Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: Pooled individual data analysis of 17 prospective studies

Background: Insulin-like growth factor 1 (IGF1) stimulates mitosis and inhibits apoptosis. Some published results have shown an association between circulating IGF1 and breast-cancer risk, but it has been unclear whether this relationship is consistent or whether it is modified by IGF binding protein 3 (IGFBP3), menopausal status, oestrogen receptor status or other factors. The relationship of IGF1 (and IGFBP3) with breast-cancer risk factors is also unclear. The Endogenous Hormones and Breast Cancer Collaborative Group was established to analyse pooled individual data from prospective studies to increase the precision of the estimated associations of endogenous hormones with breast-cancer risk. Methods: Individual data on prediagnostic IGF1 and IGFBP3 concentrations were obtained from 17 prospective studies in 12 countries. The associations of IGF1 with risk factors for breast cancer in controls were examined by calculating geometric mean concentrations in categories of these factors. The odds ratios (ORs) with 95% CIs of breast cancer associated with increasing IGF1 concentrations were estimated by conditional logistic regression in 4790 cases and 9428 matched controls, with stratification by study, age at baseline, and date of baseline. All statistical tests were two-sided, and a p value of less than 0\ub705 was considered significant. Findings: IGF1 concentrations, adjusted for age, were positively associated with height and age at first pregnancy, inversely associated with age at menarche and years since menopause, and were higher in moderately overweight women and moderate alcohol consumers than in other women. The OR for breast cancer for women in the highest versus the lowest fifth of IGF1 concentration was 1\ub728 (95% CI 1\ub714-1\ub744; p<0\ub70001). This association was not altered by adjusting for IGFBP3, and did not vary significantly by menopausal status at blood collection. The ORs for a difference in IGF1 concentration between the highest and lowest fifth were 1\ub738 (95% CI 1\ub714-1\ub768) for oestrogen-receptor-positive tumours and 0\ub780 (0\ub757-1\ub713) for oestrogen-receptor-negative tumours (p for heterogeneity=0\ub7007). Interpretation: Circulating IGF1 is positively associated with breast-cancer risk. The association is not substantially modified by IGFBP3, and does not differ markedly by menopausal status, but seems to be confined to oestrogen-receptor-positive tumours

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A Psychodynamic View of Counseling Psychology

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69032/2/10.1177_001100008000900114.pd

O fenômeno El Niño Oscilação Sul e a variabilidade interanual da evaporação do tanque Classe A e da umidade relativa do ar em Santa Maria, RS El Niño Southern Oscilation and the interannual variability of Pan evaporation and air relative humidity in Santa Maria, RS, Brazil

O objetivo deste trabalho foi associar a variabilidade interanual da evaporação do tanque Classe A e da umidade relativa do ar com o fenômeno El Niño Oscilação Sul (ENOS) em Santa Maria, RS. Foram utilizados os dados diários de evaporação do tanque Classe A (ECA, mm dia-1) e umidade relativa média diária do ar (UR, %) medidos em Santa Maria, RS. A ECA foi medida de 1973 a 2006 e a UR de 1969 a 2006. Os anos foram classificados em El Niño (EN), La Niña (LN) e Neutros (N), considerando o período de 01/07 de um ano até 30/06 do ano seguinte. Os resultados mostraram que a ECA é menor nos anos de EN e maior nos anos de LN. Já a UR foi maior em anos de EN e menor em anos de LN. O efeito do fenômeno ENOS sobre a ECA é maior nos meses de novembro, dezembro, janeiro e maio, enquanto que sobre a UR os meses de maior influência do ENOS são outubro, novembro, dezembro e maio.<br>The objective of this study was to associate the interannual variability of Pan evaporation and air relative humidity with the El Niño Southern Oscilation (ENSO) phenomenon in Santa Maria, RS, Brazil. Daily data records of Pan evaporation (PAN, mm day-1) and mean daily relative humidity (RH, %) measured in Santa Maria, RS, were used. PAN was measured from 1973 to 2006 and RH was measured from 1969 to 2006. Years were grouped into El Niño (EN) years, La Niña (LN) years, and Neutral (N) years, from July 1st of the year to June 30th of the following year. Results showed that PAN is lower in EN years and greater in LN years. On the other hand, RH was greater in EN years and lower in LN years. The effect of ENSO on PAN is greater in November, December, January, and May, whereas RH is affected by ENSO in October, November, December and May