Patient- and Tumor-Level Factors Impacting Chemotherapy Use and Effectiveness

Background: Chemotherapy efficacy is determined in clinical trial settings, which have limited representation of Black women. In clinical practice, there is more variation in how chemotherapy regimens are assigned and whether they are completed. Identifying factors related to chemotherapy receipt and cessation, as well as factors across which chemotherapy effectiveness may vary, may help to improve clinical outcomes among breast cancer patients.Methods: This project had three primary goals: 1) to describe real-world patterns of chemotherapy receipt and regimens in a diverse population of women with incident breast cancer, 2) to identify factors associated with cessation of chemotherapy, and 3) to explore the relationship between tumor biological characteristics and recurrence within chemotherapy treatment groups.Results: In Aim 1, both clinical characteristics and younger age at diagnosis were strongly associated with receipt of any chemotherapy and with receipt of anthracycline-inclusive regimens. There was not strong evidence of a relationship between race and receipt of chemotherapy. Next, an association was observed between both adjuvant and neoadjuvant chemotherapy regimens and early cessation of chemotherapy. There was also evidence that side effects were strongly associated with cessation of adjuvant chemotherapy. Within patient- and tumor-level characteristics, associations between these factors and cessation varied by chemotherapy regimen. Cessation of chemotherapy was associated with more breast cancer recurrence after treatment. In Aim 2, chemotherapy regimens were associated with recurrence. In unadjusted models, taxane-based treatment was associated with lower recurrence; however, after adjustment for features of disease aggressiveness, this relationship shifted and taxane-based treatment was associated with increased recurrence. Biological factors associated with DNA damage repair (p53, homologous recombination deficiency) were predictive of recurrence among women receiving anthracycline-inclusive regimens, but not among women receiving taxane-based regimens. The prognostic value of Ki-67 status did not vary by chemotherapy regimen.Conclusions: Chemotherapy receipt and cessation vary by some demographic characteristics. Effectiveness of chemotherapy may vary by adherence to treatment and by biological characteristics of the tumor.Doctor of Philosoph

Struktur och kultur gör en ny organisation levande - en fallstudie om hur organisationsstruktur och organisationskultur ter sig i en ny multiarena i södra Sverige

Syftet med denna uppsats är att undersöka hur en ny organisation tar form. Uppsatsen kommer att behandla de centrala faktorerna; struktur och kultur, och hur de kan påverkas genom medarbetarskap. Fokus läggs på processen att forma en ny organisation och vilken funktion de två faktorerna har i de inledande faserna av en organisations livcykel. Frågeställningarna är vilken betydelse får faktorerna struktur och kultur för processen att forma en ny organisation och hur påverkar medarbetarskap faktorerna struktur och kultur? Det är en kvalitativ studie med abduktivt förhållningsätt där empiriinsamlingen har skett genom sju semistrukturerade djupintervjuer med respondenter med olika kopplingar till fallstudien. Det har även utförts en deltagande observation under ett personalmöte. Slutsatserna blev att en ny organisation går igenom olika faser under dess första tid. Dessa faser är kopplade till organisationslivcykeln som skapar olika förutsättningar för organisationen gällande struktur och kultur. Struktur och kultur är två faktorer som skapas och anpassas av medarbetarna och har möjlighet att stärka en ny organisation. Ett utökat arbete kring medarbetarskap där relationen mellan ledaren och medarbetaren är i fokus kan vara ett verktyg för att bygga en hälsosam struktur och kultur i en organisation

Föräldrainvolvering vid samtal med minderåriga : En kvalitativ studie om kuratorers syn på föräldrainvolvering

Author: Linnea Olsson och Sandra Brandt Title: Föräldrainvolvering vid samtal med minderåriga Supervisor: Johan Cronehed Assessor: Anna Tegunimataka The aim of this study was to examine counselors approach to parental involvement in dialouge with adolescents in the age 13-17 years old. The main questions in this study was 1) what is counselors view on parental involvement? 2) what is the counselors approach towards the adolescents maturity and ability to manage their mental illness? 3) how do counselors work in the handling of adolescents mental illness and parental involvement? We interviewed two counselors within health care, two within the youth clinic and two school counselors in Scania (Skåne), which have been randomly selected. Partly the analysis is based on Pierre Bourdieus concepts about field and doxa. Most of the analysis is however based on Erik Eriksons and James Marcias theorys about identity. We found that counselours work differently with parental involvement and make individual assessments when parents should be contacted or not, unless the adolescent itself wants the counsleor to contact their parents. All the counselors could see something positive and something negative in parental involvement. Some conselors thought that parental involvement was the main focus, while some wanted to involve them as little as possible. This means that they have different kinds of doxa, and their work routine is different from each others. The adolescents are in a process where they have to find their own identity and be independent. They are still in need of adult support, but have to manage to take care of them self and begin their journey to the adult life. Key words: parental involvement, adolescents, counselors, separation-individuation, identit

