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BACKGROUND: Breast cancer is the second most common cause of brain metastases (BM). Despite increasing incidence of BM in older women, there are limited data on the optimal management of BM in this age group. In this study, we assessed the survival outcomes and treatment patterns of older breast cancer patients ≥65 years old with BM compared to younger patients at our institution. METHODS: An IRB-approved single-institutional retrospective review of biopsy-proven breast cancer patients with BM treated with 1- to 5-fraction stereotactic radiation therapy (SRS) from 2015 to 2020 was performed. Primary endpoint was intracranial progression-free survival (PFS) defined as the time interval between the end of SRS to the date of the first CNS progression. Secondary endpoints were overall survival (OS) from the end of SRS and radiation treatment patterns. Kaplan-Meier estimates and Cox proportional hazard regression method were used for survival analyses. RESULTS: A total of 112 metastatic breast cancer patients with BMs were included of which 24 were ≥65 years old and 88 were

Psychometric testing is a valuable educational tool for the assessment and monitoring of students’ abilities in core subjects. However, the manual development of these tests is a tedious process requiring test specialists to produce and curate large volumes of high-quality items. In this paper, we consider whether automating test item generation with modern machine learning methods is a feasible solution for obtaining strong psychometric test items at low cost in the domain of sentence reading fluency. We assess the ability of the large neural language model GPT-3 to produce items ``few-shot’’--- from a short prompt with only a handful of examples. Our results show that generated items closely resemble standardized test items in terms of their factual ambiguity, content appropriateness, and complexity. Furthermore, after filtering for correct answer-labeling these generated items possess similar latent psychometric properties to standardized test items, even capturing subtle grade-level variation.

PurposeAccrual to clinical trials that challenge well-established treatment paradigms represents a unique challenge. Physician opinions on investigation of a novel approach to breast cancer treatment, in which patients with complete response to neoadjuvant chemotherapy are offered omission of lumpectomy, are unknown. NRG-CC006 sought to describe physician attitudes toward a novel approach to breast cancer treatment.MethodsWe recruited 18 participants in the fields of surgery, medical oncology, and radiation oncology to participate in the semi-structured telephone interviews. Main outcomes are qualitative themes associated with omission of surgery.ResultsOf 18 interview participants, specialty and gender were evenly represented across surgery, medical oncology, and radiation oncology. Qualitative themes included general attitudes toward treatment de-escalation, stakeholder considerations, and trial/protocol considerations. The vast majority of participants expressed interest in investigation of omission of surgery, with all participants endorsing need for further investigation into treatment de-escalation. Stakeholder considerations in opening such a trial emphasized need for multidisciplinary involvement and, particularly, the unique role of surgeons as gatekeepers in breast cancer treatment. Finally, participants endorsed a need for further foundational studies to develop ways to predict complete pathologic response to chemotherapy without surgical intervention.ConclusionsPhysicians expressed interest in investigating a novel approach to breast cancer treatment that would omit surgery in complete responders to neoadjuvant chemotherapy. Multidisciplinary input, and specifically surgeon engagement, will be key to the success of future investigations. Ongoing work to develop approaches to predict pathologic complete response accurately is needed to achieve the promise of this idea. ClinTrials #: BR005: NCT03188393 June 13, 2017.

Despite the overwhelming body of research suggesting that students with intellectual disability benefit from access to general education placements, students with intellectual disability continue to be educated primarily in segregated settings. Furthermore, the percentage of students with intellectual disability included in general education classrooms varies greatly among and within states across the United States. In an effort to explore such variability in New York State, we examined trends in general education placement rates of students with intellectual disability across districts and possible predictors of placement in regular classes. Results suggest that although descriptive patterns of placement exist, a more definitive explanation of variability requires a deeper analysis of policy and procedure at the district level.

