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Heart failure (HF) in the United States represents a significant burden for patients and a tremendous strain on the healthcare system. Patients receiving a diagnosis of HF can be placed into 1 of 4 New York Heart Association (NYHA) functional classifications; the greatest proportion of patients are in the NYHA class II category, which is defined as patients having a slight limitation of physical activity but who are comfortable at rest, and for whom ordinary physical activity results in symptoms of HF. Because the severity of NYHA class II HF may be perceived as mild or unalarming by this definition, the urgency to treat this type of HF may be overlooked. However, these patients are optimal candidates for active intervention because their HF is at a critical point on the disease progression continuum when untoward changes can be halted or reversed. This review discusses the physiological consequences of NYHA class II HF with reduced ejection fraction and describes recent clinical trials that have demonstrated a therapeutic benefit for patients in this population. In doing so, we hope to establish that patients with NYHA class II disease merit careful attention and to provide reassurance to the treating community that options are available for these patients. [ABSTRACT FROM PUBLISHER]

Diffuse solar radiation (Rd), known as an important component of global solar radiation (Rg), is a key parameter for solar energy related applications and ecosystem photosynthesis. Some meteorological models have been developed to estimate Rd with acceptable accuracy, but their spatial scales are often small due to the limited meteorological station number. Satellite-based models provide accurate and large-scale Rg estimates. However, remote sensing estimations of Rd are often with low spatial resolutions and large uncertainties, because their methods were based on inaccurate surface and atmospheric parameters. To address these challenges, the high-spatiotemporal-resolution (half-hourly and 1-km) Rd in the United States was estimated using the top-of-atmosphere (TOA) data from the new-generation geostationary satellite Geostationary Operational Environmental Satellites (GOES-16) and the method iterative random forest (RF). The results showed that the iterative RF model had higher accuracy than the simple RF and artificial neural network (ANN) models, and using TIR (thermal infrared) bands can improve models' accuracy. The best model can estimate half-hourly Rd with the accuracy R2 = 0.88, RMSE = 37.81 W/m2, and MBE = 0.01 W/m2. Compared with the previous 0.01-degree (∼11-km) Rd product Earth Polychromatic Imaging Camera (EPIC), the GOES-16 estimated 1-km Rd had similar spatial patterns. Moreover, based on the GOES-16 estimated half-hourly and 1-km Rd in the United States, the spatiotemporal heterogeneity of Rd was quantitatively observed. The proposed approach can be used to produce more high-spatiotemporal-resolution Rd products, and these products are very helpful for many solar-related research topics and industrial applications. [Display omitted] • Diffuse solar radiation was estimated using a new satellite-based machine learning model. • Top-of-atmosphere thermal infrared information helps the estimation of diffuse solar radiation. • Half-hourly/daily 1-km diffuse solar radiation in the United States was mapped. • Spatiotemporal heterogeneity of diffuse solar radiation was quantitatively observed. [ABSTRACT FROM AUTHOR]

This article discusses why the policy of affirmative action is not supported by some Americans. Affirmative action is perhaps one of the most controversial policies in recent U.S. history. Affirmative action, as a general policy, often involves a set of policies that share a common concern as the inclusion of categorical membership such as race and gender. Social psychological literature abounds with evidence suggesting that salience of group identity facilitates stereotyping and differential treatment. In reality, however, an affirmative action appointee is labeled as a "special" employee and treated differently, either positively or negatively. This "otherness" perception will not be eradicated. Labeling the candidate will bring heightened salience of group identity to the candidate. Resentment on the part of other candidates is particularly intense when opportunities are scarce and the gain of the affirmative action appointee is seen as at the expense of other more competent candidates.

Reports on the experience of the author on her education in the U.S. after she came for studies from Taiwan. Author's friendship with Chinese classmates; Experience of author in high school; Work of a volunteer done by author at her elder cousin's kindergarten; Ambitions of author.

