Search

We present spatially resolved H$\alpha$ properties of 21 type 1 AGN host galaxies at z$\sim$2 derived from the SUPER survey. These targets were observed with the adaptive optics capabilities of the SINFONI spectrograph, a near-infrared integral field spectrograph, that provided a median spatial resolution of 0.3 arcsec ($\sim$2 kpc). We model the H$\alpha$ emission line profile in each pixel to investigate whether it traces gas in the narrow line region or if it is associated with star formation. To do this, we first investigate the presence of resolved H$\alpha$ emission by removing the contribution of the AGN PSF. We find extended H$\alpha$ emission in sixteen out of the 21 type 1 AGN host galaxies (76%). Based on the BPT diagnostics, optical line flux ratios and the line widths (FWHM), we show that the H$\alpha$ emission in five galaxies is ionised by the AGN (30%), in four galaxies by star formation (25%) and for the rest (45%), the ionisation source is unconstrained. Two galaxies show extended H$\alpha$ FWHM $>$600 km/s, which is interpreted as a part of an AGN-driven outflow. Morphological and kinematic maps of H$\alpha$ emission in targets with sufficient signal-to-noise ratio suggest the presence of rotationally supported disks in six galaxies and possible presence of companions in four galaxies. In two galaxies, we find an anti-correlation between the locations of extended H$\alpha$ emission and [OIII]-based ionised outflows, indicating possible negative feedback at play. However, in the majority of galaxies, we do not find evidence of outflows impacting H$\alpha$ based star formation., Comment: 16 pages, 11 figures, 2 tables, accepted for publication in MNRAS; Appendix = 2 tables and 3 figures

PURPOSE: To confirm that a multi-component physical activity index (PAI), with physical activity (PA)-related behaviors and performance measures, enhances PA assessment for adults with cancer history (“survivors”) v. the general population for key health variables. METHODS: Data from 2011-2014 NHANES were analyzed (n= 9,620 adults, including 866 survivors). We generated PAI scores by calculating sub-scales for activity-related behaviors (i.e., moderate-to-vigorous PA and TV viewing hours/sedentary time) (n/8) and performance (i.e., cardiorespiratory fitness and muscle strength) (n/8), then combined for an overall PAI score (n/16 points). Dependent variables (self-reported health, multimorbidity and functional limitations) were dichotomized and tested with logistic regression to estimate associations with PAI variables. RESULTS: Survivors obtaining 22.5+ MET-hours/week of PA were >5x more likely to report excellent health than non-exercisers (OR=5.5, 95% CI 3.27-9.28). We observed a general decrease in likelihood of multimorbidity and functional limitations with increasing PA. Models with the combined score showed that higher PAI scores had larger positive associations with all three for all adults. Survivors with higher PAI scores were >30% more likely to report excellent self-rated health (OR=1.3, 95% CI 1.2-1.4) and 20% less likely to report multimorbidity and functional limitations compared to survivors with lower PAI scores, considering covariates. CONCLUSIONS: Greater PA-related behavior and performance was beneficial for adults irrespective of cancer history. However, using a combined score elucidates unique needs and benefits for survivors v. general population. IMPLICATIONS FOR SURVIVORS: Using a multi-component approach to PA assessment could help in developing validated tools to plan exercise programs and interventions for survivors.

Introduction Sunburn increases skin cancer risk and is common among U.S. adults. However, little is known about the contexts in which sunburns often occur. The purpose of this study is to examine the contextual factors surrounding sunburns among U.S. adults. Methods Cross-sectional data from a 2018 online panel survey were analyzed. A total of 4,088 panel members were recruited by mail using probability-based, random sampling by address. Respondents were asked about their most recent sunburn, and analyses were limited to those who remembered their most recent sunburn (N=3,106). Data were weighted to match the U.S. Current Population Survey proportions; analyses were conducted in 2018 and 2019. Results Participants’ age ranged from 18 to 93 years. About half (50.8%) were women, and most (82.3%) were non-Hispanic White adults. Swimming or spending time in water (32.5%), working outside at home (26.2%), traveling/vacationing (20.7%), and engaging in nonswimming physical activity (14.2%) were the most frequently reported activities. Using sunscreen on the face, neck, and chest (38.8%) and on the body (19.9%) and wearing sunglasses (34.2%) were the most frequently reported sun safety behaviors. Wearing clothes to the ankles (6.6%) and a long-sleeved shirt (4.5%) were least frequently reported. Conclusions This study provides new information about the contexts in which adult sunburns often occur, especially about contexts unrelated to intentional tanning, which was relatively infrequent. The results suggest the need to promote multiple forms of sun protection tailored to specific outdoor activities and develop innovative solutions for outdoor physical and aquatic activities, which present unique sun safety challenges.

Quasar feedback in the form of powerful outflows is invoked as a key mechanism to quench star formation in galaxies, although direct observational evidence is still scarce and debated. Here we present Early Release Science JWST NIRSpec IFU observations of the z=1.59 prototypical obscured Active Galactic Nucleus (AGN) XID2028: This target represents a unique test case for studying quasar feedback at the peak epoch of AGN-galaxy co-evolution because extensive multi-wavelength coverage is available and a massive and extended outflow is detected in the ionised and molecular components. With the unprecedented sensitivity and spatial resolution of the JWST, the NIRSpec dataset reveals a wealth of structures in the ionised gas kinematics and morphology that were previously hidden in the seeing-limited ground-based data. In particular, we find evidence of an interaction between the interstellar medium of the galaxy and the quasar-driven outflow and radio jet that produces an expanding bubble from which the fast and extended wind detected in previous observations emerges. The new observations confirm the complex interplay between the AGN jet, wind and the interstellar medium of the host galaxy, highlighting the role of low-luminosity radio jets in AGN feedback. They also clearly show the new window that NIRSpec opens for detailed studies of feedback at high redshift., 12 pages, 11 figures, accepted for publication in A&A

