Burden of lymphedema in long-term breast cancer survivors by race and age

Background: Risk assessment for breast cancer–related lymphedema has emphasized upper-limb symptoms and treatment-related risk factors. This article examined breast cancer–related lymphedema after surgery, overall and in association with broader demographic and clinical features. Methods: The Carolina Breast Cancer Study phase 3 followed participants for breast cancer–related lymphedema from baseline (on average, 5 months after breast cancer diagnosis) to 7 years after diagnosis. Among 2645 participants, 552 self-reported lymphedema cases were identified. Time-to-lymphedema curves and inverse probability weighted conditional Cox proportional hazards model were used to evaluate whether demographics and clinical features were associated with breast cancer–related lymphedema. Results: Point prevalence of breast cancer–related lymphedema was 6.8% at baseline, and 19.9% and 23.8% at 2 and 7 years after diagnosis, respectively. Most cases had lymphedema in the arm (88%-93%), whereas 14% to 27% presented in the trunk and/or breast. Beginning approximately 10 months after diagnosis, younger Black women had the highest risk of breast cancer–related lymphedema and older non-Black women had the lowest risk. Positive lymph node status, larger tumor size (>5 cm), and estrogen receptor–negative breast cancer, as well as established risk factors such as higher body mass index, removal of more than five lymph nodes, mastectomy, chemotherapy, and radiation therapy, were significantly associated with increased hazard (1.5- to 3.5-fold) of lymphedema. Conclusions: Findings highlight that hazard of breast cancer–related lymphedema differs by demographic characteristics and clinical features. These factors could be used to identify those at greatest need of lymphedema prevention and early intervention. Lay summary: In this study, the aim was to investigate breast cancer–related lymphedema (BCRL) burden. This study found that risk of BCRL differs by race, age, and other characteristics

word~river literary review (2013)

wordriver is a literary journal dedicated to the poetry, short fiction, and creative nonfiction of adjunct, part-time and fulltime instructors teaching under a semester or yearly contract in our universities, colleges, and community colleges worldwide. Graduate student teachers who have used up their teaching assistant time and are teaching with adjunct contracts for the remainder of their graduate program are also eligible. We’re looking for work that demonstrates the creativity and craft of adjunct/part-time instructors in English and other disciplines. We reserve first publication rights and onetime anthology publication rights for all work published. We do not accept simultaneous submissions.https://digitalscholarship.unlv.edu/word_river/1004/thumbnail.jp

Sustainable intensification – “oxymoron” or “third-way”? A systematic review

Sustainable Intensification (SI) is a term that has been advanced to capture a concept that some consider as the ‘third paradigm’ for global agricultural development. However, the term has become subject to intense debates as well as scepticism and confusion regarding its meaning and the characteristics of production systems that could indicate SI (defined as “indicators”). This has resulted in a proliferation of literature. We have conducted a systematic review of a sample of this literature analysing the most commonly suggested indicators of SI in order to investigate the extent to which the critiques of SI are valid in their viewpoints that SI is an oxymoron, underpinned by a productivist agenda, and to identify the critical issues in the development of a comprehensive and unambiguous set of SI indicators. From 633 articles identified by a search of relevant databases, a sample of 75 articles were selected and analysed using the NVIVO™ software. The results were organised according to a Socio-Ecological Systems (SES) framework comprising seven sub-systems or components − resource system, resource units, governance system, resource users, interactions, outcomes, and environment. A total of 218 indicators (both positive and negative) were identified. Most of these indicators focused on the ‘outcomes’ of agricultural systems with the majority being related to agricultural production. Few indicators were identified as relating to the economic and societal dimensions of food systems. Whilst this potentially suggested a productivist bias in the current interpretation of SI it was difficult to draw a black and white conclusion, since for the other system components, the majority of the indicators suggested appeared to take a more holistic point-of-view and emphasised both productivity and sustainability of agricultural systems. Our analysis suggests that a key reason why SI may be viewed with scepticism is a lack of specificity and elucidation of the rationale, scale, and farm type for which SI is proposed. Moreover, a number of the indicators were so loosely defined that the interventions they imply could be enacted without due consideration of the social impacts of their adoption. We conclude that there is need to develop SI indicators according to specific farming types and scales and also with more consideration of the social and political dimensions of food systems in order to promote a constructive dialogue around the concept of SI to take place. Unless the concept of SI is described and measured in such a holistic and inclusive manner, it is unlikely to be accepted as a valid descriptor of sought-after agricultural practices by players in the Third Sector

Epidemiology of basal-like breast cancer

Risk factors for the newly identified “intrinsic” breast cancer subtypes (luminal A, luminal B, basal-like and human epidermal growth factor receptor 2-positive/estrogen receptor-negative) were determined in the Carolina Breast Cancer Study, a population-based, case–control study of African-American and white women. Immunohistochemical markers were used to subtype 1,424 cases of invasive and in situ breast cancer, and case subtypes were compared to 2,022 controls. Luminal A, the most common subtype, exhibited risk factors typically reported for breast cancer in previous studies, including inverse associations for increased parity and younger age at first full-term pregnancy. Basal-like cases exhibited several associations that were opposite to those observed for luminal A, including increased risk for parity and younger age at first term full-term pregnancy. Longer duration breastfeeding, increasing number of children breastfed, and increasing number of months breastfeeding per child were each associated with reduced risk of basal-like breast cancer, but not luminal A. Women with multiple live births who did not breastfeed and women who used medications to suppress lactation were at increased risk of basal-like, but not luminal A, breast cancer. Elevated waist-hip ratio was associated with increased risk of luminal A in postmenopausal women, and increased risk of basal-like breast cancer in pre- and postmenopausal women. The prevalence of basal-like breast cancer was highest among premenopausal African-American women, who also showed the highest prevalence of basal-like risk factors. Among younger African-American women, we estimate that up to 68% of basal-like breast cancer could be prevented by promoting breastfeeding and reducing abdominal adiposity

