Tamoxifen after adjuvant chemotherapy for premenopausal women with lymph node-positive breast cancer: International Breast Cancer Study Group Trial 13-93

PURPOSE: The value of adjuvant tamoxifen after chemotherapy for premenopausal women with breast cancer has not been adequately assessed. PATIENTS AND METHODS: Between 1993 and 1999, International Breast Cancer Study Group Trial 13-93 enrolled 1,246 assessable premenopausal women with axillary node-positive, operable breast cancer. All patients received chemotherapy (cyclophosphamide plus either doxorubicin or epirubicin for four courses followed by immediate or delayed classical cyclophosphamide, methotrexate, and fluorouracil for three courses), which was followed by either tamoxifen (20 mg daily) for 5 years or no further treatment. The primary end point was disease-free survival (DFS). Tumors were classified as estrogen receptor (ER) -positive (n = 735, 59%) if immunohistochemical (IHC) or ligand-binding assays (LBA) were clearly positive. The ER-negative group included all other tumors (n = 511, 41%). A subset of the ER-negative group was defined as ER absent (n = 108, 9%) if IHC staining was none or if the LBA result was 0 fmol/mg cytosol protein. The median follow-up time was 7 years. RESULTS: Tamoxifen improved DFS in the ER-positive cohort (hazard ratio [HR] for tamoxifen v no tamoxifen = 0.59; 95% CI, 0.46 to 0.75; P < .0001) but not in the ER-negative cohort (HR = 1.02; 95% CI, 0.77 to 1.35; P = .89). Tamoxifen had a detrimental effect on patients with ER-absent tumors compared with no tamoxifen in an unplanned exploratory analysis (HR = 2.10; 95% CI, 1.03 to 4.29; P = .04). Patients with ER-positive tumors who achieved chemotherapy-induced amenorrhea had a significantly improved outcome (HR for amenorrhea v no amenorrhea = 0.61; 95% CI, 0.44 to 0.86; P = .004), whether or not they received tamoxifen. CONCLUSION: Tamoxifen after adjuvant chemotherapy significantly improved treatment outcome in premenopausal patients with endocrine-responsive disease, but its use as adjuvant therapy for patients with ER-negative tumors is not recommended.

A Method for Visualizing Multivariate Time Series Data

Visualization and exploratory analysis is an important part of any data analysis and is made more challenging when the data are voluminous and high-dimensional. One such example is environmental monitoring data, which are often collected over time and at multiple locations, resulting in a geographically indexed multivariate time series. Financial data, although not necessarily containing a geographic component, present another source of high-volume multivariate time series data. We present the mvtsplot function which provides a method for visualizing multivariate time series data. We outline the basic design concepts and provide some examples of its usage by applying it to a database of ambient air pollution measurements in the United States and to a hypothetical portfolio of stocks.

Exploring the Association Between Household Food Insecurity, Parental Self-Efficacy, and Fruit and Vegetable Parenting Practices Among Parents of 5- to 8-Year-Old Overweight Children

Background: Food insecurity may negatively impact children’s nutritional status by affecting parenting quality. Because parents have a strong influence on their children’s eating and food choices, examining the effects of food insecurity on parenting may provide important insights into obesity prevention efforts. Objectives: This study explored whether food insecurity was associated with parental self-efficacy and parenting practices related to fruit and vegetable consumption. Methods: Secondary analysis was performed using baseline data from 31 mothers of 5-8 year old overweight or obese children who had participated in a pilot obesity treatment program. Household food security status, fruit and vegetable parental self-efficacy (modeling/socialization, planning/encouraging and availability/accessibility) and fruit and vegetable parenting practices (structure, responsiveness, non-directive control, and external control) were assessed using validated measures. Students' t-test investigated differences in subscales by food security status. Results: There were no significant differences in fruit and vegetable parenting practices and parental self-efficacy between food secure and insecure groups. There was a trend towards a decrease in parental self-efficacy for making fruit and vegetables available in the home among food insecure parents (p=.06). Conclusions: In this small sample no significant associations were found between food insecurity and fruit and vegetable parenting practices and parental self-efficacy. However, the trend observed in this exploratory analysis supports further hypothesis-driven research with a larger sample size able to detect more subtle differences.

