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Immigrants are routinely seen as less "deserving" of access to social protection than natives. This experiment investigates whether inducing people to take the perspective of immigrants and empathize with their struggles - a form of de-biasing - can reduce the deservingness gap between immigrants and natives.

Welfare chauvnism is the attitude that immigrants are by default less "deserving" of access to social protection than natives. This experiment investigates whether welfare chauvnism is driven by ethnocentrist stereotypes: Beliefs that immigrants have more negative attributes (lazy, unintelligent,...) and fewer positive ones (hard-working, intelligent) than natives.

The design of multifunctional nanostructured materials is the key to the development of smart wearable devices. For instance, nanostructures endowed with both piezoelectric and photocatalytic activities could well be the workhorse for solar-light-driven self-cleaning wearable sensors. In this work, a simple strategy for the assembly of a flexible, semitransparent piezophotocatalytic system is demonstrated by leveraging rational wet chemistry synthesis of ZnO-based nanosheets/nanoflowers (NSs/NFs) under basic pH conditions onto flexible ITO/PET supports. A KMnO4 pretreatment before the ZnO synthesis (seeded ZnO) allows for the control of the density, size, and orientation of the NSs/NFs systems compared to the systems produced in the absence of seeding (seedless ZnO). The electrical response of the sensors is extracted at a 1 V bias as a function of bending in the interval between 0 and 90°, being the responsivity toward bending significantly enhanced by the KMnO4 treatment effect. The photocatalytic activity of the sensors is analyzed in aqueous solution (methylene blue, 25 μM) by a solar simulator, resulting in similar values between seedless and seeded ZnO. Upon bending the sensor, the photocatalytic activity of seedless ZnO is almost unaffected, whereas that of seeded ZnO is improved by about 25%. The sensor’s reusability and repeatability are tested in up to three different cycles. These results open up the way toward the seamless integration of bending sensitivity and photocatalysis into a single device.

In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.

A Leavitt labelled path algebra over a commutative unital ring is associated with a labelled space, generalizing Leavitt path algebras associated with graphs and ultragraphs as well as torsion-free commutative algebras generated by idempotents. We show that Leavitt labelled path algebras can be realized as partial skew group rings, Steinberg algebras, and Cuntz-Pimsner algebras. Via these realizations we obtain generalized uniqueness theorems, a description of diagonal preserving isomorphisms and we characterize simplicity of Leavitt labelled path algebras. In addition, we prove that a large class of partial skew group rings can be realized as Leavitt labelled path algebras.

One of the main problems related to ferruginous-asbestos bodies (ABs) exposure is their potential pathogenetic role in asbestos-related diseases. The aim of this study was to examine whether purified ABs, might stimulate inflammatory cells. ABs were isolated by exploiting their magnetic properties, therefore avoiding the strong chemical treatment usually employed for this purpose. This latter treatment, which is based upon the digestion of organic matter with concentrated hypochlorite, may markedly modify the AB structure and consequently also their "in vivo" manifestations. ABs were found to induce secretion of human neutrophil granular component myeloperoxidase, as well as stimulate rat mast cell degranulation. Data demonstrated that by triggering secretory processes in inflammatory cells, purified ABs may play a role in the pathogenesis of asbestos-related diseases by continuing and enhancing the pro-inflammatory activity of the asbestos fibers.

