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- Darby, S, et al.
(author)
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Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death : meta-analysis of individual patient data for 10,801 women in 17 randomised trials
- 2011
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In: The Lancet. - 0140-6736 .- 1474-547X. ; 378:9804, s. 16-1707
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Journal article (peer-reviewed)abstract
- BACKGROUND: After breast-conserving surgery, radiotherapy reduces recurrence and breast cancer death, but it may do so more for some groups of women than for others. We describe the absolute magnitude of these reductions according to various prognostic and other patient characteristics, and relate the absolute reduction in 15-year risk of breast cancer death to the absolute reduction in 10-year recurrence risk.METHODS: We undertook a meta-analysis of individual patient data for 10,801 women in 17 randomised trials of radiotherapy versus no radiotherapy after breast-conserving surgery, 8337 of whom had pathologically confirmed node-negative (pN0) or node-positive (pN+) disease.FINDINGS: Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35·0% to 19·3% (absolute reduction 15·7%, 95% CI 13·7-17·7, 2p<0·00001) and reduced the 15-year risk of breast cancer death from 25·2% to 21·4% (absolute reduction 3·8%, 1·6-6·0, 2p=0·00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31·0% to 15·6% (absolute recurrence reduction 15·4%, 13·2-17·6, 2p<0·00001) and from 20·5% to 17·2% (absolute mortality reduction 3·3%, 0·8-5·8, 2p=0·005), respectively. In these women with pN0 disease, the absolute recurrence reduction varied according to age, grade, oestrogen-receptor status, tamoxifen use, and extent of surgery, and these characteristics were used to predict large (≥20%), intermediate (10-19%), or lower (<10%) absolute reductions in the 10-year recurrence risk. Absolute reductions in 15-year risk of breast cancer death in these three prediction categories were 7·8% (95% CI 3·1-12·5), 1·1% (-2·0 to 4·2), and 0·1% (-7·5 to 7·7) respectively (trend in absolute mortality reduction 2p=0·03). In the few women with pN+ disease (n=1050), radiotherapy reduced the 10-year recurrence risk from 63·7% to 42·5% (absolute reduction 21·2%, 95% CI 14·5-27·9, 2p<0·00001) and the 15-year risk of breast cancer death from 51·3% to 42·8% (absolute reduction 8·5%, 1·8-15·2, 2p=0·01). Overall, about one breast cancer death was avoided by year 15 for every four recurrences avoided by year 10, and the mortality reduction did not differ significantly from this overall relationship in any of the three prediction categories for pN0 disease or for pN+ disease.INTERPRETATION: After breast-conserving surgery, radiotherapy to the conserved breast halves the rate at which the disease recurs and reduces the breast cancer death rate by about a sixth. These proportional benefits vary little between different groups of women. By contrast, the absolute benefits from radiotherapy vary substantially according to the characteristics of the patient and they can be predicted at the time when treatment decisions need to be made.FUNDING: Cancer Research UK, British Heart Foundation, and UK Medical Research Council.
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- D'Andrea, S. D., et al.
(author)
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Understanding global secondary organic aerosol amount and size-resolved condensational behavior
- 2013
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In: Atmospheric Chemistry And Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 13:22, s. 11519-11534
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Journal article (peer-reviewed)abstract
- Recent research has shown that secondary organic aerosols (SOA) are major contributors to ultrafine particle growth to climatically relevant sizes, increasing global cloud condensation nuclei (CCN) concentrations within the continental boundary layer (BL). However, there are three recent developments regarding the condensation of SOA that lead to uncertainties in the contribution of SOA to particle growth and CCN concentrations: (1) while many global models contain only biogenic sources of SOA (with annual production rates generally 10-30 Tg yr(-1)), recent studies have shown that an additional source of SOA around 100 Tg yr(-1) correlated with anthropogenic carbon monoxide (CO) emissions may be required to match measurements. (2) Many models treat SOA solely as semi-volatile, which leads to condensation of SOA proportional to the aerosol mass distribution; however, recent closure studies with field measurements show nucleation mode growth can be captured only if it is assumed that a significant fraction of SOA condenses proportional to the Fuchs-corrected aerosol surface area. This suggests a very low volatility of the condensing vapors. (3) Other recent studies of particle growth show that SOA con-densation at sizes smaller than 10 nm and that size-dependent growth rate parameterizations (GRP) are needed to match measurements. We explore the significance of these three findings using GEOS-Chem-TOMAS global aerosol microphysics model and observations of aerosol size distributions around the globe. The change in the concentration of particles of size D-p > 40 nm (N40) within the BL assuming surface-area condensation compared to mass-distribution net condensation yielded a global increase of 11% but exceeded 100% in biogenically active regions. The percent change in N40 within the BL with the inclusion of the additional 100 Tg SOAyr(-1) compared to the base simulation solely with biogenic SOA emissions (19 Tg yr-1) both using surface area condensation yielded a global increase of 13.7 %, but exceeded 50% in regions with large CO emissions. The inclusion of two different GRPs in the additional-SOA case both yielded a global increase in N40 of < 1 %, however exceeded 5% in some locations in the most extreme case. All of the model simulations were compared to measured data obtained from diverse locations around the globe and the results confirmed a decrease in the model-measurement bias and improved slope for comparing modeled to measured CCN number concentration when non-volatile SOA was assumed and the extra SOA was included.