Purpose: To describe the impact of fractionation scheme and tumor location on toxicities in stereotactic body radiation therapy (SBRT) for ≥5-cm non-small cell lung cancer (NSCLC), as part of a multi-institutional analysis.Methods: Patients with primary ≥5-cm N0 M0 NSCLC who underwent ≤5-fraction SBRT were examined across multiple high-volume SBRT centers. Collected data included clinical/treatment parameters; toxicities were prospectively assessed at each institution according to the Common Terminology Criteria for Adverse Events. Patients treated daily were compared with those treated every other day (QOD)/other nondaily regimens. Stratification between central and peripheral tumors was also performed.Results: Ninety-two patients from 12 institutions were evaluated (2004-2016), with median follow-up of 12 months. In total there were 23 (25%) and 6 (7%) grade ≥2 and grade ≥3 toxicities, respectively. Grades 2 and 3 pulmonary toxicities occurred in 9% and 4%, respectively; 1 patient treated daily experienced grade 5 radiation pneumonitis. Of the entire cohort, 46 patients underwent daily SBRT, and 46 received QOD (n=40)/other nondaily (n=6) regimens. Clinical/treatment parameters were similar between groups; the QOD/other group was more likely to receive 3-/4-fraction schemas. Patients treated QOD/other experienced significantly fewer grade ≥2 toxicities as compared with daily treatment (7% vs 43%, P<.001). Patients treated daily also had higher rates of grade ≥2 pulmonary toxicities (P=.014). Patients with peripheral tumors (n=66) were more likely to receive 3-/4-fraction regimens than those with central tumors (n=26). No significant differences in grade ≥2 toxicities were identified according to tumor location (P>.05).Conclusions: From this multi-institutional study, toxicity of SBRT for ≥5-cm lesions is acceptable, and daily treatment was associated with a higher rate of toxicities. [ABSTRACT FROM AUTHOR]

Summary: Background: Levodopa is the most effective therapy for Parkinson's disease, but chronic treatment is associated with the development of potentially disabling motor complications. Experimental studies suggest that motor complications are due to non-physiological, intermittent administration of the drug, and can be reduced with continuous delivery. We aimed to assess efficacy and safety of levodopa-carbidopa intestinal gel delivered continuously through an intrajejunal percutaneous tube. Methods: In our 12-week, randomised, double-blind, double-dummy, double-titration trial, we enrolled adults (aged ≥30 years) with advanced Parkinson's disease and motor complications at 26 centres in Germany, New Zealand, and the USA. Eligible participants had jejunal placement of a percutaneous gastrojejunostomy tube, and were then randomly allocated (1:1) to treatment with immediate-release oral levodopa-carbidopa plus placebo intestinal gel infusion or levodopa-carbidopa intestinal gel infusion plus oral placebo. Randomisation was stratified by site, with a mixed block size of 2 or 4. The primary endpoint was change from baseline to final visit in motor off-time. We assessed change in motor on-time without troublesome dyskinesia as a prespecified key secondary outcome. We assessed efficacy in a full-analysis set of participants with data for baseline and at least one post-baseline assessment, and imputed missing data with the last observation carried forward approach. We assessed safety in randomly allocated patients who underwent the percutaneous gastrojejunostomy procedure. This study is registered with ClinicalTrials.gov, numbers NCT00660387 and NCT0357994. Findings: From baseline to 12 weeks in the full-analysis set, mean off-time decreased by 4·04 h (SE 0·65) for 35 patients allocated to the levodopa-carbidopa intestinal gel group compared with a decrease of 2·14 h (0·66) for 31 patients allocated to immediate-release oral levodopa-carbidopa (difference −1·91 h [95% CI −3·05 to −0·76]; p=0·0015). Mean on-time without troublesome dyskinesia increased by 4·11 h (SE 0·75) in the intestinal gel group and 2·24 h (0·76) in the immediate-release oral group (difference 1·86 [95% CI 0·56 to 3·17]; p=0·0059). In the safety analyses 35 (95%) of 37 patients allocated to the levodopa-carbidopa intestinal gel group had adverse events (five [14%] serious), as did 34 (100%) of 34 patients allocated to the immediate-release oral levodopa-carbidopa group (seven [21%] serious), mainly associated with the percutaneous gastrojejunostomy tube. Interpretation: Continuous delivery of levodopa-carbidopa with an intestinal gel offers a promising option for control of advanced Parkinson's disease with motor complications. Benefits noted with intestinal gel delivery were of a greater magnitude than were those obtained with medical therapies to date, and our study is, to our knowledge, the first demonstration of the benefit of continuous levodopa delivery in a double-blind controlled study. Funding: AbbVie. [Copyright &y& Elsevier]