University of Washington Tacoma

The quest for carbon neutrality in the 21st century has led to the rise of decentralized low-carbon energy systems as a promising solution. Blockchain technology has played a pivotal role in catalyzing this transition, with various Web3 projects exploring decentralized operational models and carbon credit markets. However, there is a notable gap in harnessing blockchain’s potential to integrate electric vehicles (EVs) into low-carbon energy systems effectively. This article addresses this gap by proposing a decentralized low-carbon EV charging system that enables transactions between individual low-carbon energy producers and EV owners. Leveraging blockchain and smart contracts, the proposed system issues low-carbon tokens to certify and incentivize environmentally conscious charging behaviors, while enabling token circulation to further promote low-carbon participation. A blockchain-based double auction mechanism is designed to ensure fair and efficient energy allocation, achieving individual rationality, incentive compatibility, and social welfare maximization. By incentivizing user engagement and ensuring fair transactions, this model paves the way for sustainable EV integration within low-carbon energy systems.

Underserved older adults face increased risk for certain chronic conditions and multimorbidity, yet research on healthcare spending and utilization in these groups is limited. For example, there is a glaring absence of research on sexual and gender minority (SGM) Medicare beneficiaries. To address this gap, this study uses linked data from Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS) and CMS Chronic Conditions Warehouse data (n = 902) to examine chronic conditions, healthcare spending and utilization among a diverse sample of SGM older adult Medicare beneficiaries. Chronic condition complexity was identified using the Medicare Chronic Conditions/Other Chronic Conditions files. Additional explanatory variables included adverse experiences, psychological and social resources, health-related indicators, socioeconomic factors, and background characteristics. The Cost and Use file was used to calculate four outcome variables: total Medicare spending, spending on physician services, high-cost beneficiary status, and healthcare utilization. A series of linear and logistic regressions were used to estimate the association between explanatory and outcome variables. SGM older adult participants with the greatest severity and complexity of chronic conditions had significantly higher total Medicare spending, spending on physician services, and were more likely to be a high-cost beneficiary and higher use of healthcare services compared to those who were comparatively healthy. We also find strong evidence linking higher Medicare spending to disability and dual eligibility, highlighting an urgent need for research given SGM older adults' increased risk for disabling chronic conditions, yet at times lower healthcare utilization. Higher day-to-day discrimination was associated with greater likelihood of chronic condition complexity and lower Medicare spending. Understanding the relationship between chronic health conditions and healthcare cost and utilization is a critical step in developing responsive health services and effective interventions to promote healthy aging in our increasingly diverse yet often underserved communities.

Abstract Background: Trastuzumab deruxtecan (T-DXd) was initially (12/2019) approved by the FDA for treatment of patients (pts) with HER2+ unresectable or metastatic breast cancer (mBC) with two or more prior anti-HER2 regimens. T-DXd was later (5/2022) approved for use by pts with one prior anti-HER2 regimen. This study examined clinical outcomes in pts with HER2+ mBC treated with T-DXd 2L and 3L+ settings. Methods: This retrospective cohort study used deeply-curated electronic medical record data from practices affiliated with ONCare Alliance. Adult pts with mBC diagnosis, confirmed HER2+ status, who received T-DXd in the 2L or later setting 1/2020 to 8/2024 were included. Pt characteristics, treatment utilization and medical events of interests were assessed descriptively by 2L and 3L+ cohorts. Clinical outcomes (duration of therapy [DoT], real-world time to treatment failure [rwTTF], overall survival [OS] and real-world progression-free survival [rwPFS]) were assessed by 2L and 3L+ cohorts using Kaplan-Meier methods. Clinical outcomes of 1L and 2L rwTTF were examined in an exploratory subgroup of pts with 1L taxane+trastuzumab+pertuzumab based regimen (THP) followed by 2L T-DXd vs. 2L trastuzumab emtansine (T-DM1). Results: A total of 300 pts (70 2L and 230 3L+ pts [61.3% in 3L/4L]) treated with T-DXd were included (overall mean age = 59.3 yrs; 82.3% White). At mBC diagnosis, a greater proportion of pts in the 2L T-DXd cohort vs. 3L+ cohort had distant bone / visceral metastasis (45.7% vs. 38.3%) and visceral only metastasis (47.1% vs. 42.2%), where a significantly lower proportion had bone only metastasis (7.1% vs. 19.6%; p = 0.0493). Fewer 2L pts had brain metastasis at initiation of T-DXd (14.3% vs. 37.0% in 3L+, p = 0.0031), but a higher rate of baseline comorbidities was seen in 2L pts (50.0% vs. 30.4%, p = 0.0027). Prior to the initiation of 2L T-DXd, 64.3% (n=45) pts received a trastuzumab+pertuzumab based regimen and 22.8% (n=16) received T-DM1 in 1L; prior to 3L+ T-DXd use, 38.7% (n=89) received T-DM1 in 2L. Within a median follow-up of 17.0 months (mo), pts receiving T-DXd in 2L had longer median DoT than 3L+ pts (20.5 mo vs. 12.5 mo, p = 0.0390), longer rwPFS (15.3 mo in 2L vs. 12.4 mo in 3L+, p = 0.0179), longer OS (median NR in 2L vs. 29.0 mo in 3L+, p = 0.0050), and numerically longer rwTTF (13.6 mo in 2L vs. 10.4 mo in 3L+, p = 0.0565). Of pts with a response assessment (66 2L, 205 3L+ pts), an overall objective response was observed in 80.3% 2L vs. 71.7% 3L+ pts (p = 0.1672). The overall rates of any grade medical event of interest were consistent across 2L and 3L+ cohorts (fatigue [72.9% vs. 73.0%], nausea/vomiting [78.6% vs. 72.2%], diarrhea [55.7% vs. 43.9%], and interstitial lung disease (ILD)/pneumonitis [8.6% vs. 10.4%], except respiratory infection, which was higher in 2L T-DXd [38.6% vs. 18.7%, p = 0.0006]). Of the pts who had discontinued T-DXd at any point (45 2L and 180 3L+), the most common reason for discontinuation was disease progression (51.1% vs. 55.0%), followed by toxicity other than nausea/vomiting/ILD (17.8% vs. 11.7%), pt choice (8.9% vs. 6.1%) and toxicity related to ILD (6.7% vs. 6.7%). Among exploratory subgroups, median rwTTF was 1L THP 11.6 mo à 2L T-DXd 14.2 mo (n=38) vs. 1L THP 11.6 mo à 2L T-DM1 8.4 mo (n=60) (2L p = 0.0367). Conclusion: The study findings affirm the real-world clinical effectiveness and safety of T-DXd in pts with HER2+ mBC as observed in the DESTINY clinical trials. Despite higher disease and comorbidity burden in this small sample of pts with 2L T-DXd use, longer delays in time to progression and discontinuation were observed compared to later line use of T-DXd; and longer rwTTF compared to 2L T-DM1 use, reinforcing the importance of utilizing T-DXd as early as possible in the treatment pathway to improve long-term pt outcomes. Citation Format: S. Mehta, H. Neuhalfen, A. Peevyhouse, D. Adhikari, C. Williams, M. Garretson, S. Blau, M. Walker, D. Peevyhouse. Real-world Clinical Outcomes in Patients with HER2+ Metastatic Breast Cancer Treated with Trastuzumab Deruxtecan After One or More Prior Lines of Therapy: Data from U.S Community Oncology Practices [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-05-27.

