Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

Radiative forcing effect of ice-age dust

During glacial periods, dust deposition rates and inferred atmospheric concentrations were globally much higher than present. According to recent model results, the large enhancement of atmospheric dust content at the last glacial maximum (LGM) can be explained only if increases in the potential dust source areas are taken into account. Such increases are to be expected, due to effects of low precipitation and low atmospheric (CO2) on plant growth. Here the modelled three-dimensional dust fields from Mahowald et al. and modelled seasonally varying surface-albedo fields derived in a parallel manner, are used to quantify the mean radiative forcing due to modern (non-anthropogenic) and LGM dust. The effect of mineralogical provenance on the radiative properties of the dust is taken into account, as is the range of optical properties associated with uncertainties about the mixing state of the dust particles. The high-latitude (poleward of 45°) mean change in forcing (LGM minus modern) is estimated to be small (–0.9 to +0.2 W m–2), especially when compared to nearly –20 W m–2 due to reflection from the extended ice sheets. Although the net effect of dust over ice sheets is a positive forcing (warming), much of the simulated high-latitude dust was not over the ice sheets, but over unglaciated regions close to the expanded dust source region in central Asia. In the tropics the change in forcing is estimated to be overall negative, and of similarly large magnitude (–2.2 to –3.2 W m–2) to the radiative cooling effect of low atmospheric (CO2). Thus, the largest long-term climatic effect of the LGM dust is likely to have been a cooling of the tropics. Low tropical sea-surface temperatures, low atmospheric (CO2) and high atmospheric dust loading may be mutually reinforcing due to multiple positive feedbacks, including the negative radiative forcing effect of dust.

Effect of Age on Outcome of Reduced-Intensity Hematopoietic Cell Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission or With Myelodysplastic Syndrome

Purpose Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and >= 65 years had 2-year survival rates as follows: 44% (95% Cl, 37% to 52%), 50% (95% Cl, 41% to 59%), 34% (95% Cl, 25% to 43%), and 36% (95% Cl, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% Cl, 35% to 49%), 35% (95% Cl, 27% to 43%), 45% (95% Cl, 36% to 54%), and 38% (95% Cl, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P>.3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.

Prediction of children's flavour preferences. Effect of age and stability in reported preferences

The present study investigated whether children were able to communicate stable flavour preferences and whether mothers’ ability to correctly identify their child's flavour preferences is related to the stability of their child's flavour preferences. On 2 consecutive days, 75 girls and 77 boys (3–10 years, mean age = 7.1 ± 2.3 years) carried out a preference ranking task for five ice-cream flavours: mint, coffee, chocolate and two variants of vanilla. Without input from their child, mothers ranked four of these flavours according to their own understanding of their child's flavour preferences. Spearman rank order correlations suggest that older aged children (5–10 years) have more stable flavour preferences than younger aged children (3–5 years) (p < 0.05). Only 39% of mothers were able to correctly predict children's most preferred flavour, but significantly more parents (61%) were able to predict children's least preferred flavour (p < 0.05). Mothers’ ability to correctly predict their children's least preferred flavour seemed to be facilitated by children's ability to communicate their least preferred flavours in a consistent manner (p < 0.05). It is recommended to apply proper sensory methodologies with children rather than relying on mothers’ report when interested in children's likes. When interested in children's dislikes mothers’ report might be suitable.

Effect of diet, sex and age on fatty acid metabolism in broiler chickens : SFA and MUFA

The present study was conducted to evaluate the effect of different dietary lipid sources, age and sex on the SFA and MUFA metabolism in broiler chickens using a whole body fatty acid balance method. Four dietary lipid sources (palm fat, Palm; soyabean oil, Soya; linseed oil, Lin; and fish oil, Fish) were added at 3% to a basal diet containing 5% Palm. Diets were fed to female and male chickens from day 1 to either day 21 or day 42 of age. The accumulation (percentage of net intake and ex novo production) of SFA and MUFA was significantly lower in broilers fed on Palm than in broilers fed on the other diets (85·7 v. 97·4 %). Conversely, β-oxidation was significantly higher in Palm-fed birds than the average of the other dietary treatments (14·3 v. 2·6 %). On average, 33·1% of total SFA and MUFA accumulated in the body were elongated, and 13·8% were Δ-9 desaturated to longer chain or more unsaturated metabolites, with lower proportions being elongated and desaturated for the Palm and Fish diets than for the Soya and Lin diets. Total in vivo apparent elongase activity decreased exponentially in relation to the net intake of SFA and MUFA, while it increased with age. Total in vivo apparent Δ-9 desaturase activity was not significantly affected by dietary treatment or age. Total ex novo production and β-oxidation of SFA and MUFA showed a negative and positive curvilinear relationship with net intake of SFA and MUFA, respectively. Sex had no effect on SFA and MUFA metabolism.

