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Neoadjuvant systemic therapy (NST) for triple-negative breast cancer and HER2-positive breast cancer yields a pathological complete response in approximately 60% of patients. A pathological complete response to NST predicts an excellent prognosis and can be accurately determined by percutaneous image-guided vacuum-assisted core biopsy (VACB). We evaluated radiotherapy alone, without breast surgery, in patients with early-stage triple-negative breast cancer or HER2-positive breast cancer treated with NST who had an image-guided VACB-determined pathological complete response.This multicentre, single-arm, phase 2 trial was done in seven centres in the USA. Women aged 40 years or older who were not pregnant with unicentric cT1-2N0-1M0 triple-negative breast cancer or HER2-positive breast cancer and a residual breast lesion less than 2 cm on imaging after clinically standard NST were eligible for inclusion. Patients had one biopsy (minimum of 12 cores) obtained by 9G image-guided VACB of the tumour bed. If no invasive or in-situ disease was identified, breast surgery was omitted, and patients underwent standard whole-breast radiotherapy (40 Gy in 15 fractions or 50 Gy in 25 fractions) plus a boost (14 Gy in seven fractions). The primary outcome was the biopsy-confirmed ipsilateral breast tumour recurrence rate determined using the Kaplan-Meier method assessed in the per-protocol population. Safety was assessed in all patients who received VACB. This study has completed accrual and is registered with ClinicalTrials.gov, NCT02945579.Between March 6, 2017, and Nov 9, 2021, 58 patients consented to participate; however, four (7%) did not meet final inclusion criteria and four (7%) withdrew consent. 50 patients were enrolled and underwent VACB following NST. The median age of the enrolled patients was 62 years (IQR 55-77); 21 (42%) patients had triple-negative breast cancer and 29 (58%) had HER2-positive breast cancer. VACB identified a pathological complete response in 31 patients (62% [95% CI 47·2-75·4). At a median follow-up of 26·4 months (IQR 15·2-39·6), no ipsilateral breast tumour recurrences occurred in these 31 patients. No serious biopsy-related adverse events or treatment-related deaths occurred.Eliminating breast surgery in highly selected patients with an image-guided VACB-determined pathological complete response following NST is feasible with promising early results; however, additional prospective clinical trials evaluating this approach are needed.US National Cancer Institute (National Institutes of Health).

Embodied carbon constitutes a significant portion of a building’s greenhouse gas (GHG) emissions and is a key challenge for the construction and real estate sectors. Embodied carbon includes construction product manufacturing, building construction, material replacement and end of life. During the specification and procurement stage, designers and contractors have the opportunity to prioritize products with lower carbon footprints. Environmental product declarations (EPDs) are a growing source of environmental data in the construction products market, and are increasingly being used for (1) environmental performance assessment of buildings and (2) product comparison for procurement decisions during the later stages of building design. An obstacle to identifying and purchasing lower embodied carbon products is a lack of data quality and the transparency of EPDs. However, EPDs vary widely in their data quality and specificity, which can lead to inaccurate and misleading comparisons. A new method is presented to account quantitatively for estimates of variation in underlying data specificity in EPDs to enable fairer comparisons between EPDs and to motivate the reporting of actual variability and uncertainty in EPDs. The application of this approach can help purchasers to assess EPDs quantitatively. Practice relevance Life-cycle assessments (LCAs) and LCA data can be used within the construction sector to evaluate buildings and to assist in design, specification and procurement decision-making. A new method is presented to support the assessment of comparability of functionally equivalent materials and products during the specification and procurement stage. Given the known variation and lack of precision within EPDs, this method provides quantitative metrics that correlate to a qualitative interpretation of EPD precision. This method can be used by anyone who is using EPD data to make product comparisons at the specification and procurement stage: It provides more confidence in choosing low-carbon material or product options when comparing between functionally equivalent options. It can incentivize product manufacturers and LCA practitioners to improve data quality and transparently report known variation in their EPDs. It may also motivate manufacturers to reduce GHGs from their products and processes.

Purpose The purpose of this paper is to present an analysis of common parameters in existing tools that provide guidance to carry out Whole Building Life Cycle Assessment (WBLCA) and proposes a new taxonomy, a catalogue of parameters, for the definition of the goal and scope (G&S) in WBLCA., Design/methodology/approach A content analysis approach is used to identify, code and analyze parameters in existing WBLCA tools. Finally, a catalogue of parameters is organized into a new taxonomy., Findings In total, 650 distinct parameter names related to the definition of G&S from 16 WBLCAs tools available in North America, Europe and Australia are identified. Building on the analysis of existing taxonomies, a new taxonomy of 54 parameters is proposed in order to describe the G&S of WBLCA., Research limitations/implications The analysis of parameters in WBLCA tools does not include Green Building Rating Systems and is only limited to tools available in English., Practical implications This research is crucial in life cycle assessment (LCA) method harmonization and to serve as a stepping stone to the identification and categorization of parameters that could contribute to WBLCA comparison necessary to meet current global carbon goals., Social implications The proposed taxonomy enables architecture, engineering and construction practitioners to contribute to current WBLCA practice., Originality/value A study of common parameters in existing tools contributes to identifying the type of data that is required to describe buildings and contribute to build a standardized framework for LCA reporting, which would facilitate consistency across future studies and can serve as a checklist for practitioners when conducting the G&S stage of WBLCA.