Dual pathway inhibition (DPI) with low dose rivaroxaban and aspirin in patients with coronary artery (CAD) and/or peripheral artery disease (PAD) reduces the occurrence of cardiovascular (CV) events; however, the underlying mechanisms explaining these latter CV benefits are not clearly understood. Our explorative observational study aimed to evaluate the effect of DPI on plasma inflammation and coagulation markers among real-world patients with CAD and/or PAD. We prospectively included all consecutive patients with an established diagnosis of CAD and/or PAD treated with aspirin (ASA) 100 mg once daily (OD) and rivaroxaban 2.5 mg twice daily (TD). Clinical evaluation and laboratory analyses, including haemoglobin, renal function (creatinine, urea, cystatin-C); coagulation markers (INR, aPTT); inflammation markers (IL-6, CRP, lipoprotein-associated phospholipase A2, copeptin), growth differentiation factor-15 (GDF-15), were carried-out at baseline, before starting treatment, and at 4 and 24 weeks after study drugs administration. 54 consecutive patients (mean age 66 ± 7 years; male 83%) who completed the six-months follow-up were included. At 24 weeks follow-up, a statistically significant reduction in IL-6 serum levels (4.6 [3.5- 6.5] vs 3.4 [2.4- 4.3] pg/ml; p=0.0001) and fibrinogen (336 [290- 390] vs 310 [275- 364] mg/dl; P=0.04) was shown; moreover, a significant increase in GDF-15 serum level (1309 [974- 1961] vs 1538 [1286- 2913] pg/ml; p=0.002) was observed. Haemoglobin, renal function and cardiovascular homeostasis biomarkers remain stable over the time. The anti-Xa activity at both (0.005 [0-0.02] vs 0.2 [0.1-0.34]; p

The life cycle of Andricus truncicolus (Giraud, 1869), a species previously known only from its asexual generation, is closed. Laboratory rearing and field sampling have revealed the sexual generation of this species, which develops in a hypertrophic degeneration of the terminal or lateral shoot buds appearing as a muddled agglomerate of leaves on Quercus, section Cerris oaks. We describe for the first time the newly discovered sexual generation of A. truncicolus and provide illustrations and diagnosis for adults and galls of both generations, further observations on biology and information on the species distribution.

PURPOSE Given the heterogeneity and improvement in outcomes for metastatic breast cancer (MBC), we developed a staging system that refines prognostic estimates for patients with metastatic cancer at the time of initial diagnosis, de novo MBC (dnMBC), on the basis of survival outcomes and disease-related variables. METHODS Patients with dnMBC (2010-2016) were selected from the National Cancer Database (NCDB). Recursive partitioning analysis (RPA) was used to group patients with similar overall survival (OS) on the basis of clinical T category, grade, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. Three-year OS rates were used to assign a final stage: IVA: >70%, IVB: 50%-70%, IVC: 25 to RESULTS At a median follow-up of 52.9 months, the median OS of the original cohort (N = 42,467) was 35.4 months (95% CI, 34.8 to 35.9). RPA stratified patients into 53 groups with 3-year OS rates ranging from 73.5% to 5.7%; these groups were amalgamated into four stage groups: 3-year OS, A = 73.2%, B = 61.9%, C = 40.1%, and D = 17% (log-rank P < .001). After bootstrapping, the survival outcomes for the four stages remained significantly different (log-rank P < .001). This staging system was then validated using SEER data (N = 20,469) and a separate cohort from the NCDB (N = 7,645) (both log-rank P < .001). CONCLUSION Our findings regarding the heterogeneity in outcomes for patients with dnMBC could guide future revisions of the current American Joint Committee on Cancer staging guidelines for patients with newly diagnosed stage IV disease. Our findings should be independently confirmed.

PurposeThis paper aims at examining how different types of shop floor performance feedback affect employee motivation and engagement. Based on this dataset, the authors analyzed the relationship between five types of performance feedback (safety, quality, productivity, improvement and individual performance) and three types of human-related outputs (motivation, role clarity and engagement) in light of socio-technical systems theory.Design/methodology/approachThe authors designed a survey instrument and collected data from 492 employees of a large beverage distribution company. The authors used robust construct validity tests and multiple regression analysis to test the hypotheses.FindingsThe findings indicated significant positive effects of feedback on overall production, improvements and individual performance on all human-related outputs. In turn, safety and quality performance feedback had no statistically significant impact in motivation or engagement. These findings highlight the mixed nature of the impact of performance feedback on human-related outputs that have been neglected in the literature.Originality/valueThe joint analysis of the social and technical portion of performance feedback is unusual despite its clear relevance, which characterizes an original contribution of the authors’ work. Although previous literature supports the effect of performance feedback on motivation and engagement, previous studies have not tested how different types of feedback affect those social constructs.

