Arsenic trioxide and all-trans retinoic acid treatment for acute promyelocytic leukaemia in all risk groups (AML17): results of a randomised, controlled, phase 3 trial

BACKGROUND: Acute promyelocytic leukaemia is a chemotherapy-sensitive subgroup of acute myeloid leukaemia characterised by the presence of the PML-RARA fusion transcript. The present standard of care, chemotherapy and all-trans retinoic acid (ATRA), results in a high proportion of patients being cured. In this study, we compare a chemotherapy-free ATRA and arsenic trioxide treatment regimen with the standard chemotherapy-based regimen (ATRA and idarubicin) in both high-risk and low-risk patients with acute promyelocytic leukaemia.

METHODS: In the randomised, controlled, multicentre, AML17 trial, eligible patients (aged ≥16 years) with acute promyelocytic leukaemia, confirmed by the presence of the PML-RARA transcript and without significant cardiac or pulmonary comorbidities or active malignancy, and who were not pregnant or breastfeeding, were enrolled from 81 UK hospitals and randomised 1:1 to receive treatment with ATRA and arsenic trioxide or ATRA and idarubicin. ATRA was given to participants in both groups in a daily divided oral dose of 45 mg/m(2) until remission, or until day 60, and then in a 2 weeks on-2 weeks off schedule. In the ATRA and idarubicin group, idarubicin was given intravenously at 12 mg/m(2) on days 2, 4, 6, and 8 of course 1, and then at 5 mg/m(2) on days 1-4 of course 2; mitoxantrone at 10 mg/m(2) on days 1-4 of course 3, and idarubicin at 12 mg/m(2) on day 1 of the final (fourth) course. In the ATRA and arsenic trioxide group, arsenic trioxide was given intravenously at 0·3 mg/kg on days 1-5 of each course, and at 0·25 mg/kg twice weekly in weeks 2-8 of course 1 and weeks 2-4 of courses 2-5. High-risk patients (those presenting with a white blood cell count >10 × 10(9) cells per L) could receive an initial dose of the immunoconjugate gemtuzumab ozogamicin (6 mg/m(2) intravenously). Neither maintenance treatment nor CNS prophylaxis was given to patients in either group. All patients were monitored by real-time quantitative PCR. Allocation was by central computer minimisation, stratified by age, performance status, and de-novo versus secondary disease. The primary endpoint was quality of life on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status. All analyses are by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN55675535.

FINDINGS: Between May 8, 2009, and Oct 3, 2013, 235 patients were enrolled and randomly assigned to ATRA and idarubicin (n=119) or ATRA and arsenic trioxide (n=116). Participants had a median age of 47 years (range 16-77; IQR 33-58) and included 57 high-risk patients. Quality of life did not differ significantly between the treatment groups (EORTC QLQ-C30 global functioning effect size 2·17 [95% CI -2·79 to 7·12; p=0·39]). Overall, 57 patients in the ATRA and idarubicin group and 40 patients in the ATRA and arsenic trioxide group reported grade 3-4 toxicities. After course 1 of treatment, grade 3-4 alopecia was reported in 23 (23%) of 98 patients in the ATRA and idarubicin group versus 5 (5%) of 95 in the ATRA and arsenic trioxide group, raised liver alanine transaminase in 11 (10%) of 108 versus 27 (25%) of 109, oral toxicity in 22 (19%) of 115 versus one (1%) of 109. After course 2 of treatment, grade 3-4 alopecia was reported in 25 (28%) of 89 patients in the ATRA and idarubicin group versus 2 (3%) of 77 in the ATRA and arsenic trioxide group; no other toxicities reached the 10% level. Patients in the ATRA and arsenic trioxide group had significantly less requirement for most aspects of supportive care than did those in the ATRA and idarubicin group.

INTERPRETATION: ATRA and arsenic trioxide is a feasible treatment in low-risk and high-risk patients with acute promyelocytic leukaemia, with a high cure rate and less relapse than, and survival not different to, ATRA and idarubicin, with a low incidence of liver toxicity. However, no improvement in quality of life was seen.

