Promising results with exemestane in the first-line treatment of metastatic breast cancer: a randomized phase II EORTC trial with a tamoxifen control.

Because tamoxifen (TAM), a nonsteroidal antiestrogen, is routinely used in the adjuvant setting, other hormone therapies are needed as alternatives for first-line treatment of metastatic breast cancer (MBC). Currently, exemestane (EXE) and other antiaromatase agents are indicated for use in patients who experience failure of TAM. In this multicenter, randomized, open-label, TAM-controlled (20 mg/day), phase II trial, we examined the activity and tolerability of EXE 25 mg/day for the first-line treatment of MBC in postmenopausal women. Exemestane was well tolerated and demonstrated substantial first-line antitumor activity based on intent-to-treat analysis of peer-reviewed responses. In the EXE arm, values for complete, partial, and objective response, clinical benefit, and time to tumor progression (TTP) exceeded those reported for TAM although no statistical comparison was made. Based on these encouraging results, a phase III trial will compare EXE and TAM.

Taxanes alone or in combination with anthracyclines as first-line therapy of patients with metastatic breast cancer.

PURPOSE: Taxanes (paclitaxel or docetaxel) have been sequenced or combined with anthracyclines (doxorubicin or epirubicin) for the first-line treatment of advanced breast cancer. This meta-analysis uses data from all relevant trials to detect any advantages of taxanes in terms of tumor response, progression-free survival (PFS), and survival. PATIENTS AND METHODS: Individual patient data were collected on eight randomized combination trials comparing anthracyclines + taxanes (+ cyclophosphamide in one trial) with anthracyclines + cyclophosphamide (+ fluorouracil in four trials), and on three single-agent trials comparing taxanes with anthracyclines. Combination trials included 3,034 patients; single-agent trials included 919 patients. RESULTS: Median follow-up of living patients was 43 months, median survival was 19.3 months, and median PFS was 7.1 months. In single-agent trials, response rates were similar in the taxanes (38%) and in the anthracyclines (33%) arms (P = .08). The hazard ratios for taxanes compared with anthracyclines were 1.19 (95% CI, 1.04 to 1.36; P = .011) for PFS and 1.01 (95% CI, 0.88 to 1.16; P = .90) for survival. In combination trials, response rates were 57% (10% complete) in taxane-based combinations and 46% (6% complete) in control arms (P < .001). The hazard ratios for taxane-based combinations compared with control arms were 0.92 (95% CI, 0.85 to 0.99; P = .031) for PFS and 0.95 (95% CI, 0.88 to 1.03; P = .24) for survival. CONCLUSION: Taxanes were significantly worse than single-agent anthracyclines in terms of PFS, but not in terms of response rates or survival. Taxane-based combinations were significantly better than anthracycline-based combinations in terms of response rates and PFS, but not in terms of survival.

Maria Edgeworth: Nineteenth century Irish female pioneer of science education.

Maria Edgeworth was a nineteenth century novelist, primarily remembered for her adult and children's novels. Yet her book, Letters for literary ladies discussed the importance of science education for girls and in conjunction with her father, Richard Edgeworth, she wrote several treatises on education. Their book Practical education advocates an inquiry approach to teaching science and also using scientific practices, such as observation and data collection, to examine and plan children's education. They emphasised the importance and the role of experimentation, observation and critical thinking in the development of children's knowledge, skills and attitudes towards learning. However, the history of science education has to date ignored this seminal work and Maria's contributions to women's science education.

Incidence of breast cancer in first-degree female relatives of men with newly diagnosed prostate cancer

Prostate cancer is the most common incident cancer and the second leading cause of death in men in the United States. Although numerous attempts have been made to identify risk factors associated with prostate cancer, the results have been inconsistent and conflicting. The only established risk factors are age and ethnicity. A positive family history of prostate cancer has also been shown to increase the risk two- to three-fold among close relatives.^ There are several similarities between breast and prostate cancer that make the relationship between the two of interest. (1) Histologically, both cancers are predominantly adenocarcinomas, (2) both organs have a sexual and/or reproductive role, (3) both cancers occur in hormone-responsive tissue, (4) therapy often consists of hormonal manipulation, (5) worldwide distribution patterns of prostate and breast cancer are positively correlated.^ A family history study was conducted to evaluate the aggregation of prostate cancer and co-aggregation of breast cancer in 149 patients referred to The University of Texas, M.D. Anderson Cancer Center with newly diagnosed prostate cancer. All patients were white, less than 75 years of age at diagnosis and permanent residents of the United States. Through a personal interview with the proband, family histories were collected on 1,128 first-degree relatives. Cancer diagnoses were verified through medical records or death certificate. Standardized incidence ratios were calculated using a computer program by Monson incorporating data from Connecticut Tumor Registry.^ In this study, familial aggregation of prostate cancer was verified only among the brothers, not among fathers. Although a statistically significant excess of breast cancer was not found, the increased point estimates in mothers, sisters and daughters are consistent with a co-aggregation hypothesis. Rather surprising was the finding of a seven-fold increased risk of prostate cancer and a three-fold increased risk of breast cancer among siblings in the presence of a maternal history of any cancer. Larger family history studies including high risk (African-Americans) and lower-risk groups (Hispanics) and incorporating molecular genetic evaluations should be conducted to determine if genetic differences play a role in the differential incidence rates across ethnic groups. ^

