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).

Relative importance of body composition, osteoporosis- related behaviours and socioeconomic status on bone SOS in adolescent females

The purpose of this study was to examine the associations between bone speed of sound (SOS) and body composition, osteoporosis-related health behaviours, and socioeconomic status (SES) in adolescent females. A total of 442 adolescent females in grades 9-11 participated. Anthropometric measures of height, body mass, and percent body fat were taken, and osteo-protective behaviours such as oral contraceptive use (OC), physical activity and daily calcium intake were evaluated using self-report questionnaires. Bone SOS was measured by transaxial quantitative ultrasound (QUS) at the distal radius and mid-tibia. The results suggest that fat mass is a significant negative predictor of tibial SOS, while lean mass is positively associated with radial SOS scores and calcium intake was positively associated with tibial SOS scores (p

The relationship between socioeconomic status, schools and bone health among adolescent females in Southern Ontario

We studied the association between socioeconomic status (SES), school attended and bone health measured by bone speed of sound (SOS) among adolescent females in Canada. 412 participants from six randomly selected schools in Southern Ontario were examined. Bone SOS was measured by quantitative ultrasound. Participant’s school and aggregate area-based census-derived (AABCD) SES were evaluated as predictors. Mean participant age was 15.7 (SD 1.0) years. Average median family income was $68,162 (SD $19,366). Median family income was non-linearly associated with bone SOS and restricted cubic splines described the relationship. Univariate regression, accounting for clustering of participants in schools, revealed a significant non-linear association between AABCD-median family income and non-dominant tibial SOS (LRT p = 0.031). Multivariable regression revealed school to have a significant impact (LRT p = 0.0001). High schools had a strong influence on the bone health of female students and this effect overrode the effect of SES.

Drivers of Local Firms’ Focus on Internal R&D in Emerging Economies and Their International Performance

Grounded on the resource-based view of the firm, the study of this thesis investigates the effect of four internal and external factors – engineer intensity, location, affiliation with the government, government funding – on Chinese firms’ decision to either invest in internal R&D activities or external R&D and the effect of this decision on the firms’ international market success. In addition, the moderating role of the presence of foreign firms in China is examined. To understand these relationships, the thesis’ theorization focuses on the issue of how firms can combine optimally the two options – “internal R&D” and “external R&D”. In this regard I juxtapose internal R&D and external R&D and compare their advantages and disadvantages. To test my model, I apply panel data from the Annual Industrial Survey Database provided by the Chinese National Bureau of Statistics. My results show that three of the four investigated factors affect Chinese firms’ resource allocation decisions; and effective resource allocation decisions lead effectively to international market success, strengthened by the presence of foreign firms in China. Moreover the findings bear several theoretical and managerial contributions. First I propose the last dimension of the “VRIO framework” – “organization” – as an endogenous component of the VRIO framework, as my study investigated how firms can effectively combine resources to generate a competitive advantage in terms of international market success. Previous academic literature so far focused on examining whether internal and external R&D are complements or substitutes. My study fills a gap in the literature by investigating the determinants of the efficient combination of the two strategies and the outcome of the combination. One of the managerial implications is that Chinese firms can learn from foreign companies that are present in China.