Establishing the Evidence Bar for Molecular Diagnostics in Personalised Cancer Care

While personalised cancer medicine holds great promise, targeting therapies to the biological characteristics of patients is limited by the number of validated biomarkers currently available. The implementation of biomarkers has undergone many challenges with few biomarkers reaching cancer patients in the clinic. There have been many biomarkers that have been published and claimed to be therapeutically useful, but few become part of the clinical decision-making process due to technical, validation and market access issues. To reduce this attrition rate, there is a significant need for policy makers and reimbursement agencies to define specific evidence requirements for the introduction of biomarkers into clinical practice. Once these requirements are more clearly defined, in an analogous manner to pharmaceuticals, researchers and diagnostic companies can better focus their biomarker research and development on meeting these specific requirements, which should lead to the more rapid introduction of new molecular oncology tests for patient benefit.

Changes in the Pollen Seasons of the Early Flowering Trees Alnus spp. and Corylus spp. in Worcester United Kingdom 1996-2005

Previous work on Betula spp. (birch) in the UK and at five sites in Europe has shown that pollen seasons for this taxon have tended to become earlier by about 5–10 days per decade in most regions investigated over the last 30 years. This pattern has been linked to the trend to warmer winters and springs in recent years. However, little work has been done to investigate the changes in the pollen seasons for the early flowering trees. Several of these, such as Alnus spp. and Corylus spp., have allergens, which cross-react with those of Betula spp., and so have a priming effect on allergic people. This paper investigates pollen seasons for Alnus spp. and Corylus spp. for the years 1996–2005 at Worcester, in the West Midlands, United Kingdom. Pollen data for daily average counts were collected using a Burkard volumetric trap sited on the exposed roof of a three-storey building. The climate is western maritime. Meteorological data for daily temperatures (maximum and minimum) and rainfall were obtained from the local monitoring sites. The local area up to approximately 10 km surrounding the site is mostly level terrain with some undulating hills and valleys. The local vegetation is mixed farmland and deciduous woodland. The pollen seasons for the two taxa investigated are typically late December or early January to late March. Various ways of defining the start and end of the pollen seasons were considered for these taxa, but the most useful was the 1% method whereby the season is deemed to have started when 1% of the total catch is achieved and to have ended when 99% is reached. The cumulative catches (in grains/m3) for Alnus spp. varied from 698 (2001) to 3,467 (2004). For Corylus spp., they varied from 65 (2001) to 4,933 (2004). The start dates for Alnus spp. showed 39 days difference in the 10 years (earliest 2000 day 21, latest 1996 day 60). The end dates differed by 26 days and the length of season differed by 15 days. The last 4 years in the set had notably higher cumulative counts than the first 2, but there was no trend towards earlier starts. For Corylus spp. start days also differed by 39 days (earliest 1999 day 5, latest 1996 day 44). The end date differed by 35 days and length of season by 26 days. Cumulative counts and lengths of season showed a distinct pattern of alternative high (long) and low (short) years. There is some evidence of a synchronous pattern for Alnus spp.. These patterns show some significant correlations with temperature and rainfall through the autumn, winter and early spring, and some relationships with growth degree 4s and chill units, but the series is too short to discern trends. The analysis has provided insight to the variation in the seasons for these early flowering trees and will form a basis for future work on building predictive models for these taxa.

Effectiveness of three different walking prescription durations on total physical activity in normal- and overweight women.

OBJECTIVE: While there is a dose-response relationship between physical activity (PA) and health benefit, little is known about the effectiveness of different PA prescriptions on total daily PA. AIM: To test, under real-life conditions and using an objective, non-invasive measurement technique (accelerometry), the effect of prescribing additional physical activity (walking only) of different durations (30, 60 and 90 min/day) on compliance (to the activity prescribed) and compensation (to total daily PA). Participants in each group were prescribed 5 sessions of walking per week over 4 weeks. METHODS: 55 normal-weight and overweight women (mean BMI 25 ± 5 kg/m(2), height 165 ± 1 cm, weight 68 ± 2 kg and mean age 27 ± 1 years) were randomly assigned to 3 prescription groups: 30, 60 or 90 min/day PA. RESULTS: Walking duration resulted in an almost linear increase in the number of steps per day during the prescription period from an average of about 10,000 steps per day for the 30-min prescription to about 14,000 for the 90-min prescription. Compliance was excellent for the 30-min prescription but decreased significantly with 60-min and 90-min prescriptions. In parallel, degree of compensation subsequent to exercise increased progressively as length of prescription increased. CONCLUSION: A 30-min prescription of extra walking 5 times per week was well tolerated. However, in order to increase total PA further, much more than 60 min of walking may need to be prescribed in the majority of individuals. While total exercise 'volume' increased with prescriptions longer than 30 min, compliance to the prescription decreased and greater compensation was evident. © 2014 S. Karger GmbH, Freiburg.

