The role of molecular, clinical and socioeconomic factors in the long-term survival of axillary node negative breast cancer patients

The overall objective of this study was to investigate factors associated with long-term survival in axillary node negative (ANN) breast cancer patients. Clinical and biological factors included stage, histopathologic grade, p53 mutation, Her-2/neu amplification, estrogen receptor status (ER), progesterone receptor status (PR) and vascular invasion. Census derived socioeconomic (SES) indicators included median individual and household income, proportions of university educated individuals, housing type, "incidence" of low income and an indicator of living in an affluent neighbourhood. The effects of these measures on breast cancer-specific survival and competing cause survival were investigated. A cohort study examining survival among axillary node negative (ANN) breast cancer patients in the greater Toronto area commenced in 1 989. Patients were followed up until death, lost-to-follow up or study termination in 2004. Data were collected from several sources measuring patient demographics, clinical factors, treatment, recurrence of disease and survival. Census level SES data were collected using census geo-coding of patient addresses' at the time of diagnosis. Additional survival data were acquired from the Ontario Cancer Registry to enhance and extend the observation period of the study. Survival patterns were examined using KaplanMeier and life table procedures. Associations were examined using log-rank and Wilcoxon tests of univariate significance. Multivariate survival analyses were perfonned using Cox proportional hazards models. Analyses were stratified into less than and greater than 5 year survival periods to observe whether known markers of short-tenn survival were also associated with reductions in long-tenn survival among breast cancer patients. The 15 year survival probabilities in this cohort were: for breast cancerspecific survival 0.88, competing causes survival 0.89 and for overall survival 0.78. Estrogen receptor (ER) and progesterone receptor (PR) status (Hazard Ratio (HR) ERIPR- versus ER+/PR+, 8.15,95% CI, 4.74, 14.00), p53 mutation (HR, 3.88, 95% CI, 2.00, 7.53) and Her-2 amplification (HR, 2.66, 95% CI, 1.36, 5.19) were associated with significant reductions in short-tenn breast cancer-specific survival «5 years following diagnosis), however, not with long-term survival in univariate analyses. Stage, histopathologic grade and ERiPR status were the clinicallbiologieal factors that were associated with short-term breast cancer specific survival in multivariate results. Living in an affluent neighbourhood (top quintile of median household income compared to the rest of the population) was associated with the largest significant increase in long-tenn breast cancer-specific survival after adjustment for stage, histopathologic grade and treatment (HR, 0.36, 95% CI, 0.12, 0.89).

Level and precision of behavioural thermoregulation in the bearded dragon, Pogona vitticeps : effects of hypoxia and environmental thermal quality /

Most metabolic functions are optimized within a narrow range of body temperatures, which is why thermoregulation is of great importance for the survival and overall fitness of an animal. It has been proposed that lizards will thermoregulate less precisely in low thermal quality environments, where the costs associated with thermoregulation are high; in the case of lizards, whose thermoregulation is mainly behavioural, the primary costs ofthermoregulation are those derived from locomotion. Decreasing thermoregulatory precision in costly situations is a strategy that enhances fitness by allowing lizards to be more flexible to changing environmental conditions. It allows animals to maximize the benefits of maintaining a relatively high body temperature while minimizing energy expenditure. In situations where oxygen concentration is low, the costs of thermoregulation are relatively high (i.e. in relation to the amount of oxygen available for metabolic functions). As a result, it is likely that exposures to hypoxic conditions induce a decrease in the precision of thermoregulation. This study evaluated the effects of hypoxia and low environmental thermal quality, two energetically costly conditions, on the precision and level of thermoregulation in the bearded dragon, Pogona vitticeps, in an electronic temperature-choice shuttle box. Four levels of hypoxia (1O, 7, 5 and 4% 02) were tested. Environmental thermal quality was manipulated by varying the rate of temperature change (oTa) in an electronic temperature-choice shuttle box. Higher oT a's translate into more thermally challenging environments, since under these conditions the animals are forced to move a greater number of times (and hence invest more energy in locomotion) to maintain similar temperatures than at lower oTa's. In addition, lizards were tested in an "extreme temperatures" treatment during which air temperatures of the hot and cold compartments of the shuttle box were maintained at a constant 50 and 15°C respectively. This was considered the most thermally challenging environment. The selected ambient (T a) and internal body temperatures (Tb) of bearded dragons, as well as the thermoregulatory precision (measured by the central 68% ofthe Ta and T b distribution) were evaluated. The thermoregulatory response was similar to both conditions. A significant increase in the size of the Tb range, reflecting a decrease in thermoregulatory precision, and a drop in preferred body temperature of ~2 °C, were observed at both 4% oxygen and at the environment of lowest thermal quality. The present study suggests that in energetically costly situations, such as the ones tested in this study, the bearded dragon reduces energy expenditure by decreasing preferred body temperature and minimizing locomotion, at the expense of precise behavioural thermoregulation. The close similarity of the behavioural thermoregulatory response to two very different stimuli suggests a possible common mechanism and neuronal pathway to the thermoregulatory response.