In evaluating the life cycle environmental impacts of buildings, the contributions of seismic damage are rarely considered. In order to enable a more comprehensive assessment of a building's environmental impact by accounting for seismic events, this project developed an environmental impact database of building component seismic damage – the largest of its kind known to date – by combining data from Carnegie Mellon University's Economic Input-Output Life Cycle Analysis (LCA) database with cost estimates of repair previously developed for FEMA's Performance Assessment Calculation Tool (PACT), a software that models probabilistic seismic damage in buildings. Fifteen indicators of environmental impacts were calculated for the repair of approximately 800 building components for up to five levels of seismic damage, capturing ‘embodied’ impacts related to cradle-to-gate manufacturing of building materials, products, and equipment. Analysis of the data revealed that non-structural and architectural finishes often dominated the environmental impacts of seismic damage per dollar spent in repair. A statistical analysis was performed on the data using Principal Component Analysis, confirming that embodied carbon, a popular metric for evaluating environmental impacts in building LCAs, is a suitable proxy for other relevant environmental impact metrics when assessing the impact of repairing earthquake damage of buildings.

Objectives: The purpose of this study is to determine the biological markers more frequently associated with recurrence in the reconstructed breast, to evaluate the detection method, and to correlate recurrent breast cancers with the detection method. Material and Methods: An institutional review board-approved retrospective study was conducted at a single institution on 131 patients treated with mastectomy for primary breast cancer followed by breast reconstruction between 2005 and 2012. Imaging features were correlated with clinical and pathologic findings. Results: Of the 131 patients who met our inclusion criteria, 40 patients presented with breast cancer recurrence. The most common histopathologic type of primary breast cancer was invasive ductal carcinoma in 82.5% (33/40) of patients. Triple-negative breast cancer was the most common biological marker with 42.1% (16/38) of cases. Clinically, 70% (28/40) of the recurrences presented as palpable abnormalities. Of nine patients who underwent mammography, a mass was seen in eight patients. Of the 35 patients who underwent ultrasound evaluation, an irregular mass was found in 48.6% (17/35) of patients. Nine patients with recurrent breast cancer underwent breast MRI, and MRI showed an irregular enhancing mass in four patients, an oval mass in four patients, and skin and trabecular thickening in one patient. About 55% of patients with recurrent breast cancer were found to have distant metastases. Conclusion: Patients at higher risk for locoregional recurrence may benefit from imaging surveillance in order to detect early local recurrences.

Ductal carcinoma in situ (DCIS) is a commonly encountered malignancy, accounting for approximately 20% of new breast cancer diagnoses in the United States. DCIS is characterized by a proliferation of tumor cells within the terminal duct lobular unit with preservation of the basement membrane. Typically nonpalpable and asymptomatic, DCIS is most often detected as calcifications on screening mammography. However, DCIS may also be noncalcified. When compared to calcified DCIS, noncalcified DCIS is more likely to be symptomatic, with patients most often presenting with nipple discharge or a palpable mass. Diagnosing noncalcified DCIS is challenging since it may be occult or subtle on mammography, and ultrasound findings can be nonspecific and may be interpreted as benign fibrocystic changes. In cases with a calcified component of DCIS, the extent of DCIS may be underestimated by mammography because not all involved areas may calcify. Breast magnetic resonance imaging (MRI), although less readily available than mammography and ultrasound, is advantageous in detecting noncalcified DCIS, especially high grade DCIS, which may not develop microcalcifications. MRI relies on abnormal contrast uptake due to tumor vascularity and changes in vessel density and permeability. This pictoral review presents the spectrum of imaging findings of noncalcified DCIS to assist radiologists in accurately detecting and describing its key imaging findings. Utilizing different modalities, we review the differential diagnoses for noncalcified DCIS, show illustrative cases of noncalcified DCIS, and discuss the importance of this entity.

At the intersection of new technology advancements, ever-changing health policy, and fiscal constraints, public health agencies seek to leverage modern technical innovations and benefit from a more comprehensive and cooperative approach to transforming public health, health care, and other data into action. State health agencies recognized a way to advance population health was to integrate public health with clinical health data through electronic infectious disease case reporting. The Public Health Community Platform (PHCP) concept of bidirectional data flow and knowledge management became the foundation to build a cloud-based system connecting electronic health records to public health data for a select initial set of notifiable conditions. With challenges faced and lessons learned, significant progress was made and the PHCP grew into the Digital Bridge, a national governance model for systems change, bringing together software vendors, public health, and health care. As the model and technology advance together, opportunities to advance future connectivity solutions for both health care and public health will emerge.

