and gain are equally common after breast cancer, and weight loss is a consistent marker of mortality risk. Cancer Epidemiol Biomarkers Prev; 26(1); 44–50. ©2016 AACR. See all the articles in this CEBP Focus section, “The Obesity Paradox in Cancer: Evidence and New Directions.”

IMPORTANCE: Although most chemotherapies are dosed on body surface area or weight, body composition (ie, the amount and distribution of muscle and adipose tissues) is thought to be associated with chemotherapy tolerance and adherence. OBJECTIVES: To evaluate whether body composition is associated with relative dose intensity (RDI) on anthracycline and taxane-based chemotherapy or hematologic toxic effects and whether lower RDI mediates the association of adiposity with mortality. DESIGN, SETTING, AND PARTICIPANTS: An observational cohort study with prospectively collected electronic medical record data was conducted at Kaiser Permanente Northern California, a multicenter, community oncology setting within an integrated health care delivery system. Participants included 1395 patients with nonmetastatic breast cancer diagnosed between January 1, 2005, and December 31, 2013, and treated with anthracycline and taxane-based chemotherapy. Data analysis was performed between February 25 and September 4, 2019. EXPOSURES: Intramuscular, visceral, and subcutaneous adiposity as well as skeletal muscle were evaluated from clinically acquired computed tomographic scans at diagnosis. MAIN OUTCOMES AND MEASURES: The primary outcome was low RDI (

Background Body composition from computed tomography (CT) scans is associated with cancer outcomes including surgical complications, chemotoxicity, and survival. Most studies manually segment CT scans, but Automatic Body composition Analyser using Computed tomography image Segmentation (ABACS) software automatically segments muscle and adipose tissues to speed analysis. Here, we externally evaluate ABACS in an independent dataset. Methods Among patients with non‐metastatic colorectal (n = 3102) and breast (n = 2888) cancer diagnosed from 2005 to 2013 at Kaiser Permanente, expert raters annotated tissue areas at the third lumbar vertebra (L3). To compare ABACS segmentation results to manual analysis, we quantified the proportion of pixel‐level image overlap using Jaccard scores and agreement between methods using intra‐class correlation coefficients for continuous tissue areas. We examined performance overall and among subgroups defined by patient and imaging characteristics. To compare the strength of the mortality associations obtained from ABACS's segmentations to manual analysis, we computed Cox proportional hazards ratios (HRs) and 95% confidence intervals (95% CI) by tertile of tissue area. Results Mean ± SD age was 63 ± 11 years for colorectal cancer patients and 56 ± 12 for breast cancer patients. There was strong agreement between manual and automatic segmentations overall and within subgroups of age, sex, body mass index, and cancer stage: average Jaccard scores and intra‐class correlation coefficients exceeded 90% for all tissues. ABACS underestimated muscle and visceral and subcutaneous adipose tissue areas by 1–2% versus manual analysis: mean differences were small at −2.35, −1.97 and −2.38 cm2, respectively. ABACS's performance was lowest for the

PURPOSE Cardiovascular disease (CVD) is a major source of morbidity and mortality among breast cancer survivors. Although body mass index (BMI) is associated with CVD risk, adipose tissue distribution may better identify patients with a high risk of CVD after breast cancer. METHODS Among 2,943 patients with nonmetastatic breast cancer without prior CVD, we used International Classification of Diseases (9th and 10th revisions) codes to identify incidence of nonfatal stroke, myocardial infarction, heart failure, or CVD death. From clinically acquired computed tomography scans obtained near diagnosis, we measured visceral adiposity (centimeters squared), subcutaneous adiposity (centimeters squared), and intramuscular adiposity (fatty infiltration into muscle [Hounsfield Units, scored inversely]). We estimated hazard ratios (HRs) and 95% CIs per SD increase in adiposity accounting for competing risks and adjusting for demographics, smoking, cancer treatment, and pre-existing CVD risk factors. RESULTS Mean (SD) age was 56 (12) years. Over a median follow-up of 6 years, 328 CVD events occurred. Each SD increase in visceral or intramuscular adiposity was associated with an increase in CVD risk (HR, 1.15 [95% CI, 1.03 to 1.29] and HR, 1.21 [95% CI, 1.06 to 1.37]), respectively). Excess visceral and intramuscular adiposity occurred across all BMI categories. Among normal-weight patients, each SD greater visceral adiposity increased CVD risk by 70% (HR, 1.70 [95% CI, 1.10 to 2.62]). CONCLUSION Visceral and intramuscular adiposity were associated with increased CVD incidence after breast cancer diagnosis, independent of pre-existing CVD risk factors and cancer treatments. The increased CVD incidence among normal-weight patients with greater visceral adiposity would go undetected with BMI alone. Measures of adipose tissue distribution may help identify high-risk patients and tailor CVD prevention strategies.

