Genomic Predictor Of Residual Risk Of Recurrence After Chemotherapy In High Risk Estrogen Receptor Positive Breast Cancers

Gene signature based prognostic tests can help improve adjuvant treatment decisions in early stage estrogen receptor positive (ER) breast cancers. Available tests in the clinic include Oncotype DX recurrence score (RS), PAM50 molecular class, and the Genomic Grade Index (GGI), which can identify high risk tumors that are likely to recur and have less favorable survival when treated with surgery and endocrine therapy alone. These high risk patients are recommended to also receive chemotherapy to improve their chance of survival. A subset of these high risk tumors is highly sensitive to adjuvant chemotherapy due to their high proliferation rates, and will be cured. We hypothesized that a new gene signature test ACES, which predicts treatment sensitivity to both endocrine therapy and chemotherapy and identifies tumors with excellent distant relapse free survival (RFS), could further stratify the currently high risk ER positive cancers into two groups: ACES predicted low and high residual risk after chemotherapy. This is a retrospective cohort study, and samples size and power are limited by the number of available specimens. Three independent ER positive breast cancer cohorts - ACES Discovery Cohort (n=176), ACES Validation Cohort 1 (n=123), and a new Validation Cohort 2 (n=127) - were used to assess the ability of ACES to identify patients who were initially considered to be high risk for recurrence (by high RS, Luminal B subtype by PAM50, or high GGI) but became low risk after receiving adjuvant chemotherapy. The ACES algorithm was applied to the baseline high risk groups and cases were re-stratified into ACES predicted treatment sensitive and treatment insensitive groups. RFS and absolute risk reduction (ARR) of relapse were the main outcome measures compared between the ACES stratified groups. In all three cohorts, cases that were high risk at baseline but predicted to be treatment sensitive by ACES showed a trend toward improved RFS. Cases with high risk by Oncotype DX high RS showed significant difference in RFS by ACES risk strata (p=0.048 and p=0.033) in validation cohort 1 and combined validation cohorts. Among these high RS tumors, n=11-13 (28-35%) were predicted to be treatment sensitive, which had RFS of 92-100% (95% CI: 54-100%) at 4-years. The ARR at 4-years was 0-41% (95% CI: -21-60%) and increased by 10-years to 19% (95% CI: 3-30%) favoring the treatment sensitive groups. Cases with high GGI in the discovery cohort also showed significant differences in RFS by ACES risk strata (p=0.004); the 45 (50%) high GGI cases who were predicted to be treatment sensitive had a RFS of 81% (95% CI: 60-92%) with ARR of 23% (95% CI: -2-51%). For these high RS and high GGI tumors, ACES remained an independent predictor of RFS in multivariate Cox regression analysis including age, T-stage, and lymph node involvement at diagnosis (p=0.072 and 0.017 respectively). Among Luminal B cancers, ACES was significantly associated with RFS only in the multivariate model of both validation cohorts (p=0 and 0.013). This analysis provides evidence to suggest that ACES may further risk stratify high RS and high GGI tumors into low and high residual risk groups after adjuvant chemotherapy and endocrine therapy. The clinical relevance is that if ACES is adequately validated: (i) patients with low residual risk by ACES can be safely treated with current adjuvant chemotherapies and reassured, (ii) patients with high residual risk despite best current adjuvant chemotherapies could be encouraged to enter clinical trials that aim to improve the efficacy of current adjuvant therapies. Before ACES can be adopted for routine use it would require validation in an adequately powered prospective trial, and the results presented in this thesis suggest that future validation of the ACES algorithm as residual risk prediction tool should be pursued

Online Class Adaptation of Graduate and Post Graduate Students During the Covid-19 Pandemic in Bangladesh

Online class is defined as a mode of class conducted using electronic devices through the internet. There are various obstacles to adapting online classes smoothly. The objective of the study was to evaluate the adaptation of online classes of graduate and postgraduate students and to scrutinize the barriers and benefits of it. There are both primary and secondary data used in this study. The research was conducted from January - May of 2021 surveying a questionnaire of 890 samples. Some simple statistical tools; pie-chart, bar diagram and tables were used to analyze data and present the result. The findings showed poor connection; poor motivation; unreliable technology; limited timeframe of class; inappropriate support; and minimal course design were the limitations of online class and had limited benefits. The government and institutional authorities should take academic decisions focusing on the barriers. Keywords: Online Class, Covid-19 Pandemic, Online Platform, Barriers, Bangladesh DOI: 10.7176/EJBM/13-16-05 Publication date:August 31st 2021

Musical power and its effect on consumer decision making

The purpose of this article is to discuss a study which aimed to explore how musical power in advertising can affect decision making of young consumers toward advertised products and services. The method used for this study is an in-depth interview with three groups of experts which are advertisers, musicians and academicians.Participants for this approach is based on snowball sampling.This study applies Elaboration Likelihood Model (ELM) to view the process of decision making made by the young consumers.This study uses the thematic analysis to analyse the interview data.Findings show that musical power in advertising can influence the decision making mood in choosing a produc