Atherogenic dyslipidemia and residual cardiovascular risk in statin-treated patients

BACKGROUND AND PURPOSE Treatment with statins reduces the rate of cardiovascular events in high-risk patients, but residual risk persists. At least part of that risk may be attributable to atherogenic dyslipidemia characterized by low high-density lipoprotein cholesterol (≤40 mg/dL) and high triglycerides (triglycerides≥150 mg/dL). METHODS We studied subjects with stroke or transient ischemic attack in the Prevention of Cerebrovascular and Cardiovascular Events of Ischemic Origin With Terutroban in Patients With a History of Ischemic Stroke or Transient Ischemic Attack (PERFORM; n=19,100) and Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL; n=4731) trials who were treated with a statin and who had high-density lipoprotein cholesterol and triglycerides measurements 3 months after randomization (n=10,498 and 2900, respectively). The primary outcome measure for this exploratory analysis was the occurrence of major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death). We also performed a time-varying analysis to account for all available high-density lipoprotein cholesterol and triglyceride measurements. RESULTS A total of 10% of subjects in PERFORM and 9% in SPARCL had atherogenic dyslipidemia after ≥3 months on start statin therapy. After a follow-up of 2.3 years (PERFORM) and 4.9 years (SPARCL), a major cardiovascular event occurred in 1123 and 485 patients in the 2 trials, respectively. The risk of major cardiovascular events was higher in subjects with versus those without atherogenic dyslipidemia in both PERFORM (hazard ratio, 1.36; 95% confidence interval, 1.14-1.63) and SPARCL (hazard ratio, 1.40; 95% confidence interval, 1.06-1.85). The association was attenuated after multivariable adjustment (hazard ratio, 1.23; 95% confidence interval, 1.03-1.48 in PERFORM and hazard ratio, 1.24; 95% confidence interval, 0.93-1.65 in SPARCL). Time-varying analysis confirmed these findings. CONCLUSIONS The presence of atherogenic dyslipidemia was associated with higher residual cardiovascular risk in PERFORM and SPARCL subjects with stroke or transient ischemic attack receiving statin therapy. Specific therapeutic interventions should now be trialed to address this residual risk.

The mark of a good healer: Examining health care behaviors in the Vietnamese community

The purpose of this study was to conduct a descriptive, exploratory analysis of the utilization of both traditional healing methods and western biomedical approaches to health care among members of the Vietnamese community in Houston, Texas. The first goal of the study was to identify the type(s) of health care that the Vietnamese use. The second goal was to highlight the numerous factors that may influence why certain health care choices are made. The third goal of this study was to examine the issue of preference to determine which practices would be used if limiting factors did not exist. ^ There were 81 participants, consisting of males and females who were 18 years or older. The core groups of participants were Vietnamese students from the University of Houston-Downtown and volunteer staff members from VN TeamWork. Asking the students and staff members to recommend others for the study used the snowball method of recruiting additional participants. ^ Surveys and informed consents were in English and Vietnamese. The participants were given the choice to take the surveys face-to-face or on their own. Surveys consisted of structured questions with predetermined choices, as well as, open-ended questions to allow more detailed information. The quantitative and qualitative data were coded and entered into a database, using SPSS software version 15.0. ^ Results indicated that participants used both traditional (38.3%) and biomedical (59.3%) healing, with 44.4% stating that it depended on the illness as to treatment. Coining was the most used traditional healing method, clearly still used by all ages. Coining was also the method most used when issues regarding fear and delayed western medical treatment were involved. It was determined that insurance status, more than household income, guided health care choices. A person's age, number of years spent in the United States, age at migration, and the use of certain traditional healing methods like coining all played a role in the importance of the health care practitioner speaking Vietnamese. The most important finding was that 64.2% of the participants preferred both traditional and western medicine because both methods work. ^

Dietary intake patterns and relationships to polybrominated diphenyl ether (PBDE) and phthalate body burden