Author(s): Bradshaw, Patrick T; Cespedes Feliciano, Elizabeth M; Prado, Carla M; Alexeeff, Stacey; Albers, Kathleen B; Chen, Wendy Y; Caan, Bette J | Abstract: ObjectivePrevious studies of breast cancer survival have not considered specific depots of adipose tissue such as subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT).MethodsThis study assessed these relationships among 3,235 women with stage II and III breast cancer diagnosed between 2005 and 2013 at Kaiser Permanente Northern California and between 2000 and 2012 at Dana Farber Cancer Institute. SAT and VAT areas (in centimeters squared) were calculated from routine computed tomography scans within 6 (median: 1.2) months of diagnosis, covariates were collected from electronic health records, and vital status was assessed by death records. Hazard ratios (HRs) and 95% CIs were estimated using Cox regression.ResultsSAT and VAT ranged from 19.0 to 891ncm2 and from 0.484 to 454ncm2 , respectively. SAT was related to increased risk of death (127-cm2 increase; HR [95% CI]: 1.13 [1.02-1.26]), but no relationship was found with VAT (78.18-cm2 increase; HR [95% CI]: 1.02 [0.91-1.14]). An association with VAT was noted among women with stage II cancer (stage II: HR: 1.17 [95% CI: 0.99-1.39]; stage III: HR: 0.90 [95% CI: 0.76-1.07]; P interaction l 0.01). Joint increases in SAT and VAT were associated with mortality above either alone (simultaneous 1-SD increase: HR 1.19 [95% CI: 1.05-1.34]).ConclusionsSAT may be an underappreciated risk factor for breast cancer-related death.

Background: The Gail model and the model developed by Tyrer and Cuzick are two questionnaire-based approaches with demonstrated ability to predict development of breast cancer in a general population. Methods: We compared calibration, discrimination, and net reclassification of these models, using data from questionnaires sent every 2 years to 76,922 participants in the Nurses' Health Study between 1980 and 2006, with 4,384 incident invasive breast cancers identified by 2008 (median follow-up, 24 years; range, 1–28 years). In a random one third sample of women, we also compared the performance of these models with predictions from the Rosner–Colditz model estimated from the remaining participants. Results: Both the Gail and Tyrer–Cuzick models showed evidence of miscalibration (Hosmer–Lemeshow P < 0.001 for each) with notable (P < 0.01) overprediction in higher-risk women (2-year risk above about 1%) and underprediction in lower-risk women (risk below about 0.25%). The Tyrer–Cuzick model had slightly higher C-statistics both overall (P < 0.001) and in age-specific comparisons than the Gail model (overall C, 0.63 for Tyrer–Cuzick vs. 0.61 for the Gail model). Evaluation of net reclassification did not favor either model. In the one third sample, the Rosner–Colditz model had better calibration and discrimination than the other two models. All models had C-statistics Conclusions: Both the Gail and Tyrer–Cuzick models had some ability to discriminate breast cancer cases and noncases, but have limitations in their model fit. Impact: Refinements may be needed to questionnaire-based approaches to predict breast cancer in older and higher-risk women.

We compared quantitative RT-PCR (qRT-PCR), RNA-seq and capture sequencing (CaptureSeq) in terms of their ability to assemble and quantify long noncoding RNAs and novel coding exons across 20 human tissues. CaptureSeq was superior for the detection and quantification of genes with low expression, showed little technical variation and accurately measured differential expression. This approach expands and refines previous annotations and simultaneously generates an expression atlas.

