Adjuvant exemestane with ovarian suppression in premenopausal breast cancer.

BACKGROUND Adjuvant therapy with an aromatase inhibitor improves outcomes, as compared with tamoxifen, in postmenopausal women with hormone-receptor-positive breast cancer. METHODS In two phase 3 trials, we randomly assigned premenopausal women with hormone-receptor-positive early breast cancer to the aromatase inhibitor exemestane plus ovarian suppression or tamoxifen plus ovarian suppression for a period of 5 years. Suppression of ovarian estrogen production was achieved with the use of the gonadotropin-releasing-hormone agonist triptorelin, oophorectomy, or ovarian irradiation. The primary analysis combined data from 4690 patients in the two trials. RESULTS After a median follow-up of 68 months, disease-free survival at 5 years was 91.1% in the exemestane-ovarian suppression group and 87.3% in the tamoxifen-ovarian suppression group (hazard ratio for disease recurrence, second invasive cancer, or death, 0.72; 95% confidence interval [CI], 0.60 to 0.85; P<0.001). The rate of freedom from breast cancer at 5 years was 92.8% in the exemestane-ovarian suppression group, as compared with 88.8% in the tamoxifen-ovarian suppression group (hazard ratio for recurrence, 0.66; 95% CI, 0.55 to 0.80; P<0.001). With 194 deaths (4.1% of the patients), overall survival did not differ significantly between the two groups (hazard ratio for death in the exemestane-ovarian suppression group, 1.14; 95% CI, 0.86 to 1.51; P=0.37). Selected adverse events of grade 3 or 4 were reported for 30.6% of the patients in the exemestane-ovarian suppression group and 29.4% of those in the tamoxifen-ovarian suppression group, with profiles similar to those for postmenopausal women. CONCLUSIONS In premenopausal women with hormone-receptor-positive early breast cancer, adjuvant treatment with exemestane plus ovarian suppression, as compared with tamoxifen plus ovarian suppression, significantly reduced recurrence. (Funded by Pfizer and others; TEXT and SOFT ClinicalTrials.gov numbers, NCT00066703 and NCT00066690, respectively.).

An Experimental Study of Complex-Offer Auctions: Payment Cost Minimization vs. Offer Cost Minimization

A Payment Cost Minimization (PCM) auction has been proposed as an alternative to the Offer Cost Minimization (OCM) auction to be used in wholesale electric power markets with the intention to lower the procurement cost of electricity. Efficiency concerns about this proposal have relied on the assumption of true production cost revelation. Using an experimental approach, I compare the two auctions, strictly controlling for the level of unilateral market power. A specific feature of these complex-offer auctions is that the sellers submit not only the quantities and the minimum prices at which they are willing to sell, but also the start-up fees that are designed to reimburse the fixed start-up costs of the generation plants. I find that both auctions result in start-up fees that are significantly higher than the start-up costs. Overall, the two auctions perform similarly in terms of procurement cost and efficiency. Surprisingly, I do not find a substantial difference between less market power and more market power designs. Both designs result in similar inefficiencies and equally higher procurement costs over the competitive prediction. The PCM auction tends to have lower price volatility than the OCM auction when the market power is minimal but this property vanishes in the designs with market power. These findings lead me to conclude that both the PCM and the OCM auctions do not belong to the class of truth revealing mechanisms and do not easily elicit competitive behavior.

Simple-Offer vs. Complex-Offer Auctions in Deregulated Electricity Markets

In my recent experimental research of wholesale electricity auctions, I discovered that the complex structure of the offers leaves a lot of room for strategic behavior, which consequently leads to anti- competitive and inefficient outcomes in the market. A specific feature of these complex-offer auctions is that the sellers submit not only the quantities and the minimum prices at which they are willing to sell, but also the start-up fees that are designed to reimburse the fixed start-up costs of the generation plants. In this paper, using the experimental method I compare the performance of two complex-offer auctions (COAs) against the performance of a simple-offer auction (SOA), in which the sellers have to recover all their generation costs --- fixed and variable ---through a uniform market-clearing price. I find that the SOA significantly reduces consumer prices and lowers price volatility. It mitigates anti-competitive effects that are present in the COAs and achieves allocative efficiency more quickly.