BackgroundWhole-breast irradiation after breast-conserving surgery for patients with early-stage breast cancer decreases ipsilateral breast-tumour recurrence (IBTR), yielding comparable results to mastectomy. It is unknown whether accelerated partial breast irradiation (APBI) to only the tumour-bearing quadrant, which shortens treatment duration, is equally effective. In our trial, we investigated whether APBI provides equivalent local tumour control after lumpectomy compared with whole-breast irradiation.MethodsWe did this randomised, phase 3, equivalence trial (NSABP B-39/RTOG 0413) in 154 clinical centres in the USA, Canada, Ireland, and Israel. Adult women (>18 years) with early-stage (0, I, or II; no evidence of distant metastases, but up to three axillary nodes could be positive) breast cancer (tumour size ≤3 cm; including all histologies and multifocal breast cancers), who had had lumpectomy with negative (ie, no detectable cancer cells) surgical margins, were randomly assigned (1:1) using a biased-coin-based minimisation algorithm to receive either whole-breast irradiation (whole-breast irradiation group) or APBI (APBI group). Whole-breast irradiation was delivered in 25 daily fractions of 50 Gy over 5 weeks, with or without a supplemental boost to the tumour bed, and APBI was delivered as 34 Gy of brachytherapy or 38·5 Gy of external bream radiation therapy in 10 fractions, over 5 treatment days within an 8-day period. Randomisation was stratified by disease stage, menopausal status, hormone-receptor status, and intention to receive chemotherapy. Patients, investigators, and statisticians could not be masked to treatment allocation. The primary outcome of invasive and non-invasive IBTR as a first recurrence was analysed in the intention-to-treat population, excluding those patients who were lost to follow-up, with an equivalency test on the basis of a 50% margin increase in the hazard ratio (90% CI for the observed HR between 0·667 and 1·5 for equivalence) and a Cox proportional hazard model. Survival was assessed by intention to treat, and sensitivity analyses were done in the per-protocol population. This trial is registered with ClinicalTrials.gov, NCT00103181.FindingsBetween March 21, 2005, and April 16, 2013, 4216 women were enrolled. 2109 were assigned to the whole-breast irradiation group and 2107 were assigned to the APBI group. 70 patients from the whole-breast irradiation group and 14 from the APBI group withdrew consent or were lost to follow-up at this stage, so 2039 and 2093 patients respectively were available for survival analysis. Further, three and four patients respectively were lost to clinical follow-up (ie, survival status was assessed by phone but no physical examination was done), leaving 2036 patients in the whole-breast irradiation group and 2089 in the APBI group evaluable for the primary outcome. At a median follow-up of 10·2 years (IQR 7·5-11·5), 90 (4%) of 2089 women eligible for the primary outcome in the APBI group and 71 (3%) of 2036 women in the whole-breast irradiation group had an IBTR (HR 1·22, 90% CI 0·94-1·58). The 10-year cumulative incidence of IBTR was 4·6% (95% CI 3·7-5·7) in the APBI group versus 3·9% (3·1-5·0) in the whole-breast irradiation group. 44 (2%) of 2039 patients in the whole-breast irradiation group and 49 (2%) of 2093 patients in the APBI group died from recurring breast cancer. There were no treatment-related deaths. Second cancers and treatment-related toxicities were similar between the two groups. 2020 patients in the whole-breast irradiation group and 2089 in APBI group had available data on adverse events. The highest toxicity grade reported was: grade 1 in 845 (40%), grade 2 in 921 (44%), and grade 3 in 201 (10%) patients in the APBI group, compared with grade 1 in 626 (31%), grade 2 in 1193 (59%), and grade 3 in 143 (7%) in the whole-breast irradiation group.InterpretationAPBI did not meet the criteria for equivalence to whole-breast irradiation in controlling IBTR for breast-conserving therapy. Our trial had broad eligibility criteria, leading to a large, heterogeneous pool of patients and sufficient power to detect treatment equivalence, but was not designed to test equivalence in patient subgroups or outcomes from different APBI techniques. For patients with early-stage breast cancer, our findings support whole-breast irradiation following lumpectomy; however, with an absolute difference of less than 1% in the 10-year cumulative incidence of IBTR, APBI might be an acceptable alternative for some women.FundingNational Cancer Institute, US Department of Health and Human Services.

Simple Summary: Breast MRI is a valuable imaging modality that plays a critical role in the detection, diagnosis, and treatment of breast cancer. The superior sensitivity of breast MRI allows for more accurate evaluation of the extent of disease for breast cancer, which is important in an era where de-escalation of treatment is being considered and offered. In this review, we provided a detailed overview of breast MRI and its clinical utility in the management of breast cancer as a foundation for its use in the field of radiation oncology. Specifically, we describe breast MRI technique, anatomy, common breast MR imaging findings, and the role of breast MRI in assessing extent of disease and tumor response to neoadjuvant therapy. There has been increased interest in the use of MRI during radiotherapy treatment planning and delivery for patients with early-stage breast cancer as it may allow for more personalized radiotherapy. Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy. [ABSTRACT FROM AUTHOR]

In 2001, a group of student activists at Syracuse University started an organization called the Beyond Compliance Coordinating Committee (BCCC). The BCCC activists used disability studies theory to engage the campus in conversations about disability and inform significant change in the way Syracuse administration think about disability. This paper explores what makes Syracuse unique and what happened between 2001 and the present day. It concludes with recommendations for disability services providers on how they can use the experience at Syracuse to inform their thinking about campus culture and services.