Decision analysis of the effectiveness of lung cancer screening using autofluorescence bronchoscopy and computed tomography

Background: Lung cancer (LC) is the leading cause of cancer death in the developed world. Most cancers are associated with tobacco smoking. A primary hope for reducing lung cancer has been prevention of smoking and successful smoking cessation programs. To date, these programs have not been as successful as anticipated. Objective: The aim of the current study was to evaluate whether lung cancer screening combining low dose computed tomography with autofluorescence bronchoscopy (combined CT & AFB) is superior to CT or AFB screening alone in improving lung cancer specific survival. In addition, the extent of improvement and ideal conditions for combined CT & AFB screening were evaluated. Methods: We applied decision analysis and Monte Carlo simulation modeling using TreeAge Software to evaluate our study aims. Histology- and stage specific probabilities of lung cancer 5-year survival proportions were taken from Surveillance and Epidemiologic End Results (SEER) Registry data. Screeningassociated data was taken from the US NCI Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), National Lung Screening Trial (NLST), and US NCI Lung Screening Study (LSS), other relevant published data and expert opinion. Results: Decision Analysis - Combined CT and AFB was the best approach at Improving 5-year survival (Overall Expected Survival (OES) in the entire screened population was 0.9863) and in lung cancer patients only (Lung Cancer Specific Expected Survival (LOSES) was 0.3256). Combined screening was slightly better than CT screening alone (OES = 0.9859; LCSES = 0.2966), and substantially better than AFB screening alone (OES = 0.9842; LCSES = 0.2124), which was considerably better than no screening (OES = 0.9829; LCSES = 0.1445). Monte Carlo simulation modeling revealed that expected survival in the screened population and lung cancer patients is highest when screened using CT and combined CT and AFB. CT alone and combined screening was substantially better than AFB screening alone or no screening. For LCSES, combined CT and AFB screening is significantly better than CT alone (0.3126 vs. 0.2938, p< 0.0001). Conclusions: Overall, these analyses suggest that combined CT and AFB is slightly better than CT alone at improving lung cancer survival, and both approaches are substantially better than AFB screening alone or no screening.

Manpower development and nation-building : Singapore's experience

Manpower is a basic resource. It is the indispensable means of converting other resources to mankind '.s use and benefit. As a process· of increasing the knowledge, skills, and dexterity of the people of a society, manpower development is the most fundamental means of enabling a nation to acquire the capacities to bring about its desired future state of affairs -- a more mighty and wealthier nation. Singapore's brief nation-building history justifies the emphasis accorded to the importance of good quality human resources and manpower development in economic and socio-political developments. As a tiny island-state with a poor natural resource base, Singapore's long-term survival and development depend ultimately upon the quality and the creative energy of her people. In line with the nation-building goals and strategies of the Republic, as conditioned by her objective setting, Singapore's basic manpower development premise has been one of "quality and not quantity". While implementing the "stop-at-two" family planning and population control programs and the relevant immigration measures to guard against the prospect of a "population explosion", the Government has energetically fostered various educational programs, including vocational training schemes, adult education programs, the youth movement, and the national service scheme to improve the quality of Singaporeans. There is no denying that some of the manpower development measures taken by the Government have imposed sacrifice and hardship on the Singapore citizens. Nevertheless, they are the basic conditions for the island-Republic's long-term survival and development. It is essential iii to note that Singapore's continuing existence and phenomenal-success are largely attributable to the will, capacities and efforts of her leaders and people. In the final analysis, the wealth and the strength of a nation are based upon its ability to conserve, develop and utilize effectively the innate capacities of its people. This is true not only of Singapore but necessarily of other developing nations. It can be safely presumed that since most developing states' concerns about the quality of their human resources and the progress of their nation-building work are inextricably bound to those about the quantity of their population, the "quality and not quantity" motto of Singapore's manpower development programs can also be their guiding principle.

From absolutes to aesthetics : John Dewey and the art of experience /

In this thesis I sought to capture something of the integrity of John Dewey's larger vision. While recognizing this to be a difficult challenge, I needed to clear some of the debris of an overly narrow reading of Dewey's works by students of education. The tendency of reducing Dewey's larger philosophical vision down to neat theoretical snap shots in order to prop up their particular social scientific research, was in my estimation slowly damaging the larger integrity of Dewey's vast body of work. It was, in short, killing off the desire to read big works, because doing so was not necessary to satisfying the specialized interests of social scientific research. In this thesis then I made a plea for returning the Humanities to the center of higher education. It is there that students learn how to read and to think—skills required to take on someone of Dewey's stature. I set out in this thesis to do just that. I took Dewey's notion of experience as the main thread connecting all of his philosophy, and focused on two large areas of inquiry, science and its relation to philosophy, and aesthetic experience. By exploring in depth Dewey's understanding of human experience as it pertains to day-to-day living, my call was for a heightened mode of artful conduct within our living contexts. By calling on the necessity of appreciating the more qualitative dimensions of lived experience, I was hoping that students engaged in the Social Sciences might begin to bolster their research interests with more breadth and depth of reading and critical insight. I expressed this as being important to the survival and intelligent flourishing of democratic conduct.

Benefits of Using Target Activities to Assist in Improvement of Striking in Striking and Fielding Games for Individuals with Autism: A Comparative Case Study

The purpose of the research study was to increase understanding about the potential benefits of combining target activities with striking-fielding games for individuals with high functioning autism spectrum disorder. A comparative case study was conducted to understand if target activities can assist in improving the skills of striking and throwing, aid the learning of tactics and add to current understanding of how certain teaching skills might be linked to the transfer between target and striking-fielding games. Data was collected through observations, student journals and interviews and were analyzed using both inductive and deductive methods. Results show an appearance of improvement in throwing, striking, bowling and badminton for overall skill levels. In regards to teaching skills, appropriate and effective teaching techniques, appropriate and effective equipment, dynamic of participants and student-instructors and consistency of attendance are vital. Future research should further look at the transferability to outdoor settings and interview the participants.