Measuring Shared Value: How to Unlock Value by Linking Social and Business Results

Competitividad y valor compartido

Behavioural, mensural, and ecological correlates of polygyny in the eastern meadowlark (Sturnella magna)

During 1982 and 1983 I studied male attributes and attributes of the territory of male Eastern Meadowlarks (Sturnella magna) in order to determine whether there was a correlation between any of the attributes investigated and the number of females attracted by a male. Seventeen males, nine of which were polygynous and eight monogamous, were studied in 1982 and sixteen males.of which .. seven were polygynous and nine ~onogamous, were studied in 1983. The study was conducted in Short Hills Park, 10 km southwest of St. Catharines, Ontario and was designed to compare two hypotheses: the "sexy son" hypothesis (Weatherhead and Robertson,1977) and the polygyny threshold model (Verner and Willson,1966, Orians, 1969). Male attributes investigated were male size and song behaviour. Six measures of male size were taken: weight, flattened and natural wing chord length, culmen length, bill depth and length of the tarsometatarsus. In 1983 song repertoire size and song versatility measures were investigated. Attributes of the territory studied were: territory size, density of plant stems, percentage plant cover and measures of vegetation structure. In 1983 Arthropods were collected from each territory and sorted according to taxonomic group and size. During 1983, territory attributes were sampled twice, once early and once later in the nesting season. Analysis of data involved univariate comparisons between monogamous and polygynous males using T-tests and multivariate comparisons were made using discriminant function analysis (DFA) and principle components analysis (PCA).No correlations were found between the number of females attracted with, .ny measure of male size or with me, .sures of song versatili or size of song repertoire. Also no correlation was found between terri size and the number of females nesting on a terri . Some attributes of the male's terri id distinguish between monog,mous and po s males of thistudy. Analysis of Arthropod numbers showed that e~ .eran counts were significantly great~r on polygynous territories, a1 the total numb~rs of Arthropods collected showed no s fico .nt differences between territories of monogamous and po males. DFA chose ear teran and Hymenopteran counts as multivariate discriminators; both variables we' e more vegetation revealed that there were no univariate differences between the two groups of males fOT 1982 stem densities, but ~ spp. and Solidago spp. were chosen DFA as multivariate discriminators. The total number of plant stems and of Vicia spp. stems were s ficantly the early 1983 ing on monogamous territories for however DFA found no multivariate discriminators" Variables concerned with the overall aspects of vegetation structure showed significant differences between territories of monogamous and polygynous males. DFA of the 1982 sampling of vegetation structure showed significantly greater mat depth and vegetation height on polygynous territories, a finding which was not supported, however, by peA. For the early 1983 sampling period, plant height was greater on polygynous territories. Multivariate analysis identified greater green cover on polygynous territories, greater ground cover on monogamous territories, and greater depth of mat material on monogamous territories as discriminators between territories of monogamous and polygynous males. A DFA on the major variables of the study showed no significant difference between the territories of monogamous and polygynous male Meadowlarks. Of the correlations found, some were for non-prey Arthr~ods, for cover plants with very small samples sizes, or for variables which were greater for monogamous males during one sampling period and polygynous males during the next. While multivariate discriminators were found, peA showed no grouping of monogamous or polygynous males according to any of the variables investigated. On the basis of the univariate and multivariate analysis of major variables, I concluded that there were no correlations between the number of females attracted with male attributes and no unambiguous correlation with attributes of the territory. My study does not unequivocally support either the "sexy son" or the polygyny threshold hypothesis.

Introduced taxa in disturbed ecosystems

In the literature, introduced taxa are assumed to be present, more abundant, and occupy greater physical space in portions of ecosystems disturbed by human activity. This study tested this principle in two sites, Short Hills provincial Park ("SHU) and Backus Woods ("B~l"). spatial distribution of introduced taxa of vegetation, isopods, and earthworms was determined with the runs test along 300m transects encompassing gradients of anthropogenic disturbance severity. The hypothesis was that introduced taxa would be aggregated along these transects; the null hypothesis was that they would not be aggregated. The null hypothesis was rejected for the introduced taxa as a unit, and vegetation and earthworms individually. Introduced taxa were aggregated along 53.33% (N~30) and 57.14% (N~21) of the transects in SH and BW (respectively). Introduced vegetation (90.00%, N~10 and 100.00%, N~7) and earthworms (50.00%, N~10 and 50.00%, N~8) were also significantly aggregated within the sites. Introduced isopods, however, were not significantly aggregated at either place (20. 00%, N-=10 and 16. 67%, ~J~6). This study demonstrated that introduced taxa are aggregated within ecosystems disturbed by human activity. However, since introduced isopods were not significantly aggregated it was also shown that taxa respond differently.

