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Routine axillary ultrasound (AxUS) in patients receiving neoadjuvant chemotherapy (NAC) remains controversial. Here, we report rates of AxUS-detected nodal disease among patients with normal clinical exams, and rates of pathologic nodal disease after NAC based on method of nodal disease detection.Clinicopathologic findings were prospectively collected for stage I-III breast cancer patients selected for NAC. All patients had pre-treatment AxUS, suspicious nodes were biopsied. The following four patient cohorts were examined: patients with suspicious exam or AxUS but negative biopsy (Suspicious cN0); those with normal exam and normal AxUS (Not Suspicious cN0); those with normal exam but suspicious AxUS and positive biopsy (AxUS-detected cN1); and those with abnormal exam and positive biopsy (exam-detected cN1). Sentinel (SLN) and non-sentinel lymph nodes (non-SLN) were evaluated by immunohistochemistry; nodal metastases of any size were considered positive.500 patients were included. Of 310 patients with normal axillary exams, 160 had suspicious AxUS, 65 were biopsy-negative (Suspicious cN0) and 95/310 (30.6%) were biopsy-positive (AxUS-detected cN1). Of 190 with abnormal axillary exams, 166 were biopsy-proven node-positive (exam-detected cN1) and 24 were AxUS or biopsy-negative (Suspicious cN0). Rates of pathologic nodal disease were 20/150 (13.3%) among Not Suspicious cN0 patients, 12/89 (13.5%) among Suspicious cN0 (p = 0.97). Rates of residual nodal disease were 55/95 (57.9%) among AxUS-detected cN1 patients, 102/166 (61.4%) among exam-detected cN1 (p = 0.57).AxUS detected nodal disease in 30.6% of patients with normal clinical exams selected for NAC. Rates of pathologic nodal disease were similar among AxUS-detected and exam-detected cN1 patients.

Prior studies examining sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for cN1 patients have demonstrated that 20% of biopsied, clipped lymph nodes (cLNs) are nonsentinel lymph nodes (non-SLNs). Our goal was to determine how often the cLN was a non-SLN among both cN0 and cN1 patients and how often cLN pathology impacted management.Overall, 238 patients treated with NAC and surgery January 2019 to June 2020 were prospectively examined. Patients underwent routine axillary ultrasound, biopsy of suspicious nodes, and clip placement. Radioactive iodine-125 seed localization of the cLN was performed in cN1 patients only. Isolated tumor cells (ITCs) were considered node positive (ypN+) for both cN0 and cN1 cohorts. Chart review was performed to determine if cLNs were non-SLN and their ypN status.Of 118 cN0 patients, 115 of 118 (97%) underwent successful SLNB, 33 of whom had a cLN present; 21 of 33 (64%) cLNs were non-SLNs. Overall, 9 of 118 (8%) were ypN+; no cLN was ypN+ without additional +SLNs. Of 120 cN1 patients, 104 of 120 (87%) converted to cN0, 98 of 104 (94%) of which had attempted SLNB, and 95 of 98 (97%) successfully mapped. The cLN was a non-SLN in 18 of 95 (19%). Overall, 58 of 104 (56%) cN1 patients were ypN+. One patient had a positive cLN in the absence of +SLNs. This patient underwent axillary lymph node dissection (ALND); adjuvant treatment recommendations were unchanged.The cLN was a non-SLN in 19% of cN1 patients. cLN pathology did not impact adjuvant therapy recommendations, calling into question the utility of routinely clipping biopsied lymph nodes.

