Long-Term Follow-Up of Cardiac Function and Quality of Life for Patients in NSABP Protocol B-31/NRG Oncology: A Randomized Trial Comparing the Safety and Efficacy of Doxorubicin and Cyclophosphamide (AC) Followed by Paclitaxel With AC Followed by Paclitaxel and Trastuzumab in Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2

Purpose Early cardiac toxicity is a risk associated with adjuvant chemotherapy plus trastuzumab. However, objective measures of cardiac function and health-related quality of life are lacking in long-term follow-up of patients who remain cancer free after completion of adjuvant treatment. Patients and Methods Patients in NSABP Protocol B-31 received anthracycline and taxane chemotherapy with or without trastuzumab for adjuvant treatment of node-positive, human epidermal growth factor receptor 2–positive early-stage breast cancer. A long-term follow-up assessment was undertaken for patients who were alive and disease free, which included measurement of left ventricular ejection fraction by multigated acquisition scan along with patient-reported outcomes using the Duke Activity Status Index (DASI), the Medical Outcomes Study questionnaire, and a review of current medications and comorbid conditions. Results At a median follow-up of 8.8 years among eligible participants, five (4.5%) of 110 in the control group and 10 (3.4%) of 297 in the trastuzumab group had a \u3e 10% decline in left ventricular ejection fraction from baseline to a value \u3c 50%. Lower DASI scores correlated with age and use of medications for hypertension, cardiac conditions, diabetes, and hyperlipidemia, but not with whether patients had received trastuzumab. Conclusion In patients without underlying cardiac disease at baseline, the addition of trastuzumab to adjuvant anthracycline and taxane-based chemotherapy does not result in long-term worsening of cardiac function, cardiac symptoms, or health-related quality of life. The DASI questionnaire may provide a simple and useful tool for monitoring patient-reported changes that reflect cardiac function

Polyamorous Families – Parenting Practice, Stigma and Social Regulation

As a response to the greater visibility of alternative relationship and family forms, polyamory (i.e. the practice of consensual multi-partner relationships) has recently moved to the centre of public media attention. Questions of polyamory have emerged as a major concern within law, social policy, family sociology, gender and sexuality studies. Yet certain core issues have remained underexplored. This includes the distinctive nature of polyamorous intimacy, the structure of poly household formations and the dynamics of care work within poly families. In particular, poly parenting has been subject to tabooisation and scandalisation. Governing bodies, the judiciary and educational institutions have remained largely ignorant of polyamorous relationships. Research documents the exclusions of poly families (and individuals) from access to legal provisions and protections and their common discrimination in the courts, namely in custody cases. It further highlights the discrimination of polyidentified adolescents in school and college settings and the predicament that poly families face when interacting with public institutions (including schools and kindergardens). Insights into parenting practices and the organisation of childcare is vital for understanding the transformative potential of polyamorous ways of relating. It is also important for challenging the common demonisation and stigmatisation of polyamory within conservative family politics that perceives polyamory exclusively from a harm perspective. This paper will review and critically analyse existing research on poly parenting focussing on three dimensions: (a) parenting practices, (b) social and legal discrimination, and (c) parental response to stigmatisation. The paper argues for a stronger incorporation of queer perspectives within the guiding frameworks of research into parenting in consensually non-monogamous and polyamorous relationships to highlight the transformative potential of the ‘queer bonds’ that sustain many of these practices

Performance Standards and Employee Effort: Evidence from Teacher Absences

The 2001 No Child Left Behind Act (NCLB) increased accountability pressure in U.S. public schools by threatening to impose sanctions on Title 1 schools that failed to make adequate yearly progress (AYP) in consecutive years. Difference-in-difference estimates of the effect of failing AYP in the first year of NCLB on teacher effort in the subsequent year suggest that, on average, teacher absences in North Carolina fell by about 10 percent, and the probability of being absent 15 or more times fell by about 30 percent. Reductions in teacher absences were driven by within-teacher increases in effort and were larger among more effective teachers