The effectiveness of a promotora-led intervention for Mexican Americans with type 2 diabetes

Purpose. The purpose of this randomized control repeated measures trial was to determine the effectiveness of a self-management intervention led by community lay workers called promotoras on the health outcomes of Mexican Americans with type 2 diabetes living in a major city on the Texas - Mexico border. The specific aims of this study, in relation to the intervention group participants, were to: (1) decrease the glycosylated hemoglobin (A1c) blood levels at the six-month assessment, (2) increase diabetes knowledge at the three and six-month assessments, and (3) strengthen the participants' beliefs in their ability to manage diabetes at the three and six-month assessments.^ Methods. One hundred and fifty Mexican American participants were recruited at a Catholic faith-based clinic and randomized into an intervention group and a usual-care control group. Personal characteristics, acculturation and baseline A1c, diabetes knowledge and diabetes health beliefs were measured. The six-month, two-phase intervention was culturally specific and it was delivered entirely by promotoras. Phase One of the intervention consisted of sixteen hours of participative group education and bi-weekly telephone contact follow-up. Phase Two consisted of bi-weekly follow-up using inspirational faith-based health behavior change postcards. The A1c levels, diabetes knowledge and diabetes health beliefs were measured at baseline, and three and six months post-baseline. The mean changes between the groups were analyzed using analysis of covariance. ^ Results. The 80% female sample, with a mean age of 58 years, demonstrated very low: acculturation, income, education, health insurance coverage, and strong Catholicism. No significant changes were noted at the three-month assessment, but the mean change of the A1c levels (F (1, 148 = 10.28, p < .001) and the diabetes knowledge scores (F (1, 148 = 9.0, p < .002) of the intervention group improved significantly at six months, adjusting for health insurance coverage. The diabetes health belief scores decreased in both groups.^ Conclusions. This study demonstrated that an intervention led by promotoras could result in decreased A1c levels and increased diabetes knowledge in spite of the very low acculturation, educational level and insurance coverage of the intervention group participants. Clinical implications and recommendations for future research are suggested. ^

The prevalence of food insecurity and associated factors among households with children in Head Start programs in Houston, Texas and Birmingham, Alabama

The purposes of this study were to determine the prevalence of food insecurity and factors associated with food insecurity among households with children enrolled in Head Start programs in Houston, Texas, and Birmingham, Alabama. This cross-sectional study utilized data gathered from 688 households recruited by convenience sample from two Head Start districts in each city. Interviewers collected data from primary caregivers on demographic characteristics, dietary intake, and the six-item USDA food security module. Chi-square and logistic regression analysis were used to determine the association of food security and demographic characteristics. Comparison of means was used to analyze the association between the child's fruit and vegetable intake and the household's food security status. The prevalence of food insecurity among the sample was 34.9% (95% CI: 31.3%, 38.5%). Characteristics associated with food insecurity were the caregiver's national origin (Foreign-born (ref.) v. U.S.-born, adjusted OR = 0.36, 95% CI: 0.14, 0.94), gender of the child (male (ref.) v. female, adjusted OR = 1.44, 95% CI: 1.03, 2.01), and city of residence (Birmingham (ref.) v. Houston, adjusted OR = 0.20, 95% CI: 0.10, 0.39). Children in food insecure households consumed more daily servings of fruits and vegetables on average (mean = 2.44) than children in food secure households (mean = 2.16, p = 0.04). ^

Age determination, planktic foraminifera and stable istopes of sediment core MSM05/5_712-2

A sediment core from the West Spitsbergen continental margin was studied to reconstruct climate and paleoceanographic variability during the last ~9 ka in the eastern Fram Strait. Our multiproxy evidence suggests that the establishment of the modern oceanographic configuration in the eastern Fram Strait occurred stepwise, in response to the postglacial sea-level rise and the related onset of modern sea-ice production on the shallow Siberian shelves. The late Early and Mid Holocene interval (9 to 5 ka) was generally characterized by relatively unstable conditions. High abundance of the subpolar planktic foraminifer species Turborotalita quinqueloba implies strong intensity of Atlantic Water (AW) inflow with high productivity and/or high AW temperatures, resulting in a strong heat flux to the Arctic. A series of short-lived cooling events (8.2, 6.9. and 6.1 ka) occurred superimposed on the warm late Early and Mid Holocene conditions. Our proxy data imply that simultaneous to the complete postglacial flooding of Arctic shallow shelves and the initiation of modern sea-ice production, strong advance of polar waters initiated modern oceanographic conditions in the eastern Fram Strait at ~5.2 ka. The Late Holocene was marked by the dominance of the polar planktic foraminifer species Neogloboquadrina pachyderma, a significant expansion of sea ice/icebergs, and strong stratification of the water column. Although planktic foraminiferal assemblages as well as sea surface and subsurface temperatures suggest a return of slightly strengthened advection of subsurface Atlantic Water after 3 ka, a relatively stable cold-water layer prevailed at the sea surface and the study site was probably located within the seasonally fluctuating marginal ice zone during the Neoglacial period.