Polybrominated diphenyl ethers (PBDEs) and phthalates are chemicals of concern because of high levels measured in people and the environment as well as the demonstrated toxicity in animal studies and limited epidemiological studies. Exposure to these chemicals has been associated with a range of toxicological outcomes, including developmental effects, behavioral changes, endocrine disruption, effects on sexual health, and cancer. Previous research has shown that both of these classes of chemicals contaminate food in the United States and worldwide. However, how large a role diet plays in exposure to these chemicals is currently unknown. To address this question, an exploratory analysis of data collected as part of the 2003-04 National Health and Nutrition Examination Survey (NHANES) was conducted. Associations between dietary intake (assessed by 24-hour dietary recalls) for a range of food types (meat, poultry, fish, and dairy) and levels PBDEs and phthalate metabolites were analyzed using multiple linear regression modeling. Levels of individual PBDE congeners 28, 47, 99, 100 as well as total PBDEs were found to be significantly associated with the consumption of poultry. Metabolites of di-(2-ethylhexyl) phthalate (DEHP) were found to be associated with the consumption of poultry, as well as with an increased consumption of fat of animal origin. These results, combined with results from previous studies, suggest that diet is an important route of intake for both PBDEs and phthalates. Further research needs to be conducted to determine the sources of food contamination with these toxic chemicals as well as to describe the levels of contamination of US food in a large, representative sample.^

Study on the effect of metformin in patients of metastatic renal cell cancer with diabetes receiving tyrosine kinase inhibitor therapy

Objective: The primary objective of our study was to study the effect of metformin in patients of metastatic renal cell cancer (mRCC) and diabetes who are on treatment with frontline therapy of tyrosine kinase inhibitors. The effect of therapy was described in terms of overall survival and progression free survival. Comparisons were made between group of patients receiving metformin versus group of patients receiving insulin in diabetic patients of metastatic renal cancer on frontline therapy. Exploratory analyses were also done comparing non-diabetic patients of metastatic renal cell cancer receiving frontline therapy compared to diabetic patients of metastatic renal cell cancer receiving metformin therapy. ^ Methods: The study design is a retrospective case series to elaborate the response rate of frontline therapy in combination with metformin for mRCC patients with type 2 diabetes mellitus. The cohort was selected from a database, which was generated for assessing the effect of tyrosine kinase inhibitor therapy associated hypertension in metastatic renal cell cancer at MD Anderson Cancer Center. Patients who had been started on frontline therapy for metastatic renal cell carcinoma from all ethnic and racial backgrounds were selected for the study. The exclusion criteria would be of patients who took frontline therapy for less than 3 months or were lost to follow-up. Our exposure variable was treatment with metformin, which comprised of patients who took metformin for the treatment of type 2 diabetes at any time of diagnosis of metastatic renal cell carcinoma. The outcomes assessed were last available follow-up or date of death for the overall survival and date of progression of disease from their radiological reports for time to progression. The response rates were compared by covariates that are known to be strongly associated with renal cell cancer. ^ Results: For our primary analyses between the insulin and metformin group, there were 82 patients, out of which 50 took insulin therapy and 32 took metformin therapy for type 2 diabetes. For our exploratory analysis, we compared 32 diabetic patients on metformin to 146 non-diabetic patients, not on metformin. Baseline characteristics were compared among the population. The time from the start of treatment until the date of progression of renal cell cancer and date of death or last follow-up were estimated for survival analysis. ^ In our primary analyses, there was a significant difference in the time to progression of patients receiving metformin therapy vs insulin therapy, which was also seen in our exploratory analyses. The median time to progression in primary analyses was 1259 days (95% CI: 659-1832 days) in patients on metformin therapy compared to 540 days (95% CI: 350-894) in patients who were receiving insulin therapy (p=0.024). The median time to progression in exploratory analyses was 1259 days (95% CI: 659-1832 days) in patients on metformin therapy compared to 279 days (95% CI: 202-372 days) in non-diabetic group (p-value <0.0001). ^ The median overall survival was 1004 days in metformin group (95% CI: 761-1212 days) compared to 816 days (95%CI: 558-1405 days) in insulin group (p-value<0.91). For the exploratory analyses, the median overall survival was 1004 days in metformin group (95% CI: 761-1212 days) compared to 766 days (95%CI: 649-965 days) in the non-diabetic group (p-value<0.78). Metformin was observed to increase the progression free survival in both the primary and exploratory analyses (HR=0.52 in metformin Vs insulin group and HR=0.36 in metformin Vs non-diabetic group, respectively). ^ Conclusion: In laboratory studies and a few clinical studies metformin has been proven to have dual benefits in patients suffering from cancer and type 2-diabetes via its action on the mammalian target of Rapamycin pathway and effect in decreasing blood sugar by increasing the sensitivity of the insulin receptors to insulin. Several studies in breast cancer patients have documented a beneficial effect (quantified by pathological remission of cancer) of metformin use in patients taking treatment for breast cancer therapy. Combination of metformin therapy in patients taking frontline therapy for renal cell cancer may provide a significant benefit in prolonging the overall survival in patients with metastatic renal cell cancer and diabetes. ^