The Near-Infrared Spectrograph (NIRSpec) is one of the four focal plane instruments on the James Webb Space Telescope. In this paper, we summarize the in-orbit performance of NIRSpec, as derived from data collected during its commissioning campaign and the first few months of nominal science operations. More specifically, we discuss the performance of some critical hardware components such as the two NIRSpec Hawaii-2RG (H2RG) detectors, wheel mechanisms, and the micro-shutter array. We also summarize the accuracy of the two target acquisition procedures used to accurately place science targets into the slit apertures, discuss the current status of the spectro-photometric and wavelength calibration of NIRSpec spectra, and provide the as measured sensitivity in all NIRSpec science modes. Finally, we point out a few important considerations for the preparation of NIRSpec science programs., accepted by PASP for special issue on JWST in-orbit performance

Physical activity requirements (PAR; ie, courses required for graduation) have been proposed as a policy solution for increasing undergraduate physical activity. This study aimed to report prevalence of PAR among US colleges/universities participating in the American College Health Association-National College Health Assessment (ACHA-NCHA) and to understand whether these requirements were associated with campus characteristics. Data from the American College Health Association-National College Health Assessment II serial cross-sectional survey (2015–2019) were merged with researcher coded variables (2019): binary PAR status, nature of PAR (activity-based, conceptual, or combination), and number of courses required to fulfill the PAR. Logistic regression determined whether campus characteristics were associated with PAR in 2019. Nonparametric tests examined differences in nature and number of PAR courses. Of 379 schools, 59 (15.6%) had PAR, with 36 (61.0%) having activity-based PAR and 23 (39.0%) having a combination. Compared to public and four-year schools, private (OR=3.47 [1.77, 6.80]) and two-year schools (OR=6.55 [2.21, 19.45]) had significantly increased odds of having PAR. Private schools required significantly more PAR courses compared to public schools (2.42 vs. 1.73, P=.005). PAR were less prevalent in this sample than reported historically, indicating need for campus leadership attention to this issue. Research is needed to understand what barriers exist to implementing and maintaining PAR on college/university campuses, particularly among public and four-year schools. Understanding health promotion practices among ACHA member schools, which have made leadership commitments to promote student health, can provide greater knowledge of PAR barriers and best practices in schools across the United States and globally.

Lancet Oncology, The - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mercredi 11 aout 2021

State recess laws are recommended to encourage adequate and equitable access to recess and its benefits, but the downstream effects of state recess laws are unknown. We examined the association of state recess laws with district-level policy and school recess provision.This is cross-sectional analysis of the School Health Policies and Practices Survey, a US nationally representative sample of school districts (2016) and schools (2014). State-level recess laws were coded as none, recommend, or require recess. Logistic and linear regression were used to examine the association between state law with district policies and school recess provision, respectively. Data from 2000 are presented to highlight changes in recess policy and provision over time.The odds of a district policy requiring recess were 2.22 and 2.34 times greater when state recess law recommended or required recess, respectively, compared to states with no recess policy. There were no significant differences in school-level recess provision by state recess law but point estimates from 2000 indicated states without a law had the largest declines in recess provision over time.State recess laws are positively associated with district-level policy. Effects at the school level are unclear and continued surveillance is needed.

Consumers routinely underapply sunscreen, and this may be because they misinterpret application quantity directions on sunscreen labels. U.S. labels use ambiguous terms such as "apply generously" to communicate application quantity. Visual aids may be helpful to consumers to determine proper application quantity.To examine sunscreen application practices and sunscreen quantity visual aid preferences.Sets of five GIFs and five static images were created corresponding to five quantities of sunscreen. Participants extracted their typical-use sunscreen quantity from a pre-measured tube and answered questions about their estimation process and use of labeled instructions. Participants then identified their typical-use sunscreen quantity in response to three stimuli: teaspoons, images, and GIFs and reported their preferred format.No participants reported using the label directions for application quantity to inform their sunscreen use. The GIF-based visual aid for sunscreen application quantity (44%) was preferred over image-based (40%) or teaspoon-based (16%) versions (p = .0249). Addition of a GIF demonstration to clarify application quantity was reported as highly helpful.Consumers have difficulty determining the appropriate quantity of sunscreen to use and labeling does not influence their application quantity. A QR code incorporating an image or GIF demonstration of proper sunscreen quantity could be useful to sunscreen consumers.

State-level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child-level outcomes.The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6- to 11-year-old children reported physical activity, overall health, school absences, school-related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross-sectionally in 2018 and between 2003 and 2011/2012 using a difference-in-differences analysis.In 2018, 20 states had a law recommending or requiring recess. Cross-sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2-6.5) and having no difficulty making or keeping friends (2.9, 1.2-7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference-in-differences model.Significant cross-sectional associations in 2018 were not confirmed by a difference-in-differences analysis of two waves of the NSCH. Short follow-up time and the apparent weakness of existing state laws warrant further assessment of state-level recess law.

Introduction: Stereotactic ablative radiotherapy (SABR) has been shown to increase survival in oligometastatic disease, but local control of colorectal metastases remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate the progression to the polymetastatic disease (PMD). Material and methods: The study involved 23 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1033 lung metastases were reported. Clinical and biological parameters were evaluated as predictive for freedom from local progression-free survival (FLP). Secondary end-point was the time to the polymetastatic conversion (tPMC). Results: Two-year FLP was 75.4%. Two-year FLP for lesions treated with a BED < 00 Gy, 100–124 Gy, and ≥125 Gy was 76.1%, 70.6%, and 94% (p = 0.000). Two-year FLP for lesion measuring ≤10 mm, 10–20 mm, and >20 mm was 79.7%, 77.1%, and 66.6% (p = 0.027). At the multivariate analysis a BED ≥125 Gy significantly reduced the risk of local progression (HR 0.24, 95%CI 0.11–0.51; p = 0.000). Median tPMC was 26.8 months. Lesions treated with BED ≥125 Gy reported a significantly longer tPMC as compared to lower BED. The median tPMC for patients treated to 1, 2–3 or 4–5 simultaneous oligometastases was 28.5, 25.4, and 9.8 months (p = 0.035). Conclusion: The present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Predictive factors were identified for treatment personalization.