History and Theorizing: The Case of Winemaking in the Ontario Wine Industry

Despite the fact that theorization has been established as an important social mechanism in a variety of contexts, little research has explicated how this process works. I argue that theorization entails strategic constructions of history, or rhetorical history, in order to persuade audiences of legitimacy. I examine the role that history plays in actors’ theorizations of the Ontario wine industry as world class. By conducting a rhetorical analysis of the newsletters and websites of Ontario wineries, I find that various themes of history are routinely employed to re-theorize the industry as one that produces world class wines. In general, the findings suggest that the narratives of Ontario wineries tap into global repertoires of fine wine to portray the continuity of current practices with those of Old World winemaking. In addition, wineries sometimes tap into local histories to convey a sense of uniqueness, but they also obscure the history of poor winemaking in the region.

Niagara Bruce Trail Club Fonds, 1962-2014, n.d.

The Bruce trail is Canada’s longest and oldest continuous footpath. The trail runs along the Niagara Escarpment from Niagara to Tobermory through private and public land. The main trail is 890 km long and the side trails measure 400 km. In 1961, a “Save the Escarpment” conference was held in Hamilton. Gerry Wolfram, a writer for the St. Catharines Standard proposed that a committee be formed to develop a hiking trail. The Peninsula Field Naturalists Club formed a committee and President Bert Lowe contacted landowners along the proposed route to gain permission to cross their properties. Through Bert Lowe’s effort and dedication, the trail was completed in October 1963. The trail was officially opened on May 24th, 1964 in a ceremony at Queenston. The Niagara group joined the Bruce Trail Association in 1968 at which time the Niagara Bruce Trail Club was formed. The Bruce Trail Association is a charitable, membership-based volunteer organization. Their goal is to preserve public access to the Niagara Escarpment while restoring its natural habitat. The head office of the Bruce Trail Association is located in Hamilton, Ontario. The Niagara Bruce Trail Club’s goal is to secure and preserve a natural corridor along the Niagara Escarpment while providing education, awareness, and access for the public and the future. The club has organized many hikes including special hikes such as the one to commemorate the St. Catharines Centennial. The club has also hosted children’s hikes, cross country skiing hikes, wildflower hikes, jogging hikes, snowshoe hikes and bike outings. They hold annual events such as the End to End hike which is a 3 day walk from Grimsby to Queenston and the 30 km Laura Secord hike to commemorate Laura Secord’s famous walk. Charity hikes have also been held for the Heart and Stroke Foundation and the Lung Association as well as other causes. Major changes have taken place along the trail throughout the years, some of these include: a reroute which eliminated the tunnel passage (1976) and a bridge which eliminated the need to walk to Mountain Road to cross the Queen Elizabeth Way (2008). Other major changes and clean-up projects have been undertaken by the club. The Bruce Trail Conservancy (formerly Association) is made up of 9 clubs including: Niagara Bruce Trail Club (Queenston to Grimsby), Iroquia Bruce Trail Club (Grimsby to Kelso), Toronto Bruce Trail Club (Kelso to Cheltenham), Caledon Hills Bruce Trail Club (Cheltenham to Mono Centre), Dufferin Hi-Land Bruce Trail Club (Mono Centre to Lavender), Blue Mountains Bruce Trail Club (Lavender to Craigleath), Beaver Valley Bruce Trail Club (Craigleath to Blantyre), Sydenham Bruce Trail Club (Blantyre to Wiarton) and Peninsula Bruce Trail Club (Wiarton to Tobermory). Sources: http://www.niagarabrucetrail.org/index.html and http://brucetrail.org/

Niagara aerial photographs, 1921-1991, undated

This collection contains 129 aerial photographs of the Niagara region. The dates vary from 1921-1991, with some photos undated. Some of the areas covered include the Welland Canal, the Queen Elizabeth Way (QEW), Niagara Falls, the Short Hills, and St. Catharines. Most of the photos are black and white.