Sulfide petrology of basalts at DSDP Holes 69-504B and 69-505B

Primary sulfide mineralization in basalts of the Costa Rica Rift occurs mainly in chrome-spinel-bearing olivine tholeiites. Primary sulfides form both globules, consisting of quenched single-phase solid solutions, and irregular polymineralic segregations of pyrrhotite, chalcopyrite, cubanite, and pentlandite. Two types of sulfide solid solutions - iron-nickel (Mss) and iron-copper (Iss) - were found among sulfide globules. These types appear to have formed because of sulfide-sulfide liquid immiscibility in the host magmas; as proved by the presence of globules with a distinct phase boundary between Mss and Iss. Such two-phase globules are associated with large olivine phenocrysts. Inhomogeneties among the globule composition likewise are caused by sulfide-sulfide immiscibility. Secondary sulfides form irregular segregations and veins consisting of pyrite, marcasite, and chalcopyrite.

Dinoflagellate cyst assemblages, Mg/Ca based reconstructed temperatures, stable carbon isotopes, and geochemical parameters of sediment core GeoB9508-5

In order to investigate a possible connection between tropical northeast (NE) Atlantic primary productivity, Atlantic meridional overturning circulation (AMOC), and drought in the Sahel region during Heinrich Stadial 1 (HS1), we used dinoflagellate cyst (dinocyst) assemblages, Mg/Ca based reconstructed temperatures, stable carbon isotopes (d13C) and geochemical parameters of a marine sediment core (GeoB 9508-5) from the continental slope offshore Senegal. Our results show a two-phase productivity pattern within HS1 that progressed from an interval of low marine productivity between ~ 19 and 16 kyr BP to a phase with an abrupt and large productivity increase from ~ 16 to 15 kyr BP. The second phase is characterized by distinct heavy planktonic d13C values and high concentrations of heterotrophic dinocysts in addition to a significant cooling signal based on reconstructions of past sea surface temperatures (SST). We conclude that productivity variations within HS1 can be attributed to a substantial shift of West African atmospheric processes. Taken together our results indicate a significant intensification of the North East (NE) trade winds over West Africa leading to more intense upwelling during the last millennium of HS1 between ~ 16 and 15 kyr BP, thus leaving a strong imprint on the dinocyst assemblages and sea surface conditions. Therefore, the two-phase productivity pattern indicates a complex hydrographic setting suggesting that HS1 cannot be regarded as uniform as previously thought.

Supplementary material: XRF core scanning data, CaCO3 values, foraminiferal carbon and oxygen isotope data, Mg/Ca data, clay mineralogy and helium isotope results

The Paleocene-Eocene Thermal Maximum (PETM; ~56 Ma) is associated with abrupt climate change, carbon cycle perturbation, ocean acidification, as well as biogeographic shifts in marine and terrestrial biota that were largely reversed as the climatic transient waned. We report a clear exception to the behavior of the PETM as a reversing climatic transient in the eastern North Atlantic (Deep-Sea Drilling Project Site 401, Bay of Biscay) where the PETM initiates a greatly prolonged environmental change compared to other places on Earth where records exist. The observed environmental perturbation extended well past the d13C recovery phase and up to 650 kyr after the PETM onset according to our extraterrestrial 3He-based age-model. We observe a strong decoupling of planktic foraminiferal d18O and Mg/Ca values during the PETM d13C recovery phase, which in combination with results from helium isotopes and clay mineralogy, suggests that the PETM triggered a hydrologic change in western Europe that increased freshwater flux and the delivery of weathering products to the eastern North Atlantic. This state change persisted long after the carbon-cycle perturbation had stopped. We hypothesize that either long-lived continental drainage patterns were altered by enhanced hydrological cycling induced by the PETM, or alternatively that the climate system in the hinterland area of Site 401 was forced into a new climate state that was not easily reversed in the aftermath of the PETM.