In this study, the cradle-to-gate environmental impact of a hybrid, mid-rise, cross-laminated timber (CLT) commercial building is evaluated and compared to that of a reinforced concrete building with similar functional characteristics. This study evaluates the embodied emissions and energy associated with building materials, manufacturing, and construction. Two alternative designs are considered for fire protection in the hybrid CLT building: 1) a ‘fireproofing design’, where gypsum wallboard is applied to the structural wood; and 2) a ‘charring design’, where two extra layers of CLT are added to the panel. The life cycle environmental impacts are assessed using TRACI 2.1 and the total primary energy is evaluated using the Cumulative Energy Demand impact method. Results show that an average of 26.5% reduction in the global warming potential is achieved in the hybrid CLT building compared to the concrete building, excluding biogenic carbon emissions. Except ozone depletion, where the difference in impact between scenarios is

The Public Health Community Platform (PHCP) is currently piloting an initial implementation of an electronic case reporting (eCR) solution. This work integrates community-defined resources (such as the Reportable Conditions Knowledge Management System and the Reportable Conditions Trigger Codes) to extract standardized data from clinical EHRs and transport that data to the correct public health agency, automating a core function of public health surveillance. This eCR solution will allow public health to benefit from a centrally developed and deployed infrastructure and tools and decrease the burden for clinical provider participation.

Background: Prior assessments of public health readiness had identified gaps in radiation preparedness. In recent years, preparedness planning has involved an “all-hazards” approach. Current assessment of the national status related to radiation public health emergency preparedness capabilities at the state and local health department levels was needed.Methods: A survey of state health departments related to radiation readiness was undertaken in 2010 by the Council of State and Territorial Epidemiologists (CSTE). States with nuclear power plants were instructed to consider their responses exclusive of capabilities and resources related to the plants given that the emergency response plans for nuclear power plants are specific and unique.Results: Thirty-eight (76%) state health departments responded to the survey, including 26 of the 31 states with nuclear power plants. Specific strengths noted at the state level included that the majority of states had a written radiation response plan and most plans include a detailed section for communications issues during a radiation emergency. In addition, more than half of the states indicated that their relationship with federal partners is sufficient to provide resources for radiation emergencies, indicating the importance states placed on federal resources and expertise. Specific weaknesses are discussed and include that most states had completed little to no planning for public health surveillance to assess potential human health impacts of a radiation event; less than half had written plans to address exposure assessment, environmental sampling, human specimen collection and analysis, and human health assessment. Few reported having sufficient resources to do public health surveillance, radiation exposure assessment, laboratory functions and other capabilities.Discussion: Levels of planning, resources and partnerships varied among states, those with nuclear power plants were better prepared. Gaps were evident in all states; however and additional training and resources are needed to ensure adequate levels of preparedness.Conclusion: Overall results of this assessment indicate that in most measures of public health capacity and capability, states are poorly prepared to adequately respond to a major radiation emergency event. Specific recommendations are noted in the discussion.(Disaster Med Public Health Preparedness. 2011;5:S134-S142)

This presentation aims to update the public health practice community on the continuing development of the Public Health Community Platform (PHCP). Public health is at a precipice of increasing demand for the consumption and analysis of large amounts of disparate data, the centralization of local and state IT offices, and the compartmentalization of programmatic technology solutions. The PHCP is being developed as a platform to host technological solutions and accompanying community involvement for common public health problems.

The National Electronic Disease Surveillance System (NEDSS) is a web-based infrastructure for public health surveillance data exchange between CDC and the 50 states. In 2007, the Council of State and Territorial Epidemiologists (CSTE) conducted an assessment to evaluate states' electronic disease surveillance capacity. In 2010, CSTE conducted a follow-up assessment to evaluate the operational status and progress of integration, interoperability, and capacity of state electronic disease surveillance systems. This report summarizes the results of that assessment, which indicated a 17.5% increase from 40 states in 2007 to 47 states in 2010 with fully operational general communicable disease (GCD) electronic surveillance systems, a 211.5% increase from 13 to 39 states in the number of systems that were interoperable, a 22.4% increase from 23 to 34 states in the number with integrated systems, and a 20.0% increase to 42 states with the capacity to receive electronic laboratory reports (ELRs). New Centers for Medicare and Medicaid Services rules for meaningful use of health information technology encourage data exchange between electronic health record systems and public health agencies, including submission of ELRs. To meet national goals for health information exchange to improve population health, variation in disease surveillance systems should decrease, and functionality should increase.