Background: Young women with DCIS are at increased risk of recurrence and second BC compared to older women and may derive the greatest benefit from risk reduction strategies. Little is known about treatment decision-making, engagement in preventive behaviors, or fear of recurrence among young DCIS survivors. Thus, we sought to investigate treatment and prevention issues in this population. Methods: Using a multicenter prospective cohort that enrolled 1302 women with stage 0-IV BC at age ≤40, we identified participants with DCIS only who completed surveys in the year following diagnosis (dx). Surveys assessed treatment decisions, lifestyle factors (alcohol, smoking, physical activity [PA]), and fear of recurrence (Lasry Scale). Data was summarized with descriptive statistics and groups were compared with Fisher’s exact test. Results: Among 87 patients (median age 38, range 26-40), 75 had available treatment decision data, 19 (25%) of whom had breast-conserving surgery (BCS), 11 (15%) unilateral mastectomy (UM), and 45 (60%) bilateral mastectomy (BM). Most (77%) indicated their doctor said BCS was an option or recommended, including 34 (59%) who had BM. Of 40 patients who reported a patient-driven surgical decision, 73% had BM, 13% UM, and 15% BCS. Among 15 patients who reported the decision as doctor-driven, none had BM, 27% UM, and 73% BCS. Those who had BM were more likely to be extremely confident about the decision (80% vs. 73% UM vs. 53% BCS, p=0.022). Adjuvant tamoxifen was used by 10/27 (37%) patients with ER+ DCIS who had BCS/UM. Most who took tamoxifen reported this decision was shared with their doctor (90%); 1 reported the decision was made on her own. Of the 17 patients who did not take tamoxifen, 88% indicated their doctor said endocrine therapy was an option or recommended. Among all 87 patients, 31 (36%) were former and 3 (4%) were current smokers at baseline assessment (median 5 months post-dx); 51 (59%) never smoked. Overall, 4 quit within 1 year of dx. Most patients (83%) were current drinkers at baseline, though 79% consumed Citation Format: Megan E. Tesch, Julia S. Wong, Laura Dominici, Kathryn J. Ruddy, Rulla Tamini, Lidia Schapira, Virginia F. Borges, Ellen Warner, Steven E. Come, Karen Sepucha, Laura C. Collins, Ann H. Partridge, Shoshana M. Rosenberg. Breast cancer (BC) risk reduction in young women with ductal carcinoma in situ (DCIS) [abstract]. In: Proceedings of the AACR Special Conference on Rethinking DCIS: An Opportunity for Prevention?; 2022 Sep 8-11; Philadelphia, PA. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_1): Abstract nr PR009.

ObjectivesThere is a need for advancements in health information technology that will transform how patient-reported outcomes (PRO) data are collected, reported, and used in breast cancer care. The objective of this study was to develop an innovative and customizable platform, called imPROVE to support PRO uptake in breast cancer care.DesignUser-centered design and agile development were employed. Recurrent stakeholder meetings with experts in the field of breast cancer care, in-depth one-on-one qualitative interviews with a clinical sample of patients with breast cancer, and focus groups with Dana-Farber/Harvard Cancer Center (DF/HCC) Breast Cancer Advisory Group members, were used to elicit feedback for the design features and functions of a patient mobile application and clinician dashboard.SettingThis study was conducted at two academic hospitals in the USA.ParticipantsParticipants included experts in the field of breast cancer care, value-based healthcare, and health information technology, a clinical sample of patients with breast cancer, and members of the DF/HCC Breast Cancer Advisory Group.Main outcome measuresimPROVE incorporates the International Consortium for Health Outcomes Measurement (ICHOM) breast cancer standard outcome set as well as the complete BREAST-Q Breast Cancer Module.ResultsFeedback was elicited from eight stakeholder meetings (n=28 members), interviews with a clinical sample of patients (n=28), and two focus groups with members of the DF/HCC Breast Cancer Advisory Group (n=17 members in each focus group). Participant feedback led to the development of a patient mobile application consisting of five components (myCare, myStory, myResources, myCommunity, and myNotes) and a clinician dashboard that includes an overview table and individual patient profiles with data displays.ConclusionsimPROVE has the potential to transform the way we deliver care to patients. Developed from best practices in user-centered design, agile development, and qualitative methods; imPROVE addresses the needs of multiple stakeholders, including patients, clinicians, healthcare administrators, and researchers.

The Italian rice agroecosystem plays a key role in the European production and provides a unique range of rice varieties. As productive man-made wetlands, rice paddies are strategic and economic components in the habitat provision for migratory wildlife at the European scale. However, the characteristic of being a "temporary wetland" causes the creation of an ecological trap for a number of living organisms. For this reason, agricultural practices adopted for the management of rice paddies are essential to move towards more sustainable cultivations capable of promoting biodiversity and to minimising negative environmental impacts. This study proposes an ecologically-oriented strategy to implement a circular and self-regulating farming system designed considering the role of constructed wetlands in providing ecosystem services in rice agroecosystems. It demonstrates the economic feasibility and benefits provided by a self-regulating biosystem based on an integrated wetland for a small-size rice farm of the Vercelli province (Piedmont Region, Italy). The study was conducted in collaboration with the rice farm, which already experiments with organic farming techniques. The investigation focuses on the current management structure of the farm and develops an ecologically-oriented business strategy to sustain local biodiversity. This strategy rediscovers and improves the traditional co-culture technique through the development of a permanent pond. It explores the potential benefits generated by the approach, in terms of biodiversity conservation, biological control of pests and weeds and habitat provision for wildlife. The study presents a real case study of economic sustainability of the business strategy through financial analysis. The findings highlight promising economic outcomes compared to the conventional rice cultivation systems. The diversification of marketing strategy and the reduction of operating costs are key factors in the success of the strategy. The ecologically-oriented design methodology presented in this article can easily be applied to other small-scale farms in the agrifood sector.