We present a new X-ray spectroscopic study of $22$ luminous ($2\times10^{45}\lesssim L_{\rm bol}\rm /erg\,s^{-1} \lesssim 2\times10^{46}$) active galactic nuclei (AGNs) at intermediate-redshift ($0.1 \lesssim z \lesssim 0.4$), as part of the SUpermassive Black hole Winds in the x-rAYS (SUBWAYS) sample, mostly composed of quasars (QSOs) and type\,1 AGN. Here, 17 targets were observed with \textit{XMM-Newton} between 2019--2020 and the remaining 5 are from previous observations. The aim of this large campaign ($1.45\,\rm Ms$ duration) is to characterise the various manifestations of winds in the X-rays driven from supermassive black holes in AGN. In this paper we focus on the search and characterization of ultra-fast outflows (UFOs), which are typically detected through blueshifted absorption troughs in the Fe\,K band ($E>7\,\rm keV$). By following Monte Carlo procedures, we confirm the detection of absorption lines corresponding to highly ionised iron (e.g., Fe\,\textsc{xxv}\,H$\alpha$, Fe\,\textsc{xxvi}\,Ly$\alpha$) in 7/22 sources at the $\gtrsim95\%$ confidence level (for each individual line). The global combined probability of such absorption features in the sample is $>99.9\%$. The SUBWAYS campaign extends at higher luminosity and redshifts than previous local studies on Seyferts, obtained using \xmm and \suzaku observations. We find a UFO detection fraction of $\sim30\%$ on the total sample that is in agreement with the previous findings. This work independently provides further support for the existence of highly-ionised matter propagating at mildly relativistic speed ($\gtrsim0.1c$) in a considerable fraction of AGN over a broad range of luminosities, which is expected to play a key role in the self-regulated AGN feeding-feedback cycle, as also supported by hydrodynamical multiphase simulations., Comment: 30 pages, 10 figures, accepted for publication in A&A

We present a UV spectroscopic study of ionized outflows in 21 active galactic nuclei (AGN), observed with the HST. The targets of the SUBWAYS sample were selected with the aim to probe the parameter space of the underexplored AGN between the local Seyfert galaxies and the luminous quasars at high redshifts. Our targets, spanning redshifts of 0.1-0.4 and bolometric luminosities (L_bol) of 10^45-10^46 erg/s, have been observed with a large multi-wavelength campaign. Here, we model the UV spectra and look for different types of AGN outflows. We find that 60% of our targets show a presence of outflowing H I absorption, while 40% exhibit ionized outflows seen as absorption by either C IV, N V, or O VI. This is comparable to the occurrence of ionized outflows seen in the local Seyfert galaxies. All UV absorption lines in the sample are relatively narrow, with outflow velocities reaching up to -3300 km/s. We did not detect any UV counterparts to the X-ray ultra-fast outflows (UFOs), most likely due to their being too highly ionized. However, all SUBWAYS targets with an X-ray UFO demonstrate the presence of UV outflows at lower velocities. We find significant correlations between the column density (N) of the UV ions and L_bol of the AGN, with N of H I decreasing with L_bol, while N of O VI is increasing with L_bol. This is likely to be a photoionization effect, where toward higher AGN luminosities, the wind becomes more ionized, resulting in less absorption by neutral or low-ionization ions and more absorption by high-ionization ions. In addition, we find that N of the UV ions decreases as their outflow velocity increases. This may be explained by a mechanical power that is evacuating the UV-absorbing medium. Our observed relations are consistent with multiphase AGN feeding and feedback simulations indicating that a combination of both radiative and mechanical processes are in play., Comment: Accepted for publication in Astronomy & Astrophysics (A&A), 22 pages, 12 figures

We study molecular outflows in a sample of 25 nearby (z< 0.17, d 300 km/s) molecular gas disconnected from the galaxy rotation, which we attribute to outflows. In 77% of the 26 nuclei with $\log L_{IR}/L_{\odot}>11.8$, we identifid molecular outflows with an average $v_{out}= 490$ km/s, outflow masses $1-35 \times 10^7$ $M_{\odot}$, mass outflow rates $\dot{M}_{out}=6-300$ $M_{\odot}$ yr$^{-1}$, mass-loading factors $η= \dot{M}_{out}/SFR = 0.1-1$, and an average outflow mass escape fraction of 45%. The majority of these outflows (18/20) are spatially resolved with radii of 0.2-0.9 kpc and have short dynamical times ($t_{dyn}=R_{out}/v_{out}$) in the range 0.5-2.8 Myr. The outflow detection rate is higher in nuclei dominated by starbursts (SBs, 14/15=93%) than in active galactic nuclei (AGN, 6/11=55%). Outflows perpendicular to the kinematic major axis are mainly found in interacting SBs. We also find that our sample does not follow the $\dot{M}_{out}$ versus AGN luminosity relation reported in previous works. In our analysis, we include a sample of nearby main-sequence galaxies (SFR = 0.3-17 $M_{\odot}$ yr$^{-1}$) with detected molecular outflows from the PHANGS-ALMA survey to increase the $L_{IR}$ dynamic range. Using these two samples, we find a correlation between the outflow velocity and the SFR, as traced by $L_{IR}$ ($v_{out} \propto SFR^{0.25\pm0.01})$, which is consistent with what was found for the atomic ionised and neutral phases. Using this correlation, and the relation between $M_{out}/R_{out}$ and $v_{out}$, we conclude that these outflows are likely momentum-driven., 27 pages, 23 figures; Appendix: 49 pages, 41 figures. Accepted for publication in Astronomy & Astrophysics. Typo corrected in Table 1 for galaxy 19297-0406

