Parity, age at first childbirth and the prognosis of primary breast cancer.

Reproductive factors are known to be aetiologically important in breast cancer, but less is known regarding their effect on breast cancer prognosis. We have investigated the prognostic effect of age at first birth and total parity using data from the Danish Breast Cancer Cooperative Group that, since 1977, has collected population-based information on tumour characteristics, treatment regimes and follow-up status on Danish women with breast cancer. Details of pregnancy history were added from the Danish Civil Registration System and the National Birth Registry. Included in the study were 10,703 women with primary breast cancer. After adjusting for age and stage of disease (tumour size, axillary nodal status and histological grading), the number of full-term pregnancies was found without prognostic value. However, women with primary childbirth between 20 and 29 years experienced a significantly reduced risk of death compared with women with primary childbirth below the age of 20 years [20-24 years: relative risk (RR) = 0.88, 95% confidence interval (CI) 0.78-0.99; 25-29 years: RR = 0.80, 95% CI 0.70-0.91]. Further adjustment for oestrogen receptor status did not influence these results. The effect was not modified by age at diagnosis, tumour size or nodal status. In conclusion, low age at first childbirth, but not parity, was associated with a poor prognosis of breast cancer. We speculate whether women who develop breast cancer despite an early first full-term pregnancy might represent a selected group with a more malignant disease

An Infrastructure for Cost-Effective Testing of Operational Support Algorithms Based on Colored Petri Nets

Operational support is a specific type of process mining that assists users while process instances are being executed. Examples are predicting the remaining processing time of a running insurance claim and recommending the action that minimizes the treatment costs of a particular patient. Whereas it is easy to evaluate prediction techniques using cross validation, the evaluation of recommendation techniques is challenging as the recommender influences the execution of the process. It is therefore impossible to simply use historic event data. Therefore, we present an approach where we use a colored Petri net model of user behavior to drive a real workflow system and real implementations of operational support, thereby providing a way of evaluating algorithms for operational support before implementation and a costly test using real users. In this paper, we evaluate algorithms for operational support using different user models. We have implemented our approach using Access/CPN 2.0

Testicular cancer risk and maternal parity: a population-based cohort study.

The aim was to study, in a population-based cohort design, whether first-born sons run a higher risk of testicular cancer than later born sons; to investigate whether this difference in risk was affected by birth cohort, age of the son, maternal age, interval to previous delivery and other reproductive factors; and, finally, to evaluate to what extent changes in women's parity over time might explain the increasing incidence of testicular cancer. By using data from the Civil Registration System, a database was established of all women born in Denmark since 1935 and all their children alive in 1968 or born later. Sons with testicular cancer were identified in the Danish Cancer Registry. Among 1015994 sons followed for 15981 967 person-years, 626 developed testicular cancer (443 non-seminomas, 183 seminomas). Later born sons had a decreased risk of testicular cancer (RR = 0.80, 95% CI = 0.67-0.95) compared with first-born sons. The RR was 0.79 (95% CI = 0.64-0.98) for non-seminomas and 0.81 (95% CI = 0.58-1.13) for seminomas. There was no association between testicular cancer risk and overall parity of the mother, maternal or paternal age at the birth of the son, or maternal age at first birth. The decreased risk of testicular cancer among later born sons was not modified by age, birth cohort, interval to the previous birth, sex of the first-born child, or maternal age at birth of the son or at first birth. The increased proportion of first-borns from birth cohort 1946 to birth cohort 1969 only explained around 3% of an approximated two-fold increase in incidence between the cohorts. Our data document a distinctly higher risk of testicular cancer in first-born compared with later born sons and suggest that the most likely explanation should be sought among exposures in utero. The increase in the proportion of first-borns in the population has only contributed marginally to the increase in testicular cancer incidence

Consumption caught in the cash nexus.

During the last thirty years, ‘consumption’ has become a major topic in the study of contemporary culture within anthropology, psychology and sociology. For many authors it has become central to understanding the nature of material culture in the modern world but this paper argues that the concept is, in British writing at least, too concerned with its economic origins in the selling and buying of consumer goods or commodities. It is argued that to understand material culture as determined through the monetary exchange for things - the cash nexus - leads to an inadequate sociological understanding of the social relations with objects. The work of Jean Baudrillard is used both to critique the concept of consumption as it leads to a focus on advertising, choice, money and shopping and to point to a more sociologically adequate approach to material culture that explores objects in a system of models and series, ‘atmosphere’, functionality, biography, interaction and mediation

An Optical Lattice Clock with Spin-polarized 87Sr Atoms

We present a new evaluation of an 87Sr optical lattice clock using spin polarized atoms. The frequency of the 1S0-3P0 clock transition is found to be 429 228 004 229 873.6 Hz with a fractional accuracy of 2.6 10^{-15}, a value that is comparable to the frequency difference between the various primary standards throughout the world. This measurement is in excellent agreement with a previous one of similar accuracy

The effect of bundling medication-assisted treatment for opioid addiction with mHealth: study protocol for a randomized clinical trial

Completed SPIRIT figure. (PDF 103 kb

Making optical atomic clocks more stable with 10−1610^{-16} level laser stabilization

The superb precision of an atomic clock is derived from its stability. Atomic clocks based on optical (rather than microwave) frequencies are attractive because of their potential for high stability, which scales with operational frequency. Nevertheless, optical clocks have not yet realized this vast potential, due in large part to limitations of the laser used to excite the atomic resonance. To address this problem, we demonstrate a cavity-stabilized laser system with a reduced thermal noise floor, exhibiting a fractional frequency instability of $2 \times 10^{-16}$. We use this laser as a stable optical source in a Yb optical lattice clock to resolve an ultranarrow 1 Hz transition linewidth. With the stable laser source and the signal to noise ratio (S/N) afforded by the Yb optical clock, we dramatically reduce key stability limitations of the clock, and make measurements consistent with a clock instability of $5 \times 10^{-16} / \sqrt{\tau}$