The 21-gene Breast Recurrence Score test predicts benefit from adjuvant chemotherapy in estrogen receptor-positive, HER2-negative (ER+/HER2-) breast cancer (BC). We examined whether the 21-gene assay predicts response to neoadjuvant chemotherapy (NCT).We identified patients with stage I-III ER+/HER2- BC treated with NCT from the Young Women's Breast Cancer Study, a prospective cohort of women diagnosed with BC at age ≤40 years. The 21-gene assay was performed on tumor specimens removed prior to NCT either as part of clinical care or retrospectively for research. Pathological complete response (pCR) was defined as ypT0/is ypN0. The relationship between Recurrence Score result and pCR was evaluated using logistic regression modeling.76 women received NCT for ER+/HER2- BC and were eligible for this analysis. Median age at diagnosis was 37 years (range 24-40). Scores ranged between 5 and 77 with 50%25 and 5%11. Median Recurrence Score result was significantly higher among tumors achieving pCR vs. non-pCR response (61.5 vs. 23, pIn young women with ER+/HER2- BC who received NCT, higher pretreatment Recurrence Score result was associated with an increased likelihood of pCR. Gene expression profile assays may have a role in decision making in young women in need of neoadjuvant therapy.

Vertical greening systems, or living walls, are becoming increasingly used indoors for improving the sustainability of buildings, including for the mitigation of excess CO2 levels, derived from human respiration. However, light provision within indoor environments is often insufficient for the efficient functioning of many plant species , leading to low photosynthetic CO 2 removal rates, and the need for supplementary light sources. In this study, we investigated the performance of supplementary lighting employed for indoor living wall systems, and whether optimised lighting conditions could lead to improved CO2 removal. In situ trials with several medium-large indoor living walls were performed to sample the lighting scenarios currently employed. We concluded that the majority of plants in existing systems were exposed to suboptimal lighting and will have a net-zero CO2 removal efficiency. Sealed chamber experiments using two common living wall plant species were conducted to explore the effect of varying lighting conditions on CO2 removal efficiency. Comparisons on optimal and “best case” in situ conditions were carried out, showing that CO2 removal efficiency was significantly correlated with both leaf and stem angles, which suggest phototropism may influence in situ CO2 removal. After a ten-day experimental period, the highest CO2 removal efficiency for both test plant species was observed at 200 μmol m−2 s−1 light flux density (~10500 lux) at 15° from the vertical growing surface. Our results indicate that most current lighting systems are inadequate for healthy plant photosynthesis and CO 2 removal, and that modified lighting systems could improve this performance. The estimation of the CO2 removal ability of a 5 m2 passive living wall decreases from an ACH of 0.21 h−1, achieved in an optimal light exposure condition, to only 0.03 h−1 when plants are exposed to sub-optimal conditions. To reduce maintenance costs, technical guidelines for indoor living wall lighting should be established, and lighting suppliers should recognise the developing niche market for specialised indoor living wall lighting.

Cereal processing and flour production play a key role in the Italian agrifood scenario generating valuable economic incomes and contributing significantly to the export market. The European Union's commitment to the transition towards the Circular Economic model has led to increasing attention to food by-products and waste valorisation practices in order to reduce the amount of food loss and waste and costs for disposal. Processing outputs produce secondary raw materials which often remain unexplored for alternative applications and other supply chains. This article focuses on the use organic residues obtained by cereal processing conducted by a small-size milling industry to produce bio-based materials. The research is structured in two stages: (1) the first investigates the production of organic waste through material flow analysis and characterisation of wheat dust, which is considered as waste, through nutritional and toxicological analyses; (2) the second explores the opportunity of using wheat dust as reinforcing filler for a starch-based bio-composite and as culture medium for a microbial cellulose. This second stage adopts the do-it-yourself (DIY) approach for upcycling of food waste and manipulation of bio-based materials. The wheat dust/starch bio-composite was processed to obtain surrogates of disposable plates, while the microbial cellulose was manipulated to achieve a film for food packaging. Strengths and criticalities of both applications are discussed, considering limitations implied by the DIY approach, and further implementations are defined. This article focuses on a case study located in Cuneo province (Piedmont Region, Italy), but it also considers the opportunity to upscale the study to larger milling industries due to the relevance of wheat grains processing in the Italian agrifood market.