Agriculturización, inequidad distributiva y fractura del tejido social

Los cambios operados en la actividad agrícola en nuestro país a lo largo de las últimas dos décadas, identificados genéricamente bajo la denominación de agriculturización, han generado múltiples impactos, muchos de ellos de carácter contradictorio. Así, el crecimiento de la actividad económica, el incremento en los saldos exportables y en los recursos fiscales conviven, entre otras manifestaciones, con la agudización de las tensiones derivadas de la concentración económica, con nuevos impactos e incertidumbres de carácter ambiental, con desequilibrios territoriales crecientes, con la ampliación de la brecha laboral y con el incremento en la inequidad distributiva. Este trabajo presenta los resultados de un análisis exploratorio orientado a pequeñas localidades de la región pampeana, en el cual se visualiza el surgimiento de fuertes signos de fractura del tejido social, derivados del crecimiento de la inequidad distributiva de la riqueza en el interior del espacio rural. Dos tendencias fundamentales constituyen los emergentes de este proceso: 1°) los cambios en los estilos de vida de los sectores relacionados con la actividad agrícola, visibles fundamentalmente en modificaciones en las pautas de consumo (sobre todo entre los jóvenes); y 2°) la heterogeneización de las percepciones de los pobladores sobre la valorización del trabajo en la comunidad. La reconstrucción de estos procesos, escasamente abordados en la literatura académica, se realizó a través de estrategias metodológicas que combinan métodos cuanti y cualitativos, tomando como caso de estudio una pequeña localidad en la Provincia de Santa Fe

Los estudiantes de la UNLP : Apuntes cuantitativos para una caracterización estructural

En este trabajo se presentan resultados de un relevamiento realizado a los estudiantes de la UNLP a partir de una encuesta por muestreo aleatorio. Se realiza en primer término un análisis descriptivo general sobre las principales características de dicha población, y en segundo lugar un análisis exploratorio que intenta sintetizar perfiles de los estudiantes según algunas dimensiones socio-demográficas, institucionales e ideológicas, mediante la técnica multivariada del análisis de correspondencias múltiples

Variáveis evidenciadoras dos processos de transformação do campo : O caso do Espírito Santo - Brasil

This article aims to analyze the occurrence of changes in the countryside, in Brazil, from the observation of variables such as type of job, income, family profile, access to consumer goods, services, and information and communication technology. There had been used exploratory analysis and logistic regression method, based on data from the Pesquisa Nacional de Amostra de Domicílios (Brazilian National Household Sample Survey - PNAD) for the state of Espirito Santo. The study found that about 27.2 of individuals who had lived in the countryside report an urban profile, revealing that the urban lifestyle is encompassed not only in the city

La garantía cultural como justificación en sistemas de organización de conocimiento : Aproximación crítica

Se realiza un análisis exploratorio del concepto de "garantía cultural", con el objetivo de caracterizar áreas futuras de investigación en torno al mismo. En primera instancia se analiza la noción genérica de 'garantía', tal como ha sido considerada en la Organización del Conocimiento. Se reseñan diversos tipos de garantías propuestas para legitimar la inclusión de terminología en sistemas de organización del conocimiento. Se cumple un análisis crítico del concepto de "cultura" y la manera en que distintas concepciones antropológicas, sociológicas y políticas confluyen en su construcción epistemológica. Se revisa y se problematiza el tratamiento de la garantía cultural en la literatura del área. Se valora su aporte en la construcción de identidades culturales, a través de elementos de diferenciación de la interpretación y la vivencia de la realidad. En particular se desarrolla la relación entre garantía cultural y cultura local. Se pondera la inserción del factor ético a través de la garantía cultura, en el desarrollo de esquemas de clasificación y en los procesos de clasificación e indización. Entre otras conclusiones, se establece la necesidad de explorar con mayor detenimiento las alternativas metodológicas que puedan sustentarse en esta concepción integradora y democratizadora en el ámbito de la Organización del Conocimiento