Effect of diet, sex and age on fatty acid metabolism in broiler chickens : n-3 and n-6 PUFA

The PUFA metabolism in broiler chicken was studied through the whole body fatty acid balance method. Four dietary lipid sources (palm fat, Palm; soyabean oil, Soya; linseed oil, Lin; fish oil, Fish) were added at 3% to a basal diet containing 5% palm fat. Diets were fed to female and male birds from day 1 to either day 21 or day 42 of age. Birds fed the Lin diet showed a significantly higher 18 : 2n-6 accumulation compared with the other diets (85·2 v. 73·6% of net intake), whereas diet did not affect 18 : 3n-3 accumulation (mean 63% of net intake). Bioconversion of 18 : 2n-6 significantly decreased in the order Palm.> Lin > Soya > Fish (4·7, 3·9, 3·4 and 1% of net intake, respectively). The 18 : 3n-3 bioconversion on the Palm and Soya diets was similar and significantly higher than in broilers on the Lin diet (9·1 v. 5·8% of net intake). The β-oxidation of 18 : 2n-6 was significantly lower on the Lin diet than on the other diets (10·8 v. 23·3% of net intake), whereasβ-oxidation of 18 : 3n-3 was significantly higher on the Fish diet than on the other diets (41·5 v. 27·3% of net intake). Feeding fish oil suppressed apparent elongase and desaturase activity, whereas a higher dietary supply of 18 : 3n-3 and 18 : 2n-6 enhanced apparent elongation and desaturation activity on the PUFA involved in the n-3 and n-6 pathway, respectively. Accumulation of 18 : 2n-6 and 18 : 3n-3 increased andβ -oxidation decreased with age. Sex had a marginal effect on the PUFA metabolism.

A clustered randomised trial examining the effect of social marketing and community mobilisation on the age of uptake and levels of alcohol consumption by Australian adolescents

Introduction
Throughout the world, alcohol consumption is common among adolescents. Adolescent alcohol use and misuse have prognostic significance for several adverse long-term outcomes, including alcohol problems, alcohol dependence, school disengagement and illicit drug use. The aim of this study was to evaluate whether randomisation to a community mobilisation and social marketing intervention reduces the proportion of adolescents who initiate alcohol use before the Australian legal age of 18, and the frequency and amount of underage adolescent alcohol consumption.
Method and analysis
The study comprises 14 communities matched with 14 non-contiguous communities on socioeconomic status (SES), location and size. One of each pair was randomly allocated to the intervention. Baseline levels of adolescent alcohol use were estimated through school surveys initiated in 2006 (N=8500). Community mobilisation and social marketing interventions were initiated in 2011 to reduce underage alcohol supply and demand. The setting is communities in three Australian states (Victoria, Queensland and Western Australia). Students (N=2576) will complete school surveys in year 8 in 2013 (average age 12). Primary outcomes: (1) lifetime initiation and (2) monthly frequency of alcohol use. Reports of social marketing and family and community alcohol supply sources will also be assessed. Point estimates with 95% CIs will be compared for student alcohol use in intervention and control communities. Changes from 2006 to 2013 will be examined; multilevel modelling will assess whether random assignment of communities to the intervention reduced 2013 alcohol use, after accounting for community level differences. Analyses will also assess whether exposure to social marketing activities increased the intervention target of reducing alcohol supply by parents and community members.

The effect of leaving employment on mental health: testing ‘adaptation’ versus ‘sensitisation’ in a cohort of working-age Australians

Objectives To investigate the ‘adaptation’ versus ‘sensitisation’ hypotheses in relation to mental health and labour market transitions out of employment to determine whether mental health stabilised (adaptation) or worsened (sensitisation) as people experienced one or more periods without work. Methods The Household Income and Labour Dynamics of Australia (HILDA) longitudinal survey was used to investigate the relationship between the number of times a person had been unemployed or had periods out of the labour force (ie, spells without work) and the Mental Component Summary (MCS) of the Short Form 36 (SF-36). Demographic, health and employment related confounders were included in a series of multilevel regression models. Results During 2001–2010, 3362 people shifted into unemployment and 1105 shifted from employment to not in the labour force. Compared with participants who did not shift, there was a 1.64-point decline (95% CI −2.05 to −1.23, p<0.001) in scores of the MCS SF-36 among those who had one spell of unemployment (excluding not in the labour force), and a 2.56-point decline (95% CI −3.93 to −1.19, p<0.001) among those who had two or more spells of unemployment after adjusting for other variables. Findings for shifts from employment to ‘not in the labour force’ were in the same direction; however, effect sizes were smaller. Conclusions These results indicate that multiple spells of unemployment are associated with continued, though small, declines in mental health. Those who leave employment for reasons other than unemployment experience a smaller reduction in mental health.

The effect of gender and age on the association between weight status and health-related quality of life in Australian adolescents

Evidence suggests an inverse relationship between excess weight and health-related quality of life (HRQoL) in children and adolescents, however little is known about whether this association is moderated by variables such as gender and age. This study aimed to investigate these relationships.

Effect of mood, social connectivity and age in online depression community via topic and linguistic analysis

Depression afflicts one in four people during their lives. Several studies have shown that for the isolated and mentally ill, the Web and social media provide effective platforms for supports and treatments as well as to acquire scientific, clinical understanding of this mental condition. More and more individuals affected by depression join online communities to seek for information, express themselves, share their concerns and look for supports [12]. For the first time, we collect and study a large online depression community of more than 12,000 active members from Live Journal. We examine the effect of mood, social connectivity and age on the online messages authored by members in an online depression community. The posts are considered in two aspects: what is written (topic) and how it is written (language style). We use statistical and machine learning methods to discriminate the posts made by bloggers in low versus high valence mood, in different age categories and in different degrees of social connectivity. Using statistical tests, language styles are found to be significantly different between low and high valence cohorts, whilst topics are significantly different between people whose different degrees of social connectivity. High performance is achieved for low versus high valence post classification using writing style as features. The finding suggests the potential of using social media in depression screening, especially in online setting.