Educational needs and awareness of pharmacy and medical students toward Halal medicine

Halal pharmaceuticals are medicines permitted by Shariah law, and refers to medicines that do not contain any parts of animals that are categorised as haram (dogs, pigs, and ones with pointed teeth), alcohol, and other substances/preparations/extraction methods that are prohibited as ‘haram’ under Shariah law.(1

The effect of rating errors towards the effectiveness of performance appraisal

The aim of this research is to study the effect of rating errors towards the effectiveness of performance appraisal. The organization that is chosen for this study is one of the state secretaries in Malaysia. Interview is used to collect all of the required data. This research studies the informants knowledge on rating errors, the effect of halo effect, leniency and central tendency towards the effectiveness of performance appraisal and ways that could be taken to solve and prevent rating errors. The findings of this study state that rating errors such as halo effect, leniency and central tendency has a negative effect towards the effectiveness of performance appraisal. Some recommendations that have been identified are to conduct training to the raters in the organization so that they would have a full understanding about rating errors and take steps of measurements to avoid rating biases and inaccuracies. Employee feedback is also another way to avoid rating errors because employees can give their opinions and comments on their rating results. The raters can know the reason why the employees perform or not perform a particular act. Future researchers can use the information and findings of the errors mentioned in this study to continue conducting study on those errors for more helpful results. In conclusion, this research would benefit the employees and the organization because rating errors only bring more harm than good. The avoidance of rating errors would lead the employees to increase the organization’s productivity because they would be satisfied with their evaluation results, thus increase their effort to bring more benefit to the organization

Pre-Service Science Teachers’ Scientific Reasoning Competencies: Analysing the Impact of Contributing Factors

Scientific reasoning competencies (SRC) are one part of science teachers’ professional competencies. This study examines the contribution of three factors to the development of pre-service science teachers’ SRC: the amount of science education classes, the amount of science classes and the pre-service science teachers’ age. The factors amount of science education classes and amount of science classes have been operationalised in terms of ECTS credit points. N = 438 pre-service science teachers from six universities in Germany, Chile and Canada voluntarily and anonymously responded to an established multiple-choice instrument for assessing SRC, which has been developed by the authors and is available in German, Spanish and English. Multiple linear regression analyses show that the included factors explain a proportion of about 9% of the pre-service science teachers’ SRC. The factor amount of science classes is the only significant predictor and can be seen as an indicator of learning science content knowledge. These findings support the assumption of science content knowledge being a prerequisite for developing pre-service science teachers’ SRC

"I like the way the skin looks": Player perspectives on aesthetic appeal and self-representation with video game "Skins"

Microtransactions are the purchasing of in-game items in video games, often using real money. Through microtransactions, game players can obtain a type of cosmetic called 'skins' that change the physical appearance of playable characters. Considering the default 'skin' in many games is that of a white male, there are various psychosocial and economic costs that may be extended to players of color when attempting to select skins for their avatars. To examine how players of different racial and ethnic backgrounds interact with 'skins,' and the additional costs associated with them, we conducted a survey asking participants about their spending patterns with 'skins' and reasons for choosing certain 'skins' over others. The most common response from participants when asked why they select their skins was 'because I like the way the skin looks.' As this statement is broad, we delve into other results from our survey and previous studies by other scholars to analyze what this response may be able to tell us about players who selected this as their answer

Multi-hazard groundwater risks to water supply from shallow depths: challenges to achieving the sustainable development goals in Bangladesh

Background: Groundwater currently provides 98% of all drinking-water supply in Bangladesh. Groundwater is found throughout Bangladesh but its quality (i.e. arsenic and salinity contamination) and quantity (i.e., water-storage depletion) vary across hydrological environments, posing unique challenges to certain geographical areas and population groups. Yet, no national-scale, multi-parameter groundwater hazard maps currently exist enabling water resources managers and policy makers to identify vulnerable areas to public health. Methods: We develop, for the first time, groundwater multi-hazard maps at the national scale of Bangladesh combining information on arsenic, salinity and water storage. We apply geospatial techniques in ‘R’ programming language and ArcGIS environment, linking hydrological indicators for water quality and quantity to construct risk maps. A range of socio-economic variables including access to drinking and irrigation water supplies and social vulnerability (i.e., poverty) are overlaid on these risk maps to estimate exposures. Results: Our multi-parameter groundwater hazard maps show that a considerable proportion of land area (5% to 24% under extremely-high to high risks) in Bangladesh is currently under combined risk of arsenic and salinity contamination, and groundwater-storage depletion. As small as 6.5 million (2.2 million poor) to 24.4 million (8.6 million poor) people are exposed to a combined risk of high arsenic, salinity and groundwater-storage depletion. Conclusions: Our groundwater hazard maps reveal areas and exposure of population groups to water risks posed by arsenic and salinity contamination and depletion of water storage. These geospatial hazard maps can potentially guide policymakers in prioritizing mitigation and adaptation measures in order to achieve the United Nation’s Sustainable Development Goals across the water, agriculture and public health sectors in Bangladesh