Objectives In 2012, onetime hepatitis C virus (HCV) screening was recommended for all baby boomers (people born during 1945-1965) in the United States, but only 4.0%-12.9% of baby boomers have ever had a screening ordered by a health care provider. This study examined the HCV screening prevalence among adult patients in a large academic health care system and assessed factors associated with the completion of screening when ordered for baby boomers. Methods We defined HCV screening completion as the completion of an HCV antibody test when it was ordered. We used electronic health records to examine HCV screening completion rates among adults (N = 106 630) from August 1, 2015, through July 31, 2020, by birth cohort. Among baby boomers whose health care provider ordered HCV screening, we examined frequency and percentages of HCV screening completion by sociodemographic and clinical characteristics. We conducted univariate and multivariable logistic regression analyses to assess factors associated with HCV screening completion among baby boomers. Results During the study period, 73.0% of baby boomers completed HCV screening when it was ordered. HCV completion did not differ by sex or race and ethnicity among baby boomers. Baby boomers with Medicare supplemental health insurance compared with commercial health insurance (adjusted odds ratio [aOR] = 1.87) and those seeing only advanced practice professionals compared with specialty care physicians (aOR = 2.24) were more likely to complete HCV screening when it was ordered. Conclusions Noncompletion of HCV screening is one of many barriers along the HCV treatment continuum. Our findings suggest a need for interventions targeting systems, health care providers, and patients to increase HCV screening rates in the United States.

Continuous Passive Motion - CPM - is a therapeutic method that provides fast and safe patient rehabilitation. Considering the fact that the equipment performs the movement along with the patient, who also does it but passively, this treatment procedure can immediately be applied in the postoperative care period. Although this technique makes recovery faster, as strains will be spared from ligaments, muscles and tendons, not all clinics can offer CPM therapy due to its high cost. Bearing in mind the existence of such equipment that performs the aforementioned motion, the objective of this work was the development and manufacture of a prototype device for continuous passive shoulder movement, with costs reduced to an approximate value of USD$730.00 compared to the average price in the market which is around USD$1510.00. This difference in values would make it affordable for a greater majority of clinics and offices to purchase them and, thus, promote the accelerated timely recovery of the limb after operation, for a larger number of patients, allowing these patients to return to their daily tasks in shorter period of time. For the execution of the prototype, specific mechanical manufacturing methods, such us turning, milling and welding of materials, were applied in order to make the equipment safe and effective, provide comfort for the patient and, above all, make the device affordable for most physiotherapy clinics. The material used for the production was stainless steel, cables, pulleys, tilting automation kit and inductive sensors.

In principle, it should be for the Courts, which are not majoritarian institutions, to stand for the rights, even more for the new rights, that are minoritarian by definition. How far can the Courts safely go, when the recognition of such rights raises intense divergencies of opinion, confrontations between different collective identities, that populist movements can support and amplify? When should they leave the decision to the parliaments, which represent the will and the opinions of the citizens?

The aim of this case series was to assess the safety and effectiveness of peripheral nerve stimulation (PNS) of the brachial plexus performed using a low invasive percutaneous approach with ultrasound guide.Patients affected by neuropathic pain with a documented brachial plexus partial avulsion were included in this observational study. A totally implantable PNS system specifically designed for peripheral placement (Neurimpulse, Padua, Italy) was implanted and followed for 18 months, recording the level of pain (Numeric Rating Scale [NRS]), therapy satisfaction (Patient Global Impression of Improvement), quality of life (Short Form Health Survey questionnaire), and change in drug consumption and work status. Descriptive statistic (mean and SD) was used to compare pre- and postimplantation differences.A total of 18 patients were included in the observational study; 16 of them proceeded with the permanent implantation. System infection (N = 1) and lead migrations (N = 2) were recorded during a follow-up mean of 14.8 ± 5.4 months. The average NRS reduction at 18 months was 41%. Average quality-of-life physical and mental indexes increased by 14% and 32%, respectively. Drug intake was stopped in 22% and reduced in 56% of the patients.PNS systems of the brachial plexus implanted with percutaneous approach appear to be safe and effective in a follow-up period of 18 months. Longer and larger studies are needed to confirm and extend these outcomes.