National Potato Grade Labeling Act. Hearings before a subcommittee, Eighty-fifth Congress, first session, on S. 1315 and S. 1393, bills to authorize the National Potato Grade Labeling Act, which provides quality requirements for, and the inspection, certification, and labeling of Irish potatoes. May 21-22, 1957.

Mode of access: Internet.

Jerusalem, 1920-1922; being the records of the Pro-Jerusalem council during the first two years of the civil administration,

Mode of access: Internet.

Oversight of Veterans' Administration target system : hearings before the Subcommittee on Special Investigations of the Committee on Veterans' Affairs, House of Representatives, Ninety-sixth Congress, first session, June 20, September 11 [i.e. July 13] and September 11, 1979.

Mode of access: Internet.

A review of the evidence of the pretended general conspiracy of the Roman Catholics of Ireland, to massacre "all the Protestants that would not join with them," on the 23d of October, 1641. To which are added, proofs of a plan formed by the Irish administration to exterminate the Roman Catholics, and confiscate their estates ...

"This review forms an integral part of the Vindiciae hibernicae." - Pref.

History of the United States, from their first settlement as colonies to the close of the administration of Mr. Madison, in 1817.

Mode of access: Internet.

A phenomenological study of Irish and Portuguese women’s experiences of receiving family support when studying STEM subjects at technical institutes

Comunicação apresentada na 44th SEFI Conference, 12-­15 September 2016, Tampere, Finland

An audit of first-aid treatment of pediatric burns patients and their clinical outcome

This study describes the first aid used and clinical outcomes of all patients who presented to the Royal Children's Hospital, Brisbane, Australia in 2005 with an acute burn injury. A retrospective audit was performed with the charts of 459 patients and information concerning burn injury, first-aid treatment, and clinical outcomes was collected. First aid was used on 86.1% of patients, with 8.7% receiving no first aid and unknown treatment in 5.2% of cases. A majority of patients had cold water as first aid (80.2%), however, only 12.1% applied the cold water for the recommended 20 minutes or longer. Recommended first aid (cold water for >or=20 minutes) was associated with significantly reduced reepithelialization time for children with contact injuries (P=.011). Superficial depth burns were significantly more likely to be associated with the use of recommended first aid (P=.03). Suboptimal treatment was more common for children younger than 3.5 years (P<.001) and for children with friction burns. This report is one of the few publications to relate first-aid treatment to clinical outcomes. Some positive clinical outcomes were associated with recommended first-aid use; however, wound outcomes were more strongly associated with burn depth and mechanism of injury. There is also a need for more public awareness of recommended first-aid treatment.

Dasatinib, nilotinib and standard-dose imatinib for the first line treatment of chronic myeloid leukaemia: Systematic reviews and economic analyses