Attribute non-attendance (ANA) in discrete choice experiment (DCE) exercises has attracted increasing, yet limited, scholarly attention. This paper attempts to investigate ANA in a comparative case study, with a focus on its patterns and their association with socioeconomic, behavioral and perceptual factors, as well as its impacts on willingness-to-pay (WTP) estimates. We deploy a four-level polytomous scale (always, often, seldom, and never considered) for respondents to state their various degrees of attribute attendance (SANA) in an identical DCE questionnaire about urban river restoration initiatives in two global cities with contrast socioeconomic contexts, yet similar request for restoring polluted and modified urban rivers, Guangzhou (south China) and Brussels (Belgium). The survey results reveal the existence of large proportions of partial attendance in two sampled cities. We use an extended mixed logit model, which incorporates separate parameters delineating each attribute's different attendance groups, to estimate respondents' average WTP values. We find that accounting for SANA could improve the goodness-of-fit of the model and affect the magnitude of mean WTP estimates. Respondents' attribute attendance level pertaining to various attributes is mainly associated with their perceived importance of urban rivers' ecosystem services, but may not be necessarily correlated with the strength of their preference for corresponding attributes as indicated by the mean WTP estimates. Whether this discontinuity between respondents' stated ANA levels and WTP estimates within Guangzhou sample questions the ability of DCEs to generate unbiased welfare estimation and policy guidance in developing countries calls for further studies.

BACKGROUND Large social networks have been associated with better overall survival, though not consistently with breast cancer (BC)–specific outcomes. This study evaluated associations of postdiagnosis social networks and BC outcomes in a large cohort. METHODS Women from the After Breast Cancer Pooling Project (n = 9267) provided data on social networks within approximately 2 years of their diagnosis. A social network index was derived from information about the presence of a spouse/partner, religious ties, community ties, friendship ties, and numbers of living first-degree relatives. Cox models were used to evaluate associations, and a meta-analysis was used to determine whether effect estimates differed by cohort. Stratification by demographic, social, tumor, and treatment factors was performed. RESULTS There were 1448 recurrences and 1521 deaths (990 due to BC). Associations were similar in 3 of 4 cohorts. After covariate adjustments, socially isolated women (small networks) had higher risks of recurrence (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.15-1.77), BC-specific mortality (HR, 1.64; 95% CI, 1.33-2.03), and total mortality (HR, 1.69; 95% CI, 1.43-1.99) than socially integrated women; associations were stronger in those with stage I/II cancer. In the fourth cohort, there were no significant associations with BC-specific outcomes. A lack of a spouse/partner (P = .02) and community ties (P = .04) predicted higher BC-specific mortality in older white women but not in other women. However, a lack of relatives (P = .02) and friendship ties (P = .01) predicted higher BC-specific mortality in nonwhite women only. CONCLUSIONS In a large pooled cohort, larger social networks were associated with better BC-specific and overall survival. Clinicians should assess social network information as a marker of prognosis because critical supports may differ with sociodemographic factors. Cancer 2017;123:1228–1237. © 2016 American Cancer Society.

We evaluated individual grain-containing foods and whole and refined grain intake during adolescence, early adulthood, and premenopausal years in relation to breast cancer risk in the Nurses’ Health Study II. Grain-containing food intakes were reported on a baseline dietary questionnaire (1991) and every 4 years thereafter. Among 90,516 premenopausal women aged 27–44 years, we prospectively identified 3235 invasive breast cancer cases during follow-up to 2013. 44,263 women reported their diet during high school, and from 1998 to 2013, 1347 breast cancer cases were identified among these women. Cox proportional hazards regression was used to estimate relative risks (RR) and 95 % confidence intervals (95 % CI) of breast cancer for individual, whole and refined grain foods. After adjusting for known breast cancer risk factors, adult intake of whole grain foods was associated with lower premenopausal breast cancer risk (highest vs. lowest quintile: RR 0.82; 95 % CI 0.70–0.97; P trend = 0.03), but not postmenopausal breast cancer. This association was no longer significant after further adjustment for fiber intake. The average of adolescent and early adulthood whole grain food intake was suggestively associated with lower premenopausal breast cancer risk (highest vs lowest quintile: RR 0.74; 95 % CI 0.56–0.99; P trend = 0.09). Total refined grain food intake was not associated with risk of breast cancer. Most individual grain-containing foods were not associated with breast cancer risk. The exceptions were adult brown rice which was associated with lower risk of overall and premenopausal breast cancer (for each 2 servings/week: RR 0.94; 95 % CI 0.89–0.99 and RR 0.91; 95 % CI 0.85–0.99, respectively) and adult white bread intake which was associated with increased overall breast cancer risk (for each 2 servings/week: RR 1.02; 95 % CI 1.01–1.04), as well as breast cancer before and after menopause. Further, pasta intake was inversely associated with overall breast cancer risk. Our results suggest that high whole grain food intake may be associated with lower breast cancer risk before menopause. Fiber in whole grain foods may mediate the association with whole grains.