The COVID-19 pandemic has affected people's lives throughout the world. Governments have imposed restrictions on business and social activities to reduce the spread of the virus. In the US, the pandemic response has been largely left to state and local governments, resulting in a patchwork of policies that frequently changed. We examine travel behavior across income and race/ethnic groups in Los Angeles County over several stages of the pandemic. We use a difference-in-difference model based on mobile device data to compare mobility patterns before and during the various stages of the pandemic. We find a strong relationship between income/ethnicity and mobility. Residents of low-income and ethnic minority neighborhoods reduced travel less than residents of middle- and high-income neighborhoods during the shelter-in-place order, consistent with having to travel for work or other essential purposes. As public health rules were relaxed and COVID vaccines became available, residents of high-income and White neighborhoods increased travel more than other groups, suggesting more discretionary travel. Our trip purpose model results show that residents of low-income and ethnic minority neighborhoods reduced work and shopping travel less than those of White and high-income neighborhoods during the shelter-in-place order. Results are consistent with higher-income workers more likely being able to work at home than lower-income workers. In contrast, low-income/minorities apparently have more constraints associated with work or household care. The consequence is less capacity to avoid virus risk. Race and socioeconomic disparities are revealed in mobility patterns observed during the COVID-19 pandemic.

The view of the International Monetary Fund (IMF) on capital account liberalization and capital controls has undergone important reassessments over the past two and a half decades. Several financial crises, including the 2007-2008 global financial one (GFC), propelled it to partially defend the use of capital controls to eliminate certain dysfunctions, such as financial risks and pressures on exchange rate appreciation. Our study shows that this reorientation in the scope of IMF articles also configured a response to empirical studies that pointed to flaws in orthodox theory about capital account liberalization and those that investigated the effectiveness of capital controls in emerging economies in the post-global financial crisis period. However, we are yet to find no explicit defense in favor of the use of capital controls and the permanent management of exchange rates, despite relevant empirical evidence indicating the effectiveness of these measures. Resumo A visão do Fundo Monetário Internacional (FMI) sobre liberalização da conta financeira e controles de capital passou por importantes reavaliações ao longo das últimas duas décadas e meia. A ocorrência de diversas crises financeiras, incluindo a crise global em 2007-2008, impulsionou a instituição a defender parcialmente o uso de controles de capital que tenham o objetivo de eliminar algumas disfunções, tais como riscos financeiros e pressões de apreciação cambial. Neste artigo, argumenta-se que essa reorientação no escopo dos artigos do FMI também foi uma resposta a estudos empíricos que apontaram falhas na teoria ortodoxa sobre liberalização da conta financeira, e que analisaram a eficácia dos controles de capital impostos por economias emergentes ao longo do pós crise global. Não obstante, o FMI permanece não defendendo e recomendando o uso de controles de capital e a administração da taxa de câmbio em caráter permanente, apesar de evidências empíricas relevantes que indicam a eficácia dessas medidas.

