223 research outputs found

    Intratumor Heterogeneity of the Estrogen Receptor and the Long-term Risk of Fatal Breast Cancer.

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    Background:Breast cancer patients with estrogen receptor (ER)-positive disease have a continuous long-term risk for fatal breast cancer, but the biological factors influencing this risk are unknown. We aimed to determine whether high intratumor heterogeneity of ER predicts an increased long-term risk (25 years) of fatal breast cancer. Methods:The STO-3 trial enrolled 1780 postmenopausal lymph node-negative breast cancer patients randomly assigned to receive adjuvant tamoxifen vs not. The fraction of cancer cells for each ER intensity level was scored by breast cancer pathologists, and intratumor heterogeneity of ER was calculated using Rao's quadratic entropy and categorized into high and low heterogeneity using a predefined cutoff at the second tertile (67%). Long-term breast cancer-specific survival analyses by intra-tumor heterogeneity of ER were performed using Kaplan-Meier and multivariable Cox proportional hazard modeling adjusting for patient and tumor characteristics. Results:A statistically significant difference in long-term survival by high vs low intratumor heterogeneity of ER was seen for all ER-positive patients (P < .001) and for patients with luminal A subtype tumors (P = .01). In multivariable analyses, patients with high intratumor heterogeneity of ER had a twofold increased long-term risk as compared with patients with low intratumor heterogeneity (ER-positive: hazard ratio [HR] = 1.98, 95% confidence interval [CI] = 1.31 to 3.00; luminal A subtype tumors: HR = 2.43, 95% CI = 1.18 to 4.99). Conclusions:Patients with high intratumor heterogeneity of ER had an increased long-term risk of fatal breast cancer. Interestingly, a similar long-term risk increase was seen in patients with luminal A subtype tumors. Our findings suggest that intratumor heterogeneity of ER is an independent long-term prognosticator with potential to change clinical management, especially for patients with luminal A tumors

    School Centres for Teaching Excellence (SCTE): understanding new directions for schools and universities in Health and Physical Education

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    This paper critically analyzes a community collaborative approach for implementing Health and Physical Education (HPE) lessons within Gippsland primary schools (Victoria, Australia). The rural community collaborations reflected upon are embedded within the Victorian Department of Education and Early Childhood Development (DEECD) ‘School Centres for Teaching Excellence’ (SCTE) initiative and are timely with the current curriculum reform in Health and Physical Education. The purpose of this paper is to reflect on and share the experiential learning offered where the curriculum is relevant, engaging, contemporary, physically active, enjoyable and developmentally appropriate for all stakeholders; namely university pre-service teachers, primary school children and primary teachers. It is envisaged that through sharing the various dynamics involved in a SCTE program, educators may benefit and subsequently consider the suitability and possibility of establishing similar collaborations within their context

    Процесс анализа угроз, влияющих на экономическую устойчивость предприятия

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    На основании проведенного исследования были выявлены факторы возникновения угроз, их группировка по степени воздействию на экономическую устойчивость предприятий и рассмотрена формализация процесса анализа угроз экономической устойчивости предприятий. В условиях рыночной экономики невозможно управлять предприятием без учета влияния угроз, а для эффективного управления важно не только знать об их присутствии, а и правильно идентифицировать конкретную угрозу.На підставі проведеного дослідження були виявлені чинники виникнення загроз, їх угруповання по степені впливу на економічну стійкість підприємств і розглянута формалізація процесу аналізу загроз економічної стійкості підприємств. В умовах ринкової економіки неможливо керувати підприємством без вивчення впливу загроз, а для ефективного керування важливо не тільки знати про їх присутність, а і правильно ідентифікувати конкретну загрозу.On the basis of the conducted research the factors of origin of threats were exposed, their gourmet on a degree to influence on economic stability of enterprises and formalization of process of analysis of threats of economic stability of enterprises is considered. In the conditions of market economy it is impossible to manage an enterprise without taking into account influencing of threats, and for the effective management it is important not only to know about their presence, and to identify the concrete threat correctly

    ‘Scaling up’ educational change: some musings on misrecognition and doxic challenges

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    Educational policy-makers around the world are strongly committed to the notion of ‘scaling up’. This can mean anything from encouraging more teachers to take up a pedagogical innovation, all the way through to system-wide efforts to implement ‘what works’ across all schools. In this paper, I use Bourdieu’s notions of misrecognition to consider the current orthodoxies of scaling up. I argue that the focus on ‘process’ and ‘implementation problems’: (1) both obscures and legitimates the ways in which the field logics of practice actually work and, (2) produces/reproduces the inequitable distribution of educational benefits (capitals and life opportunities). I suggest that the notion of misrecognition might provide a useful lens through which to examine reform initiatives and explanations of their success/failure

    Inferring learning from big data:The importance of a transdisciplinary and multidimensional approach

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    The use of big data in higher education has evolved rapidly with a focus on the practical application of new tools and methods for supporting learning. In this paper, we depart from the core emphasis on application and delve into a mostly neglected aspect of the big data conversation in higher education. Drawing on developments in cognate disciplines, we analyse the inherent difficulties in inferring the complex phenomenon that is learning from big datasets. This forms the basis of a discussion about the possibilities for systematic collaboration across different paradigms and disciplinary backgrounds in interpreting big data for enhancing learning. The aim of this paper is to provide the foundation for a research agenda, where differing conceptualisations of learning become a strength in interpreting patterns in big datasets, rather than a point of contention
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