The identification of genetic variation with next-generation sequencing is confounded by the complexity of the human genome sequence and by biases that arise during library preparation, sequencing and analysis. We have developed a set of synthetic DNA standards, termed 'sequins', that emulate human genetic features and constitute qualitative and quantitative spike-in controls for genome sequencing. Sequencing reads derived from sequins align exclusively to an artificial in silico reference chromosome, rather than the human reference genome, which allows them them to be partitioned for parallel analysis. Here we use this approach to represent common and clinically relevant genetic variation, ranging from single nucleotide variants to large structural rearrangements and copy-number variation. We validate the design and performance of sequin standards by comparison to examples in the NA12878 reference genome, and we demonstrate their utility during the detection and quantification of variants. We provide sequins as a standardized, quantitative resource against which human genetic variation can be measured and diagnostic performance assessed.

Negative environmental impacts of golf courses have received more attention than positive ecological contributions. We studied the mature tree communities and their legacy effect in a historical urban-fringe golf-course site in Hong Kong covering 170-ha with well-managed natural-cum-cultural landscape. Some 44.3 % of the site is covered mainly by large trees forming a mature peri-urban forest. The 94 species in 35 families offer a high species diversity exceeding local secondary and climax fengshui woodlands with notable rare and protected species. Tree species composition, richness and legacy effects brought by anthropogenic and natural factors were investigated by three habitats with varying naturalness and three golf courses with different age. Landscape zone is remarkably heterogeneous versus other microhabitats (fairway and woodland) and the heterogeneity of tree communities amongst the three courses is relatively weak. Synergistic operation of natural regeneration (natural legacy effect) and anthropogenic management (anthropogenic legacy effect) has fostered diversity accumulation. On the one hand, temporal changes in landscape fashion through a century and variations in site management have driven and maintained species diversity. On the other hand, the founder effect of inherited and cultivated species, as well as successful invasion and establishment of native species, have imposed floristic imprint and inertia on woodland habitat. The findings suggested that urban golf courses can serve as potential hotspots for biodiversity conservation within urban ecosystems.

Background: In its 2014 position statement, ASCO concluded that obesity is associated with worse prognosis after cancer diagnosis. However in the same year, a comprehensive review by the World Cancer Research Fund concluded that there was limited evidence that greater body fatness increases risk of overall or breast cancer mortality, indicating that further investigation into lifestyle factors are needed. The After Breast Cancer (ABC) Pooling Project has reported, separately, significant mortality effects of pre-diagnosis BMI and of post-diagnosis physical activity (PA). We investigate whether the effect of BMI can be limited to subgroups characterized by comorbidities and physical activity. Methods: Data are from the three US cohorts that were harmonized in the ABCPP (n=9513) including: the Women's Healthy Eating and Living (WHEL), Life After Cancer Epidemiology (LACE), and Nurses' Health (NHS) studies. Stepwise delayed entry Cox proportional hazards models examined each lifestyle predictor (BMI, PA, and comorbidities assessed after diagnosis) sequentially and together in multivariate models for breast cancer and all-cause mortality. Results: In multivariate models without the other two target variables, PA was significantly associated with a 17% decrease in the risk of breast cancer mortality among women in the highest quartile of PA (MET hr/wk > 21.4), compared to the lowest quartile (MET hr/wk < 2.7) (HR=0.81,95% CI= 0.67,0.97). In the model with major comorbidities, there was a significant 40% increase in the risk of breast cancer mortality among women diagnosed with both diabetes and hypertension (HR=1.40, 95% CI= 1.01,1.93). In the model with BMI, there was no significant association with risk of breast cancer mortality. These results were essentially unchanged with all variables in a single model. For all-cause mortality, the PA-only model showed a significant PA effect with the hazard decreasing from 20% to 40% across quartiles (Q2 HR=0.80, 95% CI=0.71,0.90, Q4 HR=0.62, 95% CI=0.54,0.71). In the comorbidity-only model, both diabetes and hypertension significantly increased hazard of all-cause mortality 80% and 33%, respectively. Having both diagnoses was associated with a significant, 2.3 fold increase in all-cause mortality (HR=2.34, 95% CI= 1.95,2.81). In the BMI-only model, being underweight was associated with a significant 2.4 fold increase in risk of all-cause mortality, and there was a 20 and 37% increase in risk associated with being categorized as obese I or II (Obese I HR=1.23, 95% CI=1.07,1.40, Obese II HR=1.37, 95% CI=1.16,1.61). With all three variables in the model, the risk associated with being obese decreased and became non-significant (Obese I HR=1.06, Obese II HR=1.05), while the significance, strength, and direction of the association of comorbidities and PA with all-cause mortality remained constant. Conclusion: These data suggest that post-diagnosis comorbidities and lack of physical activity, rather than high BMI , are the important risk factors for all-cause and breast cancer specific mortality. While needing further validation, these suggest that physical activity interventions and monitoring treatment for comorbidities should become standard of care for breast cancer survivors. Citation Format: Nelson SH, Marinac CR, Patterson RE, Nachuta SJ, Caan BJ, Chen WY, Shu X-O, Pierce JP. Post-diagnosis physical activity and comorbidities, not BMI, explain mortality risk in the after breast cancer pooling project. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-08.