Agriculturización, inequidad distributiva y fractura del tejido social

Los cambios operados en la actividad agrícola en nuestro país a lo largo de las últimas dos décadas, identificados genéricamente bajo la denominación de agriculturización, han generado múltiples impactos, muchos de ellos de carácter contradictorio. Así, el crecimiento de la actividad económica, el incremento en los saldos exportables y en los recursos fiscales conviven, entre otras manifestaciones, con la agudización de las tensiones derivadas de la concentración económica, con nuevos impactos e incertidumbres de carácter ambiental, con desequilibrios territoriales crecientes, con la ampliación de la brecha laboral y con el incremento en la inequidad distributiva. Este trabajo presenta los resultados de un análisis exploratorio orientado a pequeñas localidades de la región pampeana, en el cual se visualiza el surgimiento de fuertes signos de fractura del tejido social, derivados del crecimiento de la inequidad distributiva de la riqueza en el interior del espacio rural. Dos tendencias fundamentales constituyen los emergentes de este proceso: 1°) los cambios en los estilos de vida de los sectores relacionados con la actividad agrícola, visibles fundamentalmente en modificaciones en las pautas de consumo (sobre todo entre los jóvenes); y 2°) la heterogeneización de las percepciones de los pobladores sobre la valorización del trabajo en la comunidad. La reconstrucción de estos procesos, escasamente abordados en la literatura académica, se realizó a través de estrategias metodológicas que combinan métodos cuanti y cualitativos, tomando como caso de estudio una pequeña localidad en la Provincia de Santa Fe

Los estudiantes de la UNLP : Apuntes cuantitativos para una caracterización estructural

En este trabajo se presentan resultados de un relevamiento realizado a los estudiantes de la UNLP a partir de una encuesta por muestreo aleatorio. Se realiza en primer término un análisis descriptivo general sobre las principales características de dicha población, y en segundo lugar un análisis exploratorio que intenta sintetizar perfiles de los estudiantes según algunas dimensiones socio-demográficas, institucionales e ideológicas, mediante la técnica multivariada del análisis de correspondencias múltiples

Variáveis evidenciadoras dos processos de transformação do campo : O caso do Espírito Santo - Brasil

This article aims to analyze the occurrence of changes in the countryside, in Brazil, from the observation of variables such as type of job, income, family profile, access to consumer goods, services, and information and communication technology. There had been used exploratory analysis and logistic regression method, based on data from the Pesquisa Nacional de Amostra de Domicílios (Brazilian National Household Sample Survey - PNAD) for the state of Espirito Santo. The study found that about 27.2 of individuals who had lived in the countryside report an urban profile, revealing that the urban lifestyle is encompassed not only in the city

La garantía cultural como justificación en sistemas de organización de conocimiento : Aproximación crítica

Se realiza un análisis exploratorio del concepto de "garantía cultural", con el objetivo de caracterizar áreas futuras de investigación en torno al mismo. En primera instancia se analiza la noción genérica de 'garantía', tal como ha sido considerada en la Organización del Conocimiento. Se reseñan diversos tipos de garantías propuestas para legitimar la inclusión de terminología en sistemas de organización del conocimiento. Se cumple un análisis crítico del concepto de "cultura" y la manera en que distintas concepciones antropológicas, sociológicas y políticas confluyen en su construcción epistemológica. Se revisa y se problematiza el tratamiento de la garantía cultural en la literatura del área. Se valora su aporte en la construcción de identidades culturales, a través de elementos de diferenciación de la interpretación y la vivencia de la realidad. En particular se desarrolla la relación entre garantía cultural y cultura local. Se pondera la inserción del factor ético a través de la garantía cultura, en el desarrollo de esquemas de clasificación y en los procesos de clasificación e indización. Entre otras conclusiones, se establece la necesidad de explorar con mayor detenimiento las alternativas metodológicas que puedan sustentarse en esta concepción integradora y democratizadora en el ámbito de la Organización del Conocimiento