This paper describes the development and validation of an innovative protection system based on medium-voltage fuses for a high-power switching conversion system. This special conversion system, rated to deliver about 56 MW to the load, is based on neutral-point clamped IGCT inverters, connected to the same dc link through a set of distributed busbars, with a dc-link voltage of 6.5 kV and a capacitive stored energy up to 837 kJ. The sudden release of this energy in case of a switch failure in one inverter and the subsequent short circuit of one leg can lead to destructive consequences. From the analysis of different protection strategies, performed by numerical simulations of the fault evolutions, the developed solution based on medium-voltage fuses was found the only provision able to cope with such high stored energy and uncommon circuit topology. Custom fuses were developed for this application, and a specially tailored test was designed for validating the fuse selection. The paper, after summarizing the work carried out to simulate the fault evolution and select the protection, presents the analyses carried out to set up the validation test, and describes and discusses the results of the test and the complementing numerical simulations, which demonstrated the effectiveness of the protection system.

Background This study aims to identify spatial and dosimetric patterns of breast cancer relapse in a mono-institutional large series of patients treated with mastectomy and various forms of breast reconstruction. Material and Methods We retrospectively reviewed 196 patients with Stage II-III breast cancer treated with modified radical mastectomy between 1995 and 2016 at the Radiotherapy Department of Careggi Hospital, Florence. All patients performed Skin-sparing mastectomy or nipple-sparing mastectomy with immediate or delayed breast reconstruction and subsequently received post-mastectomy radiotherapy (PMRT). Systemic therapy was prescribed as per local and international guidelines both in neoadjuvant and adjuvant setting. All patients were treated with 3DCRT technique. Diagnostic imaging (e.g. CT, MRI) obtained at recurrence were registered with the original planning computed tomography (pCT) for the dosimetric analysis. Recurrence gross tumor volume (rGTV) were delineated and co-registered with pCT. All rGTV were compared dosimetrically to planned dose and spatially with planning target volumes. Locoregional recurrence (LR) were divided in three categories relative to the high dose region, 95% of prescription dose (D95%). We defined “in field LR” those with more than 90% of their volume within D95% region,“marginal LR” when recurrence volume was between 20 and 90% within D95% and “outfield LR” those with less than 20% of their volume D95%. Results The median age was 49 years (range, 26 - 83 years).163 women (83 %) were classified as stage III; 118 women (60 %) had more than three positive axillary nodes. The majority of lesions were estrogen receptor positive ( 75 %), grade 3 (52%) ,with the presence of LVI (60 %). Adjuvant RT at chest wall were performed in all patients, most of whom underwent a RT of chest wall +infra- supraclavicular nodes (71%).Prescribed RT dose was 50 Gy in 25 fractions. With a median follow-up of 60 months (range, 12-240 months), 22 (11%) patients experienced a locoregional relapse: 10 patients in the chest wall; 7 in ipsilateral axillary region +/- chest wall; 3 in internal mammary nodes -/+ chest wall; one locoregional relapse was observed in the supraclavicular nodes. Most of relapses were G3 (75%) with documented LVI (79%). The topographic analysis of the local failure patterns showed: thirteen (59 %) were “in-field LR”; 9 (41%) were “out-field LR” . For the spatial analysis, all relapses on the chest wall were observed above the breast tissue expander or mammary prosthesis. Free time from recurrence disease was 30 months (range 5-86 months). Conclusion This study suggests that chest wall recurrences are rare after PMRT and are related to biologic aggressiveness of the disease than to inadequate irradiation of target volumes. Prospective studies are warranted to evaluate the relationship between treatment volumes and patterns of recurrences in order to refine new delineation guidelines for women undergoing PMRT and breast reconstruction. Citation Format: Desideri I, Meattini I, Becherini C, Francolini G, Scotti V, Olmetto E, Perna M, Topulli J, Livi L. Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy [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 P3-12-09.

Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT.One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities.In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09).SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.

Importance In February 2019, the US Food and Drug Administration issued a proposed rule (84 FR 6204), an amendment to the Sunscreen Innovation Act of 2014, that would require listing active ingredients on the principal display panel of sunscreens to allow consumers to “more readily compare products and either select or avoid a given product accordingly.” Objective To understand consumers’ perceived importance of active ingredients in sunscreen and their ability to recall these ingredients when comparing, avoiding, or selecting sunscreen products. Design, Setting, and Participants In this qualitative study, participants were recruited from Fors Marsh Group and User Works, Inc consumer panels and interviewed in person in November and December 2019. Eligible participants were 18 years or older, reported sunscreen use in the past 12 months, and were residents of the Washington, DC, area. After viewing 2 mock sunscreen labels (1 that meets current US Food and Drug Administration requirements and 1 designed to meet proposed requirements), participants were asked questions to assess their perceived importance of active ingredients in sunscreen products, whether they could recall any of the active ingredients on the labels, and whether they typically looked for active ingredients on a sunscreen label. Main Outcomes and Measures The main outcomes were the sunscreen label information used by participants to select a sunscreen and their ability to recall the active ingredients after viewing 2 mock sunscreen labels. Results The mean (SD) age of the 47 participants was 42.8 (13.6) years, 32 (68%) were women, and 40 (85%) had a bachelor’s or graduate degree. Of the total, 13 (28%) participants stated that sunscreen ingredients influenced their sunscreen selection, but only 5 (11%) said it was the most important information. Instead, 34 (72%) participants stated that the sun protection factor rating was the most important information. After viewing the mock sunscreen labels, only 5 (11%) participants recalled any of the active ingredients, although 10 (21%) reported typically looking at active ingredients when choosing a sunscreen. Conclusions and Relevance This qualitative study investigated the US Food and Drug Administration’s proposed new rule requiring that active ingredients be listed on the front of sunscreen labels to facilitate product comparison for consumers. However, active ingredients were not reported to be a primary reason for consumers’ sunscreen selection. Recall of active ingredients was low, and few consumers reported typically looking at the active ingredients, which were more commonly used to avoid ingredients rather than to select a sunscreen. Therefore, listing active ingredients on the front label alone may not have the intended usefulness for consumers.