Although breast cancer risk increases with age, the importance of early events on breast cancer development is increasingly recognized. Compared to the plethora of studies on adult dietary exposures and breast cancer risk, the field of adolescent diet and breast cancer risk is still in its infancy. We review the data on breast cancer risk and diet during adolescence (defined as between ages 11 and 19) with a focus on the dietary exposures that have been investigated most in adult diet. The current literature suggests possible associations with dietary intake of soy and red meat and breast cancer risk. However, the lack of strong associations for other exposures may be due to methodological issues regarding precise measurement and a paucity of published studies. Overall, the area of early life exposures and cancer risk deserves more research and increased resources to advance the field.

The purpose of this study was to examine post-diagnosis BMI, very low physical activity, and comorbidities, as predictors of breast cancer-specific and all-cause mortality. Data from three female US breast cancer survivor cohorts were harmonized in the After Breast Cancer Pooling Project (n = 9513). Delayed entry Cox proportional hazards models were used to examine the impact of three post-diagnosis lifestyle factors: body mass index (BMI), select comorbidities (diabetes only, hypertension only, or both), and very low physical activity (defined as physical activity

Author(s): Kroenke, Candyce H; Michael, Yvonne L; Shu, Xiao-Ou; Poole, Elizabeth M; Kwan, Marilyn L; Nechuta, Sarah; Caan, Bette J; Pierce, John P; Chen, Wendy Y | Abstract: ObjectiveLarger social networks have been associated with better breast cancer survival. To investigate potential mediators, we evaluated associations of social network size and diversity with lifestyle and treatment factors associated with prognosis.MethodsWe included 9331 women from the After Breast Cancer Pooling Project who provided data on social networks within approximately two years following diagnosis. A social network index was derived from information about the presence of a spouse or intimate partner, religious ties, community participation, friendship ties, and numbers of living relatives. Diversity was assessed as variety of ties, independent of size. We used logistic regression to evaluate associations with outcomes and evaluated whether effect estimates differed using meta-analytic techniques.ResultsAssociations were similar across cohorts though analyses of smoking and alcohol included US cohorts only because of low prevalence of these behaviors in the Shanghai cohort. Socially isolated women were more likely to be obese (OR = 1.21, 95% CI:1.03-1.42), have low physical activity (l10 MET-hours/week, OR = 1.55, 95% CI:1.36-1.78), be current smokers (OR = 2.77, 95% CI:2.09-3.68), and have high alcohol intake (≥15 g/d, OR = 1.23, 95% CI:1.00-1.51), compared with socially integrated women. Among node positive cases from three cohorts, socially isolated women were more likely not to receive chemotherapy (OR = 2.10, 95% CI:1.30-3.39); associations differed in a fourth cohort. Other associations (nonsignificant) were consistent with less intensive treatment in socially isolated women. Low social network diversity was independently associated with more adverse lifestyle, but not clinical, factors.ConclusionsSmall, less diverse social networks measured post-diagnosis were associated with more adverse lifestyle factors and less intensive cancer treatment. Copyright © 2016 John Wiley a Sons, Ltd.

The first International Conference on Urban Tree Diversity hosted in June 2014 by the Swedish University of Agricultural Science in Alnarp, Sweden highlighted the need for a better understanding of the current state of urban tree diversity. Here we present and discuss a selection of urban tree diversity themes with the intention of developing and sharing knowledge in a research area that is gaining momentum. We begin by discussing the specific role of species diversity in ecosystem service provision and ecosystem stability. This is followed by exploring the urban conditions that affect species richness. Having determined that many ecosystem services depend on urban tree species diversity and that urban environments are capable of supporting high species diversity, we conclude by addressing how to govern for urban tree diversity.