Body Dysmorphic Disorder (BDD) is a condition characterised by intrusive thoughts of ugliness and deformity. The efficacy of cognitive behavioural therapy (CBT) in treating BDD remains debatable despite results from several randomised controlled trials (RCTs). This study evaluated the current evidence on the efficacy of CBT compared to placebo or other interventions for treating BDD. We conducted a systematic review and meta-analysis of RCTs. Following a database search, the quality effects (QE) model was used to synthesise standardised mean differences and 95% confidence intervals for outcomes including BDD symptoms, insight, depression, body image, anxiety, global functioning and quality of life. Stratified analyses were based on outcome scale, CBT delivery mode and modality, control group type and country. Heterogeneity was assessed using the I2 statistic and publication bias using funnel and Doi plots and the LFK (Luis Furuya-Kanamori) index and the trim-and-fill analysis. Evidence quality was evaluated using the GRADE framework. The meta-analysis included 19 RCTs (978 participants), demonstrating that CBT significantly improved BDD symptoms (SMD = -1.17, CI: -1.92, -0.43, I2 = 93.3%), body image (SMD = -1.90, CI: -4.22, -0.42, I2 = 97.2%) and global functioning (SMD = 0.63, CI: 0.28, 0.98, I2 = 65.0%). CBT showed non-significant effects on insight (SMD = -0.93, CI: -2.09, 0.22, I2 = 96.7%), depression (SMD = -0.73, CI: -1.56, 0.10, I2 = 94.8%) and quality of life (SMD = 0.87, CI: -0.35, 2.09, I2 = 94.4%). In conclusion, CBT was efficacious in alleviating BDD symptoms, anxiety, body image concerns and improving global functioning. Face-to-face, online and non-specialised CBT for BDD were also efficacious; however, further investigation is needed to explore the sources of the observed heterogeneity.

Short-term rainfall forecasting presents a complex spatiotemporal modeling challenge, critical for adaptation and mitigation of high-impact hydrometeorological events such as flash floods and cloudbursts. This study examines hourly rainfall patterns in the Northwest Himalayan (NWH) region of India, enhancing forecasting accuracy using spatial correlations. The region shows a significant decline in hourly rainfall trends over the period 2019–2024, with approximately 50% of the area exhibiting statistically significant decreasing trends. The analysis reveals that high-elevation regions exhibit stronger initial 1-hour lag correlation (>0.8) and a rapid temporal decay over 9 hours. In contrast, lower-altitude areas (below 600 m) display a more gradual decrease in correlation, suggesting broader spatial influence with less intense propagation. Across all locations, rainfall variability as defined by statistically significant correlations, typically dissipates within 6 to 7 hours. Our analysis further identifies a prominent belt of high rainfall coherence aligned along the central Himalayan zone, highlighting pronounced spatial homogeneity. To improve predictive performance, this study proposes an attention-guided spatial correlation mechanism integrated within a Deformable Convolutional Long Short-Term Memory (DConvLSTM) framework. The proposed model, termed SARITA, processes hourly rainfall and spatial correlations, with the attention mechanism dynamically using spatial dependencies. This integration enhances the model’s ability to generalize across spatial-temporal patterns. Model evaluation using statistical metrics demonstrates that SARITA consistently outperforms baseline models such as ConvLSTM and standard DConvLSTM, achieving a 25% improvement in hourly rainfall forecasts. Furthermore, the model also improves anomaly detection by 3.5% over the standard DConvLSTM model.