U.S. Department of Energy (DOE) High Performance Computing (HPC) facilities are on the verge of a paradigm shift in the way they deliver systems and services to science and engineering teams. Research projects are producing a wide variety of data at unprecedented scale and level of complexity, with community-specific services that are part of the data collection and analysis workflow. On June 18-19, 2014 representatives from six DOE HPC centers met in Oakland, CA at the DOE High Performance Operational Review (HPCOR) to discuss how they can best provide facilities and services to enable large-scale data-driven scientific discovery at the DOE national laboratories. The report contains findings from that review.

Simple Summary: There is paucity of data on the optimal management of brain metastases in older women ≥65 years old with breast cancer. In this single-institutional retrospective study, we assessed the survival outcomes and treatment patterns of breast cancer patients ≥65 years old with brain metastases and compared them to younger patients. A total of 112 patients were included. Treatment-related adverse events were similar in both groups. Although older women had a poorer median overall survival compared to younger women (9.5 vs. 14.5 months), survival was similar after adjusting for KPS, extracranial progression, and systemic therapy; and there was no difference in rates of intracranial PFS, neurological deaths, and leptomeningeal disease in the different age groups. This study suggests that age alone may not play an independent role in treatment-selection and that outcomes for breast cancer patients with brain metastases and personalized decision-making including a comprehensive geriatric assessment should be considered. Background: Breast cancer is the second most common cause of brain metastases (BM). Despite increasing incidence of BM in older women, there are limited data on the optimal management of BM in this age group. In this study, we assessed the survival outcomes and treatment patterns of older breast cancer patients ≥65 years old with BM compared to younger patients at our institution. Methods: An IRB-approved single-institutional retrospective review of biopsy-proven breast cancer patients with BM treated with 1- to 5-fraction stereotactic radiation therapy (SRS) from 2015 to 2020 was performed. Primary endpoint was intracranial progression-free survival (PFS) defined as the time interval between the end of SRS to the date of the first CNS progression. Secondary endpoints were overall survival (OS) from the end of SRS and radiation treatment patterns. Kaplan–Meier estimates and Cox proportional hazard regression method were used for survival analyses. Results: A total of 112 metastatic breast cancer patients with BMs were included of which 24 were ≥65 years old and 88 were <65 years old. Median age at RT was 72 years (range 65–84) compared to 52 years (31–64) in younger patients. There were significantly higher number of older women with ER/PR positive disease (75% vs. 49%, p = 0.036), while younger patients were more frequently triple negative (32% vs. 12%, p = 0.074) and HER2 positive (42% vs. 29%, p = 0.3). Treatment-related adverse events were similar in both groups. Overall, 14.3% patients had any grade radiation necrosis (RN) (older vs. young: 8.3% vs. 16%, p = 0.5) while 5.4% had grade 3 or higher RN (0% vs. 6.8%, p = 0.7). Median OS after RT was poorer in older patients compared to younger patients (9.5 months vs. 14.5 months, p = 0.037), while intracranial PFS from RT was similar between the two groups (9.7 months vs. 7.1 months, p = 0.580). On univariate analysis, significant predictors of OS were age ≥65 years old (hazard risk, HR = 1.70, p = 0.048), KPS ≤ 80 (HR = 2.24, p < 0.001), HER2 positive disease (HR = 0.46, p < 0.001), isolated CNS metastatic disease (HR = 0.29, p < 0.001), number of brain metastases treated with RT (HR = 1.06, p = 0.028), and fractionated SRS (HR = 0.53, p = 0.013). On multivariable analysis, KPS ≤ 80, HER2 negativity and higher number of brain metastases predicted for poorer survival, while age was not a significant factor for OS after adjusting for other variables. Patients who received systemic therapy after SRS had a significantly improved OS on univariate and multivariable analysis (HR = 0.32, p < 0.001). Number of brain metastases treated was the only factor predictive of worse PFS (HR = 1.06, p = 0.041), which implies a 6% additive risk of progression for every additional metastasis treated. Conclusions: Although older women had poorer OS than younger women, OS was similar after adjusting for KPS, extracranial progression, and systemic therapy; and there was no difference in rates of intracranial PFS, neurological deaths, and LMD in the different age groups. This study suggests that age alone may not play an independent role in treatment-selection and that outcomes for breast cancer patients with BMs and personalized decision-making including other clinical factors should be considered. Future studies are warranted to assess neurocognitive outcomes and other radiation treatment toxicities in older patients. [ABSTRACT FROM AUTHOR]