- Background Nilotinib and dasatinib are now being considered as alternative treatments to imatinib as a first-line treatment of chronic myeloid leukaemia (CML). - Objective This technology assessment reviews the available evidence for the clinical effectiveness and cost-effectiveness of dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of Philadelphia chromosome-positive CML. - Data sources Databases [including MEDLINE (Ovid), EMBASE, Current Controlled Trials, ClinicalTrials.gov, the US Food and Drug Administration website and the European Medicines Agency website] were searched from search end date of the last technology appraisal report on this topic in October 2002 to September 2011. - Review methods A systematic review of clinical effectiveness and cost-effectiveness studies; a review of surrogate relationships with survival; a review and critique of manufacturer submissions; and a model-based economic analysis. - Results Two clinical trials (dasatinib vs imatinib and nilotinib vs imatinib) were included in the effectiveness review. Survival was not significantly different for dasatinib or nilotinib compared with imatinib with the 24-month follow-up data available. The rates of complete cytogenetic response (CCyR) and major molecular response (MMR) were higher for patients receiving dasatinib than for those with imatinib for 12 months' follow-up (CCyR 83% vs 72%, p < 0.001; MMR 46% vs 28%, p < 0.0001). The rates of CCyR and MMR were higher for patients receiving nilotinib than for those receiving imatinib for 12 months' follow-up (CCyR 80% vs 65%, p < 0.001; MMR 44% vs 22%, p < 0.0001). An indirect comparison analysis showed no difference between dasatinib and nilotinib for CCyR or MMR rates for 12 months' follow-up (CCyR, odds ratio 1.09, 95% CI 0.61 to 1.92; MMR, odds ratio 1.28, 95% CI 0.77 to 2.16). There is observational association evidence from imatinib studies supporting the use of CCyR and MMR at 12 months as surrogates for overall all-cause survival and progression-free survival in patients with CML in chronic phase. In the cost-effectiveness modelling scenario, analyses were provided to reflect the extensive structural uncertainty and different approaches to estimating OS. First-line dasatinib is predicted to provide very poor value for money compared with first-line imatinib, with deterministic incremental cost-effectiveness ratios (ICERs) of between £256,000 and £450,000 per quality-adjusted life-year (QALY). Conversely, first-line nilotinib provided favourable ICERs at the willingness-to-pay threshold of £20,000-30,000 per QALY. - Limitations Immaturity of empirical trial data relative to life expectancy, forcing either reliance on surrogate relationships or cumulative survival/treatment duration assumptions. - Conclusions From the two trials available, dasatinib and nilotinib have a statistically significant advantage compared with imatinib as measured by MMR or CCyR. Taking into account the treatment pathways for patients with CML, i.e. assuming the use of second-line nilotinib, first-line nilotinib appears to be more cost-effective than first-line imatinib. Dasatinib was not cost-effective if decision thresholds of £20,000 per QALY or £30,000 per QALY were used, compared with imatinib and nilotinib. Uncertainty in the cost-effectiveness analysis would be substantially reduced with better and more UK-specific data on the incidence and cost of stem cell transplantation in patients with chronic CML. - Funding The Health Technology Assessment Programme of the National Institute for Health Research.

Channel Islands marine protected areas first 5 years of monitoring: 2003-2008 [Report produced by the California Department of Fish and Game in collaboration with the Partnership for Interdisciplinary Studies of Coastal Oceans (PISCO), Channel Islands National Marine Sanctuary, and Channel Islands National Park]

The Channel Islands—sometimes called the Galapagos of North America—are known for their great beauty, rich biodiversity, cultural heritage, and recreational opportunities. In 1980, in recognition of the islands’ importance, the United States Congress established a national park encompassing 5 of California’s Channel Islands (Santa Barbara, Anacapa, Santa Cruz, Santa Rosa, and San Miguel Islands) and waters within 1 nautical mile of the islands. In the same year, Congress declared a national marine sanctuary around each of these islands, including waters up to 6 nautical miles offshore. Approximately 60,000 people visit the Channel Islands each year for aquatic recreation such as fishing, sailing, kayaking, wildlife watching, surfing, and diving. Another 30,000 people visit the islands for hiking, camping, and sightseeing. Dozens of commercial fishing boats based in Santa Barbara, Ventura, Oxnard, and other ports go to the Channel Islands to catch squid, spiny lobster, sea urchin, rockfish, crab, sheephead, flatfish, and sea cucumber, among other species. In the past few decades, advances in fishing technology and the rising number of fishermen, in conjunction with changing ocean conditions and diseases, have contributed to declines in some marine fishes and invertebrates at the Channel Islands. In 1998, citizens from Santa Barbara and Ventura proposed establishment of no-take marine reserves at the Channel Islands, beginning a 4-year process of public meetings, discussions, and scientific analyses. In 2003, the California Fish and Game Commission designated a network of marine protected areas (MPAs) in state waters around the northern Channel Islands. In 2006 and 2007, the National Oceanic and Atmospheric Administration (NOAA) extended the MPAs into the national marine sanctuary’s deeper, federal waters. To determine if the MPAs are protecting marine species and habitats, scientists are monitoring ecological changes. They are studying changes in habitats; abundance and size of species of interest; the ocean food web and ecosystem; and movement of fish and invertebrates from MPAs to surrounding waters. Additionally, scientists are monitoring human activities such as commercial and recreational fisheries, and compliance with MPA regulations. This booklet describes some results from the first 5 years of monitoring the Channel Islands MPAs. Although 5 years is not long enough to determine if the MPAs will accomplish all of their goals, this booklet offers a glimpse of the changes that are beginning to take place and illustrates the types of information that will eventually be used to assess the MPAs’ effectiveness. (PDF contains 24 pages.)