To investigate the efficacy and safety of preoperative arterial embolization for neurogenic heterotopic ossification of the hip.This single-center retrospective study reviewed outcomes in 16 consecutive patients who had surgical resection of neurogenic heterotopic ossification of the hip, 8 of whom underwent preoperative arterial embolization and 8 of whom did not. Both patient cohorts had similar baseline characteristics. A mean of 2.62+/-1.9 arteries per patient including gluteal, lateral circumflex femoral and deep circumflex iliac branches were embolized using a NBCA - Lipiodol mixture. Data from both cohorts regarding intraoperative blood loss, volume of blood transfused, complications and duration of hospitalization, were compared.A mean of 2.6±1.9 arteries was embolized with NBCA-Lipiodol, mainly gluteal arteries, lateral circumflex femoral artery and deep circumflex iliac artery. In the embolization group, mean intraoperative blood loss was 875±320ml, mean number of units of blood used was 0.5±0.7, and number of days of hospitalization was on average 6.4±1.6 days. In the control group, mean intraoperative blood loss was 1350±120 ml, mean number of units of blood used was 2±1.1, and number of days of hospitalization was on average 11.5±1.4. The embolization group had an average reduction in blood loss of 35.2% (p0.05), reduction of units of blood administered of 75% (p0.05), and reduction of days of hospitalization of 44.3% (p0.05). No procedural complications were recorded.Preoperative arterial embolization is effective and safe in reducing intraoperative blood loss, number of hospitalization days, and need for blood transfusions in surgical resection of neurogenic heterotopic ossification of the hip.

SummaryCritical period-like plasticity (iPlasticity) can be reinstated in the adult brain by several interventions, including drugs and optogenetic modifications. We have demonstrated that a combination of iPlasticity with optimal training improves behaviors related to neuropsychiatric disorders. In this context, the activation of TrkB, a receptor for BDNF, in Parvalbumin positive (PV+) interneurons has a pivotal role in cortical network changes. However, it is unknown if the activation of TrkB in PV+ interneurons is important for other plasticity-related behaviors, especially for learning and memory. Here, using mice with heterozygous conditional TrkB deletion in PV+ interneurons (PV-TrkB hCKO) in Intellicage and fear erasure paradigms, we show that chronic treatment with fluoxetine, a widely prescribed antidepressant drug that is known to promote the activation of TrkB, enhances behavioral flexibility in spatial and fear memory, largely depending on the expression of the TrkB receptor in PV+ interneurons. In addition, hippocampal long-term potentiation (LTP) was enhanced by chronic treatment with fluoxetine in wild-type mice, but not in PV-TrkB hCKO mice. Transcriptomic analysis of PV+ interneurons after fluoxetine treatment indicated intrinsic changes in synaptic formation and downregulation of enzymes involved in perineuronal net (PNN) formation. Consistently, immunohistochemistry has shown that the fluoxetine treatment alters PV expression and reduces PNNs in PV+ interneurons, and here we show that TrkB expression in PV+ interneurons is required for these effects. Together, our results provide molecular and network mechanisms for the induction of critical period-like plasticity in adulthood.

Marine heatwaves (MHWs) induce significant impacts on marine ecosystems. There is a growing need for knowledge about extreme climate events to better inform decision-makers on future climate-related risks. Here we present a unique observational dataset of MHW macroevents and their characteristics over the southern Europe and western Asian (SEWA) basins, named the SEWA-MHW dataset (https://doi.org//10.5281/zenodo.7153255; Bonino et al., 2022). The SEWA-MHW dataset is derived from the European Space Agency Sea Surface Temperature Climate Change Initiative (ESA SST CCI) v2 dataset, and it covers the 1981–2016 period. The methodological framework used to build the SEWA-MHW dataset is the novelty of this work. First, the MHWs detected in each grid point of the ESA CCI SST dataset are relative to a time-varying baseline climatology. Since intrinsic fluctuation and anthropogenic warming are redefining the mean climate, the baseline considers both the trend and the time-varying seasonal cycle. Second, using a connected component analysis, MHWs connected in space and time are aggregated in order to obtain macroevents. Basically, a macroevent-based dataset is obtained from a grid cell-based dataset without losing high-resolution (i.e., grid cell) information. The SEWA-MHW dataset can be used for many scientific applications. For example, we identified phases of the well-known MHW of summer 2003, and taking advantage of statistical clustering methods, we clustered the largest macroevents in SEWA basins based on shared metrics and characteristics.