PURPOSE/OBJECTIVE(S): stereotactic ablative radiotherapy (SABR) has been shown to increase survival rates in oligometastatic disease (OMD), but local control of colorectal metastases still remains poor. We aimed to identify potential predictive factors of SBRT response through a multicenter large retrospective database and to investigate how lung SBRT can impact on the progression to the polymetastatic disease (PMD). MATERIALS/METHODS: the study involved 22 centers, and was approved by the Ethical Committee (Prot. Negrar 2019-ZT). 1023 lung metastases treated with SBRT in 622 patients were reported. The median BED was 105 Gy10. Lesion diameter GTV, PTV volume, dose, fractionations, and site of primary tumor were evaluated as potential predictive marker for SBRT response for the primary end-point local progression-free survival (LPFS). EGFR, KRAS, NRAS, BRAF, and MSI were also evaluated. Secondary end-point was the time to the polymetastatic conversion (ttPMC). RESULTS: the median follow-up was 26 months (range 3-117 months). The median lesion diameter was 13 mm (range 4-58 mm). The 2- and 3-year LPFS were 75.6% and 71%, respectively. At the univariate analysis, BED ≥125Gy10 was associated with improved LPFS (2-year: 94.1% versus 72.6%; P = < 0.0001), single fraction SBRT correlated with better LPFS in the overall population (2-year: 80.6% versus 73.7%; P = 0.03), but no significant difference was observed when considering the population treated with BED > 100 Gy10. Lesion diameter ≤19 mm correlated with improved LPFS (2-year 80% versus 60%; P = < 0.0001). The median ttPMC was 26 months, and the 2-year ttPMC was 54.5%. The median PFS was 11.3 months. After SABR, 36% patients had polymetastatic relapse, 39.5% patients had an oligometastatic relapse, and 24.5% patients had no further relapse. CONCLUSION: the present is the largest series of lung colorectal metastases treated with SABR. The results support the use of SBRT in lung oligometastatic colorectal cancer patients as it might delay the transition to PMD or offer relatively long disease-free period in selected cases. Several biological and clinical predictive factors were identified to assure the highest local control, on the basis of which a decisional algorithm will be derived.

Today, there are more than 16.9 million cancer survivors in the United States; this number is projected to grow to 22.2 million by 2030. Although much progress has been made in describing cancer survivors’ needs and in improving survivorship care since the seminal 2006 Institute of Medicine report “From Cancer Patient to Cancer Survivor: Lost in Transition,” there is a need to identify evidence gaps and research priorities pertaining to cancer survivorship. Thus, in April 2019, the National Cancer Institute convened grant-funded extramural cancer survivorship researchers, representatives of professional organizations, cancer survivors, and advocates for a 1-day in-person meeting. At this meeting, and in a subsequent webinar aimed at soliciting input from the wider survivorship community, evidence gaps and ideas for next steps in the following 6 areas, identified from the 2006 Institute of Medicine report, were discussed: surveillance for recurrence and new cancers, management of long-term and late physical effects, management of long-term and late psychosocial effects, health promotion, care coordination, and financial hardship. Identified evidence gaps and next steps across the areas included the need to understand and address disparities among cancer survivors, to conduct longitudinal studies as well as longer-term (>5 years postdiagnosis) follow-up studies, to leverage existing data, and to incorporate implementation science strategies to translate findings into practice. Designing studies to address these broad evidence gaps, as well as those identified in each area, will expand our understanding of cancer survivors’ diverse needs, ultimately leading to the development and delivery of more comprehensive evidence-based quality care.

Introduction In this observational, retrospective, multicenter study, we aimed to assess the safety of the combination of local metastasis-directed radiotherapy (RT) and immunotherapy (IT) in a cohort of advanced non–small-cell lung cancer (aNSCLC) patients. Material and Methods We collected clinical data of aNSCLC patients who received concomitant RT and anti-PD-1/PD-L1 inhibitors in seven Italian centers from September 2015 to June 2019. Concomitant RT was defined as delivered ≤4 weeks before or after the first or last administration of immunotherapy, or within two consecutive cycles of ICI. All adverse events apparently related to RT and/or IT were graded according to the Common Terminology Criteria for Adverse Events, version 4.0, and reported in terms of incidence and severity as immune related or RT related, or combined. Results We analyzed the clinical charts of 187 patients. Median follow-up time was 23 months, and median overall survival was 16.5 months (range, 3-162). Thirteen patients developed pure RT-related side effects, and 43 patients (23.9%) developed immune-related side effects. No additive toxic effects were observed. A case of grade 5 pulmonary toxicity was recorded as a possible consequence of a combined effect. Conclusion This analysis suggests that the combination of concomitant RT and anti-PD-1/PD-L1 agents is safe, and the two toxicity profiles are independent.