Palaeolake Rehwiese, NE-Germany, Younger Dryas varved data set RW09

The first 1400-year floating varve chronology for north-eastern Germany covering the late Allerød to the early Holocene has been established by microscopic varve counts from the Rehwiese palaeolake sediment record. The Laacher See Tephra (LST), at the base of the studied interval, forms the tephrochronological anchor point. The fine laminations were examined using a combination of micro-facies and ?-XRF analyses and are typical of calcite varves, which in this case provide mainly a warm season signal. Two varve types with different sub-layer structures have been distinguished: (I) complex varves consisting of up to four seasonal sub-layers formed during the Allerød and early Holocene periods, and, (II) simple two sub-layer type varves only occurring during the Younger Dryas. The precision of the chronology has been improved by varve-to-varve comparison of two independently analyzed sediment profiles based on well-defined micro-marker layers. This has enabled both (1) the precise location of single missing varves in one of the sediment profiles, and, (2) the verification of varve interpolation in disturbed varve intervals in the parallel core. Inter-annual and decadal-scale variability in sediment deposition processes were traced by multi-proxy data series including seasonal layer thickness, high-resolution element scans and total organic and inorganic carbon data at a five-varve resolution. These data support the idea of a two-phase Younger Dryas, with the first interval (12,675 - 12,275 varve years BP) characterised by a still significant but gradually decreasing warm-season calcite precipitation and a second phase (12,275 - 11,640 varve years BP) with only weak calcite precipitation. Detailed correlation of these two phases with the Meerfelder Maar record based on the LST isochrone and independent varve counts provides clues about regional differences and seasonal aspects of YD climate change along a transect from a location proximal to the North Atlantic in the west to a more continental site in the east.

(Table T1) Fluid inclusions in siltstone and sandstone grains from ODP Hole 210-1276A

Twenty samples of siltstones and sandstones were taken from Ocean Drilling Program Site 1276 during Leg 210 for fluid inclusion studies. With the exception of one sample of vein calcite, all inclusions were in quartz grains. The results of fluid-inclusion petrology and microthermometry indicate the presence of three fluid inclusion types (Types 1, 2, and 3). Type 1 fluid inclusions are two-phase (liquid + vapor) aqueous inclusions, and Type 2 inclusions are monophase fluid inclusions (liquid or vapor). These are common in all samples and are formed either as primary isolated inclusions or as secondary inclusions as trails along annealed fractures in the grain. Type 3 fluid inclusions are three-phase (liquid + vapor + solid) inclusions. Type 3 inclusions are rare and are observed as isolated inclusions or in a cluster with other types (i.e., Types 1 and 2). The predominant population throughout the different units sampled is two-phase (liquid + vapor) aqueous fluid inclusions (i.e., Type 1). The temperature of homogenization (TH) bivariate plots for Type 1 inclusions shows dominance throughout the hole of low- to medium-salinity fluids with minimum trapping temperatures between 150° and 400°C.

A multiproxy analysis of late MIS 6 to early MIS 5d OSP Site 161-975 sediments

A multiproxy analysis based on planktic foraminiferal abundances, derived SSTs, and stable planktic isotopes measurements together with alkenone abundances and Uk'37 SSTs was performed on late MIS 6 to early MIS 5d sediment recovered from Site 975 (ODP Leg 161) in the South Balearic Islands basin (Western Mediterranean) with emphasis on reconstructing the climate progression of the last interglacial period. A number of abrupt climate changes related to alternative influence of nutrient rich northern and oligotrophic southern water masses were revealed. Heinrich event 11 and cooling events C27, C26, C25, C24, C23, which have been previously described in the North Atlantic, were recognized. However, in comparison to the eastern North Atlantic mid-latitude region, events C27 and C26 at Site 975 seem to be significantly more pronounced. Together with evidence of a two-phase climate optimum with maximum SSTs reached during its later phase, this implies a close similarity in climate dynamics between the Western Mediterranean and the Nordic seas. We propose that postglacial effects in the Nordic seas had an influence on the western Mediterranean climate via atmospheric circulation and that these effects competed with the insolation force.