Since the introduction of Regulation (EU) No 376/2014 of the European Parliament and of the Council in 2014, [1], EU Member States and EASA have been required to publish the Annual Safety Review (ASR). The ASR contains an overview of the safety statistics in each Member State, reporting numerical indicators and graphical representations. Its goal is to describe national aviation safety scenarios on which appropriate preventive measures can be based. Among the diversity of reporting practices within the EU Member States, it is possible to find a common set of criteria for the analysis of ASRs, to design homogeneous and data-driven safety measures across the continent. Currently, the main obstacles to our approach arise from the wide variety of reporting styles and the lack of shared guidelines for ASRs. This paper proposes a template to assist EU Member States in the process of producing their ASRs and presents a comparative analysis of a selected subset of these documents.

O comportamento para a saúde está relacionado ao autocontrole, tomada de decisão, condições socioafetivas e econômicas e a regulação do bem estar aonde impacta na qualidade de vida biopsicossocial. A qualidade de vida é considerada como promotora da saúde. Neste contexto, as Práticas Integrativas e Complementares [PICs], na literatura, vem demonstrando evidências para serem aplicadas na promoção da saúde com ou sem complemento às terapêuticas biomédicas. Entretanto, relacionado aos efeitos na promoção da saúde, em função de diversos grupos e delineamentos, não há consenso nos resultados dos componentes da saúde que as PICs agem onde são descritos benefícios na regulação do humor, redução do estresse, controle da dor, promoção do bem-estar e melhora no estilo de vida. Notou-se também que pesquisa com o público jovem adulto, em estratégias de saúde, no Brasil, são poucos. Neste sentido, o objetivo desta pesquisa foi verificar a relação entre as Práticas Integrativas e Complementares e a percepção do bem-estar, das funções do pensamento e da autoestima associadas ao impacto da emoção no estabelecimento de medidas comportamentais em saúde. Método: Aplicou-se o WHOQOL-100: Domínio Psicológico (facetas: Sentimentos Positivos/Pensamento, Aprendizagem.../Autoestima/ImagemCorporal e Aparência/Sentimentos Negativos) em 28 praticantes das PICs e em 35 não praticantes com característica Survey e delineamento correlacional com comparação entre grupos utilizando o software SPSS. Foi utilizado o teste t student para verificar a diferença entre as médias do WHOQOL-100 (pvalor

This paper analyzes some of the telecommunication companies' (telcos) domestic networks' main objectives and issues related to the application services Quality of Experience (QoE), i.e., "technical QoE," and the economic sustainability of the Very High Capacity (VHC) networks. Telco domestic networks and Over The Top (OTT) networks are the Internet segments connecting the end-user equipment to the servers/clouds that provide application services. With the advent of VHC networks, telcos afford difficulties in managing effectively and efficiently the application services and their business sustainability. This paper affords some issues related to traditional telcos' domestic network architectures and the approach to managing the application services' performance improvement. Some telcos started changing their architectures, although a massive transformation had not yet started in the industry. Traditionally, telcos focus on network services, i.e., the transport of IP packets. Performance improvement is obtained by QoS-based traffic management techniques, such as bandwidth reservation and packet prioritization. To manage application performance improvement, the use of layer 4 techniques and Edge Cloud Computing (ECC) is effective, as demonstrated by the multiyear experience of OTTs which already use these technologies. In telco domestic networks, layer 2 tunnels increase the complexity of deploying ECC. However, some vendors provide non-standard solutions to make the IP layer 3 user plane visible and to deploy ECC. ECC is the key factor for the transformation. It is a mini/micro-data center that distributes some applications and content closer to the end users. The distribution can provide a paradigm shift in a telco's business. In the paper, we first highlight the need for regulators to appreciate the need to encourage this industry transformation fully.