BACKGROUND: Thymoma is a rare mediastinal neoplasia. Surgery is the backbone of the treatment, but the role of postoperative radiotherapy (PORT) remains controversial. We aimed to obtain data on survival and safety in patients treated with PORT in three different Italian institutions. METHODS: We retrospectively analyzed 183 consecutive patients who underwent surgery from 1981 to 2015. According to the Masaoka-Koga staging system, 39.3%, 32.7%, 18.6% and 9.8% patients were in stage I, II, III and IV of disease, respectively. PORT was indicated in 114 patients (62.3%), while 69 subjects underwent surgery alone. Complete resection was obtained in 68 patients who underwent PORT. Adverse events (AEs) were graded according to CTCAE v4.0. We analyzed the recent literature to describe the current reports on PORT for resected thymoma. RESULTS: Mean follow-up was 130 months (range, 3–417 months). Overall survival (OS) at 1-, 5- and 10-year from surgery was 98.3%, 90.2% and 69.7% respectively. One-, 5- and 10-year disease specific survival (DSS) was 98.9%, 92.3% and 89.8% respectively. Disease free survival (DFS) at 1, 5 and 10 years from surgery was 96.7%, 88.3% and 82.8% respectively. Univariate analysis showed that complete resection, cell histology A-AB-B1 and stages I–II were significant predictors of better DSS and DFS. Multivariate analysis showed that sex, R0 margins and WHO histology was independent prognostic factors. Among patients treated with PORT, a trend towards better OS was evident with Masaoka stage I–II (P=0.09). Patients with R0 margins treated with PORT showed better OS and DSS (P=0.05). No differences in DSS for performance status (P=0.70), WHO histology (P=0.19), paraneoplastic syndrome (P=0.23) and surgical procedure (P=0.53) were evident. Patients treated with PORT had a higher level of acute AEs compared to surgery alone, but none of these was graded ≥3. CONCLUSIONS: Our results confirmed that patients with incompletely resected thymoma had the worst OS and DSS. High grade acute toxicity was not different between PORT and surgery alone. Other trials reported a significant benefit in OS, DSS and DFS in stage IIb–IV thymoma treated with PORT.

Background Sunburn is the strongest risk factor for melanoma and non-melanoma skin cancers. Adolescent sunburns are related to higher risk of developing melanoma later in life. Little is known about the association of sunburns and shade, particularly tree cover, around adolescent homes and schools. This linkage study assessed associations of adolescent self-reported sunburns with ambient ultraviolet radiation (UV) and tree cover. Methods We analyzed a U.S. national sample of parent–child dyads (n = 1333) from the 2014 Family Life, Activity, Sun, Health, and Eating (FLASHE) study conducted by the National Cancer Institute. The outcome was adolescent sunburns reported for the previous 12 months. GIS buffers around geocoded home and school addresses were used to summarize UV and tree cover. A sensitivity analysis assessed different UV measures and tree cover buffer distances. Logistic regression models estimated the adjusted odds of any sunburns for five models: (1) no environmental variables; (2) spatial variables of latitude and longitude; (3) UV; (4) tree cover; and, (5) a combined model with UV and tree cover. Covariates included common sunburn-related items such as sun protective behaviors, socio-demographics, and latitude. Model residuals were assessed for spatial dependency and clustering. Results Overall, 44% of adolescents reported any sunburns in the previous 12 months. For the bivariate associations, lower categories of UV were associated with any reported sunburns (p-trend = 0.002). Home tree cover was not associated with any reported sunburns (p-trend = 0.08), whereas schools with lower categories of tree cover were associated with sunburns (p-trend = 0.008). The adjusted odds of any sunburns by UV tertiles, as a linear tread, was 0.89 (0.76–1.05) (p = 0.17); school tree cover was: 0.91 (0.78–1.07) (p = 0.25). Neither UV nor tree cover, in a combined model, were significant. Sensitivity analyses resulted in the optimal buffer size of 200 m for summarizing tree cover. Spatial dependence of residuals was not significant and clustering was significant for about 6% or less of the sample in each model. Conclusions We did not find significant relationships between UV or tree cover and adolescent sunburns, when adjusted by sunburn-related covariates. Better contextual data about where sunburns occurred is needed to identify environmental correlates of sunburn.

L’analisi delle pressioni e impatti eseguita sui corpi idrici della Regione Toscana è stata condotta in stretta collaborazione con la Direzione Difesa del suolo e protezione civile – Settore Tutela Acqua e Costa della Regione Toscana, nonché con ARPAT. L’analisi è stata condotta nel contesto della stesura del nuovo Piano di Tutela Acque per il quale si è reso necessario aggiornare l'analisi pressioni ed impatti sulla base delle Linea Guida ISPRA emanate nell' aprile 2018 (nelle Linee Guida per l’Analisi delle pressioni ai sensi della Direttiva 2000/60/CE (ISPRA, 177/2018) – LLGG). Il Consorzio LaMMA, a seguito di incarico specifico di Regione Toscana (DDR 18020 del 18/10/2018) ha eseguito l’analisi attraverso una caratterizzazione ambientale e geo-idro-morfologica dei bacinI idrografici, una analisi territoriali e dell’impatto antropico sui corpi idrici, integrando l'analisi dell'impatto antropico con l'elaborazione di specifici strati informativi.

Up to 85% of adult cancer survivors and 99% of adult survivors of childhood cancer live with an accumulation of chronic conditions, frailty, and/or cognitive impairments resulting from cancer and its treatment. Thus, survivors often show an accelerated development of multiple geriatric syndromes and need therapeutic interventions. To advance progress in this area, the National Cancer Institute convened the second of 2 think tanks under the auspices of the Cancer and Accelerated Aging: Advancing Research for Healthy Survivors initiative. Experts assembled to share evidence of promising strategies to prevent, slow, or reverse the aging consequences of cancer and its treatment. The meeting identified research and resource needs, including geroscience-guided clinical trials; comprehensive assessments of functional, cognitive, and psychosocial vulnerabilities to assess and predict age-related outcomes; preclinical and clinical research to determine the optimal dosing for behavioral (eg, diet, exercise) and pharmacologic (eg, senolytic) therapies; health-care delivery research to evaluate the efficacy of integrated cancer care delivery models; optimization of intervention implementation, delivery, and uptake; and patient and provider education on cancer and treatment-related late and long-term adverse effects. Addressing these needs will expand knowledge of aging-related consequences of cancer and cancer treatment and inform strategies to promote healthy aging of cancer survivors.