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| 8. |
- Riipinen, Ilona, et al.
(author)
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The contribution of organics to atmospheric nanoparticle growth
- 2012
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In: Nature Geoscience. - : Springer Science and Business Media LLC. - 1752-0894 .- 1752-0908. ; 5:7, s. 453-458
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Journal article (peer-reviewed)abstract
- Aerosols have a strong, yet poorly quantified, effect on climate. The growth of the smallest atmospheric particles from diameters in the nanometre range to sizes at which they may act as seeds for cloud droplets is a key step linking aerosols to clouds and climate. In many environments, atmospheric nanoparticles grow by taking up organic compounds that are derived from biogenic hydrocarbon emissions. Several mechanisms may control this uptake. Condensation of low-volatility vapours and formation of organic salts probably dominate the very first steps of growth in particles close to 1 nm in diameter. As the particles grow further, formation of organic polymers and effects related to the phase of the particle probably become increasingly important. We suggest that dependence of particle growth mechanisms on particle size needs to be investigated more systematically.
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| 9. |
- D'Andrea, S. D., et al.
(author)
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Effect of Secondary Organic Aerosol Amount and Condensational Behavior on Global Aerosol Size Distributions
- 2013
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In: NUCLEATION AND ATMOSPHERIC AEROSOLS. - : American Institute of Physics (AIP). - 9780735411524 ; , s. 667-670
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Conference paper (peer-reviewed)abstract
- Recent research has shown that secondary organic aerosols (SOA) are major contributors to ultrafine particle growth to climatically relevant sizes, increasing global cloud condensation nuclei (CCN) concentrations within the continental boundary layer. Many models treat SOA solely as semivolatile, which leads to condensation of SOA proportional to the aerosol mass distribution; however, recent closure studies with field measurements show that a significant fraction of SOA condenses proportional to the aerosol surface area, which suggests a very low volatility. Additionally, while many global models contain only biogenic sources of SOA (with emissions generally 10-30 Tg yr(-1)), recent studies have shown a need for an additional source of SOA around 100 Tg yr(-1) correlated with anthropogenic carbon monoxide (CO) emissions is required to match measurements. Here, we explore the significance of these two findings using the GEOS-Chem-TOMAS global aerosol microphysics model. The percent change in the number of particles of size D-p > 40 nm (N40) within the continental boundary layer between the surface-area-and mass-distribution condensation schemes, both with the base biogenic SOA only, yielded a global increase of 8% but exceeds 100% in biogenically active regions. The percent change in N40 within the continental boundary layer between the base simulation (19 Tg yr(-1)) and the additional SOA (100 Tg yr(-1)) both using the surface area condensation scheme (very low volatility) yielded a global increase of 14%, and a global decrease in the number of particles of size D-p > 10 nm (N10) of 32%. These model simulations were compared to measured data from Hyytiala, Finland and other global locations and confirmed a decrease in the model-measurement bias. Thus, treating SOA as very low volatile as well as including additional SOA correlated with anthropogenic CO emissions causes a significant global increase in the number of climatically relevant sized particles, and therefore we must continue to refine our SOA treatments in aerosol microphysics models.
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| 10. |
- Hakkinen, S. A. K., et al.
(author)
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Semi-empirical parameterization of size-dependent atmospheric nanoparticle growth in continental environments
- 2013
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In: Atmospheric Chemistry And Physics. - : Copernicus GmbH. - 1680-7316 .- 1680-7324. ; 13:15, s. 7665-7682
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Journal article (peer-reviewed)abstract
- The capability to accurately yet efficiently represent atmospheric nanoparticle growth by biogenic and anthropogenic secondary organics is a challenge for current atmospheric large-scale models. It is, however, crucial to predict nanoparticle growth accurately in order to reliably estimate the atmospheric cloud condensation nuclei (CCN) concentrations. In this work we introduce a simple semi-empirical parameterization for sub-20 nm particle growth that distributes secondary organics to the nanoparticles according to their size and is therefore able to reproduce particle growth observed in the atmosphere. The parameterization includes particle growth by sulfuric acid, secondary organics from monoterpene oxidation (SORG(MT)) and an additional condensable vapor of non-monoterpene organics (background). The performance of the proposed parameterization was investigated using ambient data on particle growth rates in three diameter ranges (1.5-3 nm, 3-7 nm and 7-20 nm). The growth rate data were acquired from particle / air ion number size distribution measurements at six continental sites over Europe. The longest time series of 7 yr (2003-2009) was obtained from a boreal forest site in Hyytiala, Finland, while about one year of data (2008-2009) was used for the other stations. The extensive ambient measurements made it possible to test how well the parameterization captures the seasonal cycle observed in sub-20 nm particle growth and to determine the weighing factors for distributing the SORG(MT) for different sized particles as well as the background mass flux (concentration). Besides the monoterpene oxidation products, background organics with a concentration comparable to SORGMT, around 6x10(7) cm(-3) (consistent with an additional global SOA yield of 100 Tg yr(-1)) was needed to reproduce the observed nanoparticle growth. Simulations with global models suggest that the background could be linked to secondary biogenic organics that are formed in the presence of anthropogenic pollution.
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