Background: Immune checkpoint inhibition (ICI) is synergistic with HER2-directed therapy in pre-clinical models. Clinically, pembrolizumab (K)-mediated ICI plus HER2-directed therapy with trastuzumab (H) was safe and demonstrated modest activity in H-resistant HER2-positive (HER2+) metastatic breast cancer. Because ICI may confer more robust activity when administered earlier in the course of disease, H and K administered in the curative-intent, treatment-naive setting may allow for de-escalation of cytotoxic chemotherapy; confer life-long, tumor-specific immunity; and ultimately, improve cure rates. Moreover, the synergy of H and K with paclitaxel (T) may overcome the need for dual HER2-blockade with H plus pertuzumab (P). In this randomized, multicenter, phase II, open-label, multi-center trial the efficacy and safety of neoadjuvant THP vs THP-K vs TH-K are explored. Methods: 174 patients (pts) ≥18y with previously untreated, stage II-III, HER2+ breast cancer will be randomized and stratified by clinical nodal status (positive vs. negative) and hormone receptor status (positive vs. negative). In arm A, pts receive T at 80mg/m2 weekly for 12 weeks, H at 8mg/Kg (loading dose) and then 6mg/Kg every 3 weeks x 3 doses, P at 840 mg (loading dose) and then 420mg/Kg every 3 weeks x 3 doses (THP). In arm B, pts receive THP plus K at 200mg every 3 weeks x 4 doses (THP-K). In arm C, pts receive TH-K; however, in a preplanned interim analysis, arm C did not meet the pre-defined efficacy threshold and this arm was subsequently closed. Enrollment to arms A and B continue. Definitive surgery is 3-6 weeks after the last dose. After surgery, pts are treated per the treating physician’s discretion including radiotherapy per local clinical standard. Pts whose tumors are hormone-receptor positive will receive hormone therapy per local standard-of-care. The primary end point is pathologic complete response (pCR) rate in the breast and axilla (ypT0/Tis ypN0). Secondary end points include pCR rate by ypT0ypN0 and ypT0/Tis, residual cancer burden index, event free survival, breast conserving surgery rate, safety and overall survival. Exploratory correlative studies will characterize potential immune biomarkers predictive of efficacy and/or toxicity. Funding sources: BCRF, Merck NCT03747120 Citation Format: Heather McArthur, Jorge Henrique Santos Leal, Christina DiLauro Abaya, Sangeetha Reddy, Meredith Carter, Reva Basho, Michelle Phillips, David Chan, Hugo Hool, Dorothy Park, Mary El-Masry, Philomena McAndrew, Swati Sikaria, Laura M. Spring, Aditya Bardia, Mourad Tighiouart, Farnaz Dadmanesh, Armando Giuliano, Stephen Shiao, David B. Page. Neoadjuvant HER2-targeted Therapy +/- Immunotherapy with Pembrolizumab (neoHIP): An Open Label Randomized Phase II Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-25-01.

We investigate the extent to which redundancy (including with diversity) can help mitigate the impact of cyber attacks that aim to reduce system performance. Using analytical techniques, we estimate impacts, in terms of monetary costs, of penalties from breaching Service Level Agreements (SLAs), and find optimal resource allocations to minimize the overall costs arising from attacks. Our approach combines attack impact analysis, based on performance modeling using queueing networks, with an attack model based on attack graphs. We evaluate our approach using a case study of a website, and show how resource redundancy and diversity can improve the resilience of a system by reducing the likelihood of a fully disruptive attack. We find that the cost-effectiveness of redundancy depends on the SLA terms, the probability of attack detection, the time to recover, and the cost of maintenance. In our case study, redundancy with diversity achieved a saving of up to around 50 percent in expected attack costs relative to no redundancy. The overall benefit over time depends on how the saving during attacks compares to the added maintenance costs due to redundancy.