BackgroundPopulation-based data from the National Health Interview Survey were examined to provide estimates of a wide range of health behaviors in cancer survivors (ie, physical activity, sun protection, alcohol use, cigarette and e-cigarette use, sleep, and diet) and trends over time.MethodsData were collected from 92 257 participants across 3 waves of the National Health Interview Survey. A total of 8050 participants reported having had cancer (2428 in 2005, 2333 in 2010, 3289 in 2015). Weighted and adjusted odds ratios (OR) between cancer survivors and controls were calculated using logistic and multivariable regressions in SPSS, and trend analyses from 2005 to 2015 were conducted. All statistical tests are 2-sided.ResultsAfter adjusting for demographics (2005-2015), cancer survivors, compared with controls, were more likely to wear sunscreen (OR = 1.41, 95% confidence interval [CI] = 1.32 to 1.51) and protect their skin (P < .001) and were less likely to tan indoors (OR = 0.81, 95% CI = 0.69 to 0.95), but reported less sleep (OR = 0.91, 95% CI = 0.85 to 0.98). In adjusted models, no differences were found for physical activity, sunburns, alcohol use, smoking, e-cigarette use, and diet. Smoking rates for cancer survivors decreased from 2005 to 2015 (P < .001) and physical activity increased (P = .02), but physical activity was not statistically significant after adjusting for multiple comparisons. All other health behavior rates for cancer survivors were unchanged from 2005 to 2015 (P > .14).ConclusionAfter adjusting for covariates, cancer survivors exhibited healthier sun protection, but not sleep behaviors, compared with controls. Cancer survivors (and controls) exhibited decreased smoking rates over time. These results may inform interventions focused on improving cancer control and prevention of other chronic conditions among cancer survivors.

Purpose: To determine dose constraints that correlate with alopecia in patients treated with photon-based Volumetric Modulated Arc Therapy (VMAT) for primary brain tumors. Methods: During the treatment planning process, the scalp was drawn as a region of interest. Dose received by 0.1 cc (D0.1cc), mean dose (Dmean), absolute volumes receiving different doses (V16Gy, V20Gy, V25Gy, V30Gy, V35Gy, V40Gy, and V43Gy) were registered for the scalp. Alopecia was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Receiver operating characteristics (ROC) curve analysis was used to identify parameters associated with hair-loss. Results: One-hundred and one patients were included in this observational study. At the end of radiotherapy (RT), 5 patients did not develop alopecia (Dmean scalp 3.1 Gy). The scalp of the patients with G1 (n = 11) and G2 (n = 85) alopecia received Dmean of 10.6 Gy and 11.8 Gy, respectively. At ROC analysis, V16Gy20Gy ≥ 5.2 cc were the strongest predictors of acute alopecia risk. Chronic hair-loss assessment was available for 74 patients: median time to recovery from G2 alopecia was 5, 9 months. The actuarial rate of hair regrowth was 98.1% at 18 months after the end of RT. At ROC analysis, V40Gy43Gy ≥2.2 cc were the strongest predictors of chronic G2-alopecia risk. V20Gy, V40Gy, and D0,1cc were shown to be independent variables according to correlation coefficient r. Conclusions: V20Gy and V40Gy were the strongest predictors for acute and chronic G2 hair-loss, respectively. The low-dose bath typical of VMAT corresponds to large areas of acute but transient alopecia. However, the steep dose gradient of VMAT allows to reduce the areas of the scalp that receive higher doses, minimizing the risk of permanent alopecia. The application of our dosimetric findings for the scalp may help in reducing the alopecia risk and also in estimating the probability of hair-loss during patient counseling before starting radiotherapy.

The physical and mental benefits children receive from physical activity have been well documented, and physical education is a key way to ensure that physical activity opportunities are available during the school day. This study evaluates whether state PE laws are associated with school-level practices of requiring structured PE classes and whether students take PE classes daily. State laws were obtained as part of the National Cancer Institute’s Classification of Laws Associated with School Students (CLASS) and were compiled for all 50 states and District of Columbia using Boolean keyword searches in LexisAdvance and WestlawNext. PE time requirements and state daily PE requirements in the laws were subsequently linked to school-required structured PE classes and daily PE in the School Nutrition and Meal Cost Study (SNMCS) Principal Survey. Logistic regression analyses were conducted while controlling for grade level, district child poverty rate, district race/ethnicity, school urbanicity, and school size. The state daily PE analysis also controlled for region. Schools located in a state that required at least 90 min of PE per week at the elementary level or 150 min of PE per week at the middle or high school levels had almost seven times higher odds of requiring structured PE. Schools located in a state that required daily participation of PE had almost five times higher odds of at least some students taking PE daily. State policymakers can utilize these findings to promote laws that require time for PE every week, daily if possible.

In case of circumscribed recurrent glioblastoma (rec-GBM), a second surgery (Re-S) and reirradiation (Re-RT) are local strategies to consider. The aim is to provide an algorithm to use in the daily clinical practice. The first step is to consider the life expectancy in order to establish whether the patient should be a candidate for active treatment. In case of a relatively good life expectancy (>3 months) and a confirmed circumscribed disease(i.e. without multiple lesions that are in different lobes/hemispheres), the next step is the assessment of the prognostic factors for local treatments. Based on the existing prognostic score systems, patients who should be excluded from local treatments may be identified; based on the validated prognostic factors, one or the other local treatment may be preferred. The last point is the estimation of expected toxicity, considering patient-related, tumor-related and treatment-related factors impacting on side effects. Lastly, patients with very good prognostic factors may be considered for receiving a combined treatment.