Despite the overwhelming body of research suggesting that students with intellectual disability benefit from access to general education placements, students with intellectual disability continue to be educated primarily in segregated settings. Furthermore, the percentage of students with intellectual disability included in general education classrooms varies greatly among and within states across the United States. In an effort to explore such variability in New York State, we examined trends in general education placement rates of students with intellectual disability across districts and possible predictors of placement in regular classes. Results suggest that although descriptive patterns of placement exist, a more definitive explanation of variability requires a deeper analysis of policy and procedure at the district level. Keywords: intellectual disability, special education, least restrictive environment, inclusive education, A continued focus on access to placement in regular classes for students with disabilities is apparent in many countries (Ainscow & Cesar, 2006; Drudy & Kinsella, 2009). In fact, UNESCO [...]

Films portraying characters with disabilities are often shown in the English classroom. Films such as "Of Mice and Men," "Simon Birch," "To Kill a Mockingbird," "The Hunchback of Notre Dame," "The Glass Menagerie," "Moby Dick," "Gattaca," and "A Beautiful Mind" often show simplistic and stereotypical representations of characters and their disabilities. Although students are frequently encouraged to think critically about a film's structure, themes, or symbolic elements, the authors argue that they should also learn to examine critically the representations of disability in these films. If stereotypical representations of characters with disabilities are not identified and challenged, another generation of people may hold on to outdated and unhealthy assumptions about real people with disabilities. In this article, the authors show what an active reading of "The Mighty," a commonly used film by English teachers adapted from Rodman Philbrick's novel "Freak the Mighty," might look like. "The Mighty" is valuable in that it positively portrays friendships between disabled and nondisabled characters, but the damaging and limited representations of disability that this film offers may perpetuate prevailing stereotypes of disability so that students maintain a stigmatizing viewpoint of persons with disability labels. The authors provide a synopsis of "The Mighty" and then describe an analytical tool--Martin Norden's stereotypic roles--that they think is useful in challenging negative constructions of characters with disabilities in the film. They present Norden's roles and their own critical reading of "The Mighty" as a model for other English teachers to use when "reading" disability in both film and literature. The authors end with recommendations for teachers on how to approach using film in ways that are respectful of people with disabilities and that are accepting of difference in classrooms. (Contains 2 figures and 2 notes.)

For nearly four decades, school finance has become progressively more central in school reform efforts aimed at improving student performance. At the same time, the focus of many school business officials and policymakers has turned to efficient uses of current resources in lieu of uniform increases in school funding. With regard to improving student achievement, class size reduction has become a popular state policy tool, but it remains one of the more costly education reforms, given the need to hire additional teaching personnel and provide additional classrooms. However, if co-teaching were allowed, capital costs associated with new classroom space could be reduced, or even eliminated. Given the popularity of class size reform, costs for implementation, and fiscal concerns of school business officials and policymakers, this article brief reviews the literature on the efficacy of class size reduction, describes the context of Florida's adoption of a Class Size Amendment, and examines the benefits and challenges related to co-teaching instructional strategies. The final section discusses implications for other states considering class size reform. (Contains 38 endnotes.)

Many patients with non-metastatic breast cancer benefit from adjuvant radiation therapy after lumpectomy or mastectomy on the basis of many randomized trials. However, there are many patients that have such low risks of recurrence after surgery that de-intensification of therapy by either reducing the treatment volume or omitting radiation altogether may be appropriate options. On the other hand, dose intensification may be necessary for more aggressive breast cancers. Until recently, these treatment decisions were based solely on clinicopathologic factors. Here, we review the current literature on the role of genomic assays as prognostic and/or predictive biomarkers to help guide adjuvant radiation therapy decision-making. [ABSTRACT FROM AUTHOR]