Background Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomized controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question. Objectives To assess the effects of breast surgery on long term outcomes of women with metastatic breast cancer. Search methods We conducted searches using the MeSH terms ’breast neoplasms’, ’mastectomy’, and ’analysis, survival’ in the following databases: the Cochrane Breast Cancer Specialised Register, CENTRAL, MEDLINE (by PubMed) and Embase (by OvidSP) on 08 December 2021. Selection criteria The inclusion criteria were randomized controlled trials of women with metastatic breast cancer at initial diagnosis comparing breast surgery plus systemic therapy versus systemic therapy alone. The primary outcomes were overall survival and quality of life. Secondary outcomes were progression-free survival (local and distant control), breast cancer-specific survival, and toxicity from local therapy. Data collection and analysis Two review authors independently conducted trial selection, data extraction, and ’Risk of bias’ assessment (using Cochrane’s ’Risk of bias’ tool), which a third review author checked. We used the GRADE tool to assess the quality of the body of evidence. We used the risk ratio (RR) to measure the effect of treatment for dichotomous outcomes and the hazard ratio (HR) for time-to-event outcomes. We calculated 95% confidence intervals (CI) for these measures. We used the random-effects model, as we expected clinical or methodological heterogeneity, or both, among the included studies. Main results We included four trials enrolling women with metastatic breast cancer in the review. These studies included 961 participants, 477 in the surgery group, and 485 in the control group. The evidence suggests that surgery does not improve overall survival as the quality of the evidence has been assessed as very low (HR 0.92, 95% CI 0.72 to 1.18; 4 studies; 961 women). The evidence suggests that surgery does not improve overall survival subgroup analysis according to the number of metastasis sites (HR 1.08, 95% CI 0.74 to 1.58; 3 studies, 320 women); bone metastasis only (HR 0.86, 95% CI 0.67 to 1.11; 3 studies, 253 women). According to the tumor subtype surgery seems not improve the overall survival in triple-negative (HR 1.10, 95% CI 0.53 to 2.28; 3 studies, 132 women) and HER 2 positive profile (HR 0.83, 95% CI 0.63 to 1.11; 3 studies, 262 women). However, for patients with luminal tumors surgery can significantly or marginally increase the survival (HR 0.81, 95% CI 0.67 to 0.98; 3 studies, 547 women). Breast surgery may improve local progression-free survival (HR 0.48, 95% CI 0.27 to 0.84; 3 studies; 686 women; low-quality evidence), while it does not change distant progression-free survival (HR 1.03, 95% CI 0,77 to 1.36; 3 studies; very low-quality evidence). Two studies reported quality of life outcomes, however it was not possible to perform a meta-analysis due to different tools used by these trials. Authors’ conclusions Based on existing evidence from four randomized clinical trials, breast surgery does not to improve overall survival for women with metastatic breast cancer. However, in subgroup analysis, women with luminal tumors present increase in survival. The quality of evidence was very low and the decision to perform breast surgery on these women should be individualized and discussed by a multidisciplinary team considering the potential risks, benefits, and costs of each intervention. Citation Format: Giuliano Tosello, Rachel Riera, Diego Christofaro, Crystian Oliveira, Marcelo Cruz, Thais R. Paulo, Bruna S. Mota. Breast surgery for metastatic breast cancer: a Cochrane systematic review. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-16.

Building performance models for software services in DevOps is costly and error-prone. Accurate service demand distribution estimation is critical to precisely modeling queueing behaviors and performance prediction. However, current estimation methods focus on capturing the mean service demand, disregarding higher-order moments of the distribution that still can largely affect prediction accuracy. To address this limitation, we propose to estimate higher moments of the service demand distribution for a microservice from monitoring traces. We first generate a closed queueing model to abstract software performance and use it to model the departure process of requests completed by the software service as a Markovian arrival process (MAP). This allows formulating the estimation of service demand into an optimization problem, which aims to find the first multiple moments of the service demand distribution that maximize the likelihood of the MAP using generated the measured inter-departure times. We then estimate the service demand distribution for different classes of service with a maximum likelihood algorithm and novel heuristics to mitigate the computational cost of the optimization process for scalability. We apply our method to real traces from a microservice-based application and demonstrate that its estimations lead to greater prediction accuracy than exponential distributions assumed in traditional service demand estimation approaches for software services.