Choroidal localization from non-small cell lung cancer is rare and when it occurs may cause visual alterations. Targeted therapy against actionable gene mutations represents the standard of care in advanced non-small cell lung cancer. We report the case of a 53-year-old woman affected by metastatic anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer who received ALK tyrosine kinase inhibitors, from January 2017. The patient had a complete response of choroidal metastasis after therapy with ALK tyrosine kinase inhibitors. She recovered a complete visus and actually she still continue therapy with alectinib. The patient had a complete recovery of visus in addiction to a long response on treatment.

Afatinib, a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is effective as first-line treatment in patients with EGFR-mutated non-small cell lung cancer (NSCLC). We report 2 cases of EGFR-mutated locally advanced NSCLC treated in neoadjuvant setting with EGFR tyrosine kinase inhibitor at University of Florence/Careggi Hospital. In both cases, afatinib was used for up to 3 months, until 1 week before surgery. Both patients achieved significant reduction (downstaging) of the pulmonary mass and lymphadenopathies and after surgery, it was decided for both cases to restore afatinib treatment up to a further 4 months. Both patients experienced local and distant disease relapses after 9 and 10 months, respectively, and then we restored the afatinib treatment.

The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.

Introduction: This retrospective study analyzes the safety and feasibility of concurrent chemoradiotherapy (CRT) in adjuvant treatment of soft tissue sarcoma (STS). Methods: A total of 158 patients with STS were retrospectively analyzed. Anthracycline-based computed tomography was performed in high-risk patients. Acute radiotherapy toxicity and chemotherapy-related toxicity were assessed according to the Common Terminology Criteria for Adverse Events 4.0; late radiotherapy toxicity was recorded according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. Results: Fifty-four (34.2%) patients received CRT. Mean follow up was 5.4 years (range .2–21.1 years). Local DFS–recurrence-free survival, distant DFS–relapse-free survival, and overall survival were 79.1%, 76.4%, and 64.6%, respectively, at last follow-up. Leukopenia occurred in 11.4% of patients. Skin acute toxicity developed in 60.1% of patients and determined interruption of radiotherapy treatment in 19 (12%) patients. Nineteen patients (12%) experienced moderate fibrosis (grade 2). Mild and moderate joint stiffness was recorded in 16 (10.1%) patients. Size ≥5 cm was the only predictor of local recurrence at multivariate analysis (hazard ratio [HR] 9.65, 95% confidence interval [CI] 1.28–72.83, p = .028). Age and stage resulted as independent distant relapse predictors (HR 4.77, 95% CI 1.81–12.58, p = .002 and HR 4.83, CI 1.41–16.57, p = .012, respectively). At Cox regression univariate analysis, Karnofsky Performance Status, size, and stage were significant survival predictors (HR 2.23, 95% CI 1.02–4.87, p = .045; HR 2.88, 95% CI 1.10–7.52, p = .031; HR 2.59, 95% CI 1.11–6.04, p = .028). Conclusions: Concurrent CRT is a well-tolerated treatment option with no additional toxicity compared to exclusive radiotherapy or sequential CRT.

Introduction. Invasive apocrine carcinoma of the breast is a rare type of breast cancer (BC), pure apocrine carcinoma constitutes Methods. We analyzed clinical and pathological features of a series of TN apocrine carcinomas treated at our Centre in a 15-year period. Clinical and pathological characteristics and outcomes have been compared with a control series of NA-TN tumors treated during the same follow up period. Local relapse-free survival (LRFS), distant metastases-free survival (DMFS), and overall survival (OS) have been evaluated and compared between groups of patients. Results. Forty-five TN apocrine carcinomas were analyzed. The mean age at diagnosis was 60 years (range 34-83 years). The proportions of apocrine tumor grades varied, with G1 being seen in 6.8% of patients, G2 in 51.1%, and G3 in 40.1%. The majority of apocrine carcinomas had small tumor size (T1: 72.7%; T2: 27.3%), and negative axillary nodal status (66.7%). The series was compared to a homogenous control group of 45 NA-TN patients. The mean age was 54 years (range 32-79 years), affected by high grade (G3: 53.7%), small tumor size (T1: 87.5%; T2: 12.5%), and mostly negative axillary nodal status (82.9%). LRFS in the apocrine group was 85% and 78% at 5- and 10-year, respectively. LRFS in the NA-TN group was 90% and 79% at 5- and 10-year, respectively. No difference was evidenced between groups (HR 1.44 95%CI 0.62-3.79; p=0.39). DMFS in the apocrine group was 85% and 85% at 5- and 10-years, respectively. DMFS in the NA-TN group was 85% and 75% at 5- and 10-year, respectively. DMFS was significantly better in the apocrine group (HR 0.69 95%CI 0.28-1.62). OS in the apocrine group was 86% and 83% at 5- and 10-year, respectively. OS in the NA-TN group was 86% and 63% at 5- and 10-years, respectively. OS was significantly better in the apocrine group (HR 0.57 95%CI 0.26-1.18). Conclusions. Apocrine carcinomas represent a clinic-pathological distinct group of triple-negative BC, characterized by significantly more favorable clinical prognosis in terms of long-term disease-related morbidity or mortality when compared to NA-TN tumors. Citation Format: Meattini I, Pezzulla D, Carta GA, Becherini C, Perna M, Grassi R, Garlatti P, Desideri I, Scotti V, Bernini M, Sanchez LJ, Orzalesi L, Nori J, Bianchi S, Livi L. Triple negative apocrine carcinomas as a distinct subtype of triple negative breast cancer: A case-control study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-07.