Investigating Microbial Trace-fossils and Abiotic Alteration in Hydrovolcanic Tuffs of the Fort Rock Volcanic Field, Oregon

Microbial ichnofossils in volcanic rocks provide a significant record of subsurface microbes and potentially extraterrestrial biosignatures. Here, the textures, mineralogy, and geochemistry of two continental basaltic hydrovolcanic deposits - Reed Rocks and Black Hills - in the Fort Rock Volcanic Field (FRVF) are investigated. Methods include petrographic microscopy, micro and powder X-ray diffraction, SEM/BSE/EDF imaging, energy dispersive spectroscopy, stable isotopes, and X-ray fluorescence. Petrographic analysis revealed granular and tubular textures with biogenic morphologies that include terminal enlargements, septate divisions, branching forms, spiral filaments, and ovoid bodies resembling endolithic microborings described in ocean basalts. They display evidence of behaviour and a geologic context expressing their relative age and syngenicity. Differences in abiotic alteration and the abundance/morphotype assemblage of putative microborings between the sites indicate that water/rock ratio, fluid composition and flux, temperature and secondary phase formation are influences on microboring formation. This study is the first report of reputed endolithic microborings in basalts erupted in a continental lacustrine setting.

Étude technologique et morphologique de la cornéenne dans le sud du Québec : le cas de la carrière préhistorique du mont Royal (BjFj-97) à Montréal.

Le site de la carrière du mont Royal (BjFj-97), découvert en 1993 par Yvon Codère et inventorié en 1997 par l’équipe d’Ethnoscop Inc., constitue une énigme archéologique intéressante pour quiconque s’intéresse à la préhistoire de l’île de Montréal et de sa région adjacente. Lors des activités archéologiques de 1997, quelques idées furent émises quant à son affiliation chronologique et sa nature, suggérant une occupation remontant à l’Archaïque terminal (4000 à 3000 AA) orientée vers l’extraction et la transformation de la cornéenne, une pierre métamorphique résultant de la transformation du substrat rocheux en place suite à des intrusions magmatiques lors du Crétacé qui ont créé les Montérégiennes. Le matériel, comprenant plus de 10 000 déchets de taille et un peu plus de 70 artéfacts divers, ne fît pas l’objet d’analyses poussées hormis la datation approximative du site par un examen sommaire des pointes de projectile. Ce mémoire reprend les données de 1997 et apporte une perspective nouvelle au site en décrivant morphologiquement et technologiquement le débitage de la pierre de façon à comprendre la chaîne opératoire de la cornéenne, une matière peu étudiée, mais fort commune au Québec méridional, appréhender les possibilités de la matière et aborder les questions de datation. L’ensemble du matériel lithique fît l’objet d’une analyse lithique poussée axée sur le débitage et les produits finis et propose la prépondérance de la taille bifaciale, ponctuée par un débitage sur éclat conséquent. L’ensemble des étapes de la chaîne opératoire est présent sur le site de la carrière du mont Royal. La cornéenne est une matière difficile à tailler en raison de son imprévisibilité, liée à la structure même de la matière, menant à un fort taux d’échecs lors de l’élaboration des outils. La datation de l’occupation principale du site pointe vers l’Archaïque terminal, mais le caractère équivoque des diverses classes d’objets rend difficile sa définition absolue, faute d’objets parfaitement diagnostiques. Le site BjFj-97 ressemble grandement à un site homologue en Nouvelle-Angleterre où la cornéenne fût travaillée suivant le même schéma opératoire, suggérant un apparentement culturel possible. La cornéenne abonde et domine dans les assemblages archéologiques de la région montréalaise, substituant ainsi des matières de meilleure qualité absentes régionalement. Leurs correspondances chronologiques transcendent celles établies lors de l’analyse du matériel de la carrière et montrent un étalement chronologiquement plus étendu, de l’Archaïque laurentien au Sylvicole supérieur. La cornéenne se retrouve habituellement sous forme d’outils bifaciaux fonctionnels (bifaces, couteaux et pointes de projectile) de piètre facture et d’outils sur éclats (grattoirs et racloirs) rudimentaires, suggérant une signification strictement utilitaire, le propre des matières de basse qualité. Les modes d’extraction de la cornéenne restent inconnus sur le mont Royal. Le mont Royal est plus qu’un vulgaire point défensif, il constitue la base de la subsistance des populations préhistoriques de jadis où se trouvent les matériaux nécessaires à la taille d’outils de prédation liés à un mode de vie mobile où domine la chasse.

La cinéphanie et sa réappropriation : l’«affect originel» et sa réactualisation par le fan, un spectateur néoreligieux

Thèse écrite grâce au financement du Fonds Québécois de la Recherche sur la Société et la Culture (FQRSC)