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Developing Social Marketing Strategies to Reduce Puget Sound Shoreline Armoring

The net reduction of shoreline armor along the marine nearshore of Puget Sound is a key goal for ecosystem recovery. WDFW and DNR are the leads of the Puget Sound Marine and Nearshore Grant Program, funded by the U.S. Environmental Protection Agency through the National Estuary Program, and have funded a project to develop a social marketing framework and strategies for voluntary removal and/or replacement of hard armor for residential parcels. In the future, the Grant Program will provide this social marketing and behavior change strategy, as well as information about incentive options, to local governments and other entities interested in implementing armoring reduction programs. Social marketing and behavior change strategies that achieve voluntary stewardship among shoreline landowners can be used to complement regulatory, education, restoration, and other efforts that seek to protect Puget Sound beaches. The project includes a) GIS assessment of all residential marine parcels to in Puget Sound, including shoreform and geomorphology, as well as basic demographic information and segmented parcel types; b) through primary and secondary research, identifying barriers and motivators impacting property owner decisions to remove or forgo hard armor; c) identifying sub-segments of shoreline property owners most likely to be receptive to messages about voluntary armor removal, choosing softer alternatives to armor install, and other “natural” shoreline protection behaviors; d) testing messaging, outreach strategies and motivators for selected population segments to choose alternatives to hard armor along their shorelines (where not needed to protect property); and e) developing an outreach strategy toolkit for program implementers to use when conducting local campaigns. Qualitative interviews with a variety of shoreline property owners and a cross-section of “influencer” audiences were conducted to gain insight about how shoreline armor decisions are made, and what barriers and motivators may be most common. The team also conducted a literature review of existing research, outreach and pilot programs already complete (or in progress) related to shoreline armor. The interviews, database development and literature review were used to develop a quantitative survey distributed to a cross section of shoreline property owners in January 2014, which drilled down into barriers and motivations tied to target behaviors and provided insights into messaging and terminology that the team will then use to inform development of the social marketing strategy/toolkit. The project is scheduled to be complete by May 31, 2014

Spitzer Space Telescope: Innovations and Optimizations in the Extended Mission Era

NASA’s Spitzer Space Telescope continues to operate well past its original cryogenic mission concept (2003-2009), executing both a follow-on “Warm” mission (2009-2016) and the current “Beyond” (2016-present) mission phase. As Spitzer’s unique Earth-trailing orbit carries it ever further from us (now surpassing 1.6 astronomical unit), its orbital geometry provides challenges to all operational teams. Nevertheless, the combined efforts of the geographically dispersed Spitzer teams ensure that the observatory’s instrumental and observational capabilities remain either undiminished or improved, and the high overall science data collection efficiency remains nearly unchanged. In this contribution, we outline several operational changes, innovations, and optimizations that have both minimized the impact of the growing distance on data transmission and enhanced the precision of data acquired by the science instruments. Though faced with diminishing budgetary resources that reduced staffing and allowed fewer upgrades of aging equipment, extended mission operations can provide an opportunity to acquire extensive science at bargain prices. The spacecraft, ground, and mission operations systems and procedures to perform the extended mission are already in place from the prime mission. The key to maintaining successful extended operations is the proper automation, modification and process enhancement of extant prime mission capabilities and procedures to maximize science return with acceptable risk as opposed to the creation of new capabilities. Spitzer’s successful optimization of existing operational capabilities and the associated lessons learned that have gone into maximizing the lifetime well into its second decade of operation will hopefully provide guidelines for future missions, as it continues to make important contributions to the field of astrophysics, including the recent, highly significant discovery and characterization of exoplanets in the TRAPPIST-1 system

Spitzer Space Telescope: Innovations and Optimizations in the Extended Mission Era

NASA’s Spitzer Space Telescope continues to operate well past its original cryogenic mission concept (2003-2009), executing both a follow-on “Warm” mission (2009-2016) and the current “Beyond” (2016-present) mission phase. As Spitzer’s unique Earth-trailing orbit carries it ever further from us (now surpassing 1.6 astronomical unit), its orbital geometry provides challenges to all operational teams. Nevertheless, the combined efforts of the geographically dispersed Spitzer teams ensure that the observatory’s instrumental and observational capabilities remain either undiminished or improved, and the high overall science data collection efficiency remains nearly unchanged. In this contribution, we outline several operational changes, innovations, and optimizations that have both minimized the impact of the growing distance on data transmission and enhanced the precision of data acquired by the science instruments. Though faced with diminishing budgetary resources that reduced staffing and allowed fewer upgrades of aging equipment, extended mission operations can provide an opportunity to acquire extensive science at bargain prices. The spacecraft, ground, and mission operations systems and procedures to perform the extended mission are already in place from the prime mission. The key to maintaining successful extended operations is the proper automation, modification and process enhancement of extant prime mission capabilities and procedures to maximize science return with acceptable risk as opposed to the creation of new capabilities. Spitzer’s successful optimization of existing operational capabilities and the associated lessons learned that have gone into maximizing the lifetime well into its second decade of operation will hopefully provide guidelines for future missions, as it continues to make important contributions to the field of astrophysics, including the recent, highly significant discovery and characterization of exoplanets in the TRAPPIST-1 system