The paper analyses the relationship between currently changes, about cultural paradigm, and systemic designer's education. It represents a critical moment, because a suitable learning gives opportu...

SummaryBecause knowledge of fungal diversity is very incomplete, it is possible that anthropogenic impacts are driving species to extinction before they have been discovered. Fungal inventories are still incomplete and do not reflect the complete diversity of this large taxon. Whilst molecular advancements are leading to an increased rate of species discovery, there is still much to be done to understand the diversity of fungi, identify rare species and establish conservation goals. Citizen science via social media could play an increasingly important role in mycological research, and its continued development should be supported and encouraged. The involvement of non-professionals in data collection helps increase public awareness, as well as extending the scope and efficiency of fungal surveys. Future academic mycological research could benefit from social media interaction and engagement with the amateur mycological community, which may accelerate the achievement of more effective conservation goals.

This practical paper presents a required reflection on paradigm shift toward an aware water management in urban context for the provision of renewable energy and for the enhancement of pre-industrial heritage. It investigates the transition toward systemic and ecological approach to face the complexity of urban environment and infrastructures for energy supply. The study investigates the sustainable energy framework in Piedmont Region and in the Municipality of Turin. Especially, it analyses opportunities provided by urban rivers and streams for installing mini-hydro power plants using historical unused infrastructures. The real case study presents the conversion of an historical check dam of Regio Parco canal in a mini-hydro power plant in the city of Turin (Piedmont Region, Italy), and it investigates the “land use-water-energy nexus” from an ecological perspective. The paper considers the 12 principles of infrastructure ecology in the urban water management to provide innovative solutions for blue-urban infrastructures that increase sustainability in cities. According to the urban ecological infrastructure, the project of mini-hydro power plant presents multi-functional features and this method can be replied in other similar contexts. Concerning technical solutions adopted for the mini-hydro power plant, it examines the potential of the green/blue infrastructure approach to integrate the flood risk management and the production of renewable energy. It analyses opportunities provided by low impact development to preserve freshwater ecosystems and to maintain biodiversity using inflatable dam, Kaplan turbine and fish ladder. The “Regio Parco” mini-hydro power plant is designed to provide energy for almost 600 households improving the environmental value and the usability of the area. The paper discusses the adoption of an ecological approach to design multiple functions blue infrastructure that can be implemented on other networks improving the urban landscape.

Through the critical analysis of some case studies, this paper intends to investigate different tools useful to the ecological education,to analyse didactic activities which have more influence in the development of an individual and collective awareness and which of them can get closer students to the systemic approach. The systemic design is one of many actors that takes place inside a well-structured social network that presents always more frequently complex problems, which are difficult to solve by the application of linear approach. Always more it's clear that the way applied by the actual system to solve problems around not only ecological area, but also economic and cultural, it's not enough to answer to real needs. It's necessary a change of paradigm, from an approach based on the competition and on the logic of continuous growth, to a systemic vision, based on the collaboration, on the awareness and on the rediscovery of qualitative values. The ecological emergency demands more and more the development of sustainable and resilient communities; for this reason we have to change the way of thinking processes and relations, in other words we have to become ecoliterate: we have to be able to understand the organizational principles of ecosystems and the way of manage complexity. So ecoliteracy represent the starting point of innovative processes: it gives importance to the relations and to the multidisciplinary team-work. It's clear that next to the cultural change we have to rearrange the schooling system which now represents the official institution appointed of knowledge communication. The current academic system has been defined by the same linear and competitive approach used to delineate our economic systems, in this way, inside its structure, it usually reproduces the same social hierarchy and inequality that we can observe in our society. In practice, to achieve some important changes, it is necessary to extend precepts of systemic view to a huge group of people (starting from students of primary school to college students and over). Others two key points are the discussion around the strict hierarchy between teacher and student and the support of collaborative behaviour. Different experiences, academic and not, are compared, considering actors involved, activities, team-working and final outcome. For this reason the role of project-based-learning and practical academic activities is considered inside an education whose aim is to train people eco-competent and who are able to enhance their active role available to the community.DOI: http://dx.doi.org/10.4995/IFDP.2016.3712