Joint and individual analysis of breast cancer histologic images and genomic covariates

A key challenge in modern data analysis is understanding connections between complex and differing modalities of data. For example, two of the main approaches to the study of breast cancer are histopathology (analyzing visual characteristics of tumors) and genetics. While histopathology is the gold standard for diagnostics and there have been many recent breakthroughs in genetics, there is little overlap between these two fields. We aim to bridge this gap by developing methods based on Angle-based Joint and Individual Variation Explained (AJIVE) to directly explore similarities and differences between these two modalities. Our approach exploits Convolutional Neural Networks (CNNs) as a powerful, automatic method for image feature extraction to address some of the challenges presented by statistical analysis of histopathology image data. CNNs raise issues of interpretability that we address by developing novel methods to explore visual modes of variation captured by statistical algorithms (e.g. PCA or AJIVE) applied to CNN features. Our results provide many interpretable connections and contrasts between histopathology and genetics

Race-associated biological differences among luminal A and basal-like breast cancers in the Carolina Breast Cancer Study

Abstract Background We examined racial differences in the expression of eight genes and their associations with risk of recurrence among 478 white and 495 black women who participated in the Carolina Breast Cancer Study Phase 3. Methods Breast tumor samples were analyzed for PAM50 subtype and for eight genes previously found to be differentially expressed by race and associated with breast cancer survival: ACOX2, MUC1, FAM177A1, GSTT2, PSPH, PSPHL, SQLE, and TYMS. The expression of these genes according to race was assessed using linear regression and each gene was evaluated in association with recurrence using Cox regression. Results Compared to white women, black women had lower expression of MUC1, a suspected good prognosis gene, and higher expression of GSTT2, PSPHL, SQLE, and TYMS, suspected poor prognosis genes, after adjustment for age and PAM50 subtype. High expression (greater than median versus less than or equal to median) of FAM177A1 and PSPH was associated with a 63% increase (hazard ratio (HR) = 1.63, 95% confidence interval (CI) = 1.09–2.46) and 76% increase (HR = 1.76, 95% CI = 1.15–2.68), respectively, in risk of recurrence after adjustment for age, race, PAM50 subtype, and ROR-PT score. Log2-transformed SQLE expression was associated with a 20% increase (HR = 1.20, 95% CI = 1.03–1.41) in recurrence risk after adjustment. A continuous multi-gene score comprised of eight genes was also associated with increased risk of recurrence among all women (HR = 1.11, 95% CI = 1.04–1.19) and among white (HR = 1.14, 95% CI = 1.03–1.27) and black (HR = 1.11, 95% CI = 1.02–1.20) women. Conclusions Racial differences in gene expression may contribute to the survival disparity observed between black and white women diagnosed with breast cancer

The One- or Two- Way Route? : A quantitative study on the effects of one-way and two-way marketing communication on brand loyalty among members of loyalty programs in the beauty industry.

Marketing communication has been a widely researched area throughout recent years, due to the emergence of the internet. The different marketing communication channels used by customer loyalty programs in order to reach members efficiently, must be adapted to fit the consumer’s demand in order to deliver the message of the marketing actions. The marketing communication matrix claims that marketing communication can be divided into two perspectives, where one-way marketing communication is the communication actions that creates a monologue from a firm, and two-way marketing communication is the communicative action that creates a dialogue between companies and their loyal members. In order to test this, the communication channels for one-way communication have been identified as direct emails, text messages and catalogue send outs. The drivers of two-way communication have been further identified as tangible rewards, interpersonal communication and social media interaction. Thereby, the purpose of this study has been to test the effects of one-way marketing communication and two-way marketing communication on attitudinal loyalty and behavioral loyalty, among members of a loyalty program within the beauty industry. In addition, the effects of relationship quality have also been tested on brand loyalty. The findings have been applied foranalysis on the big cosmetics chain SEPHORA on their operations in Scandinavia. Therefore, the population has been found within Sweden and Denmark.Prior research has found that standardized, non-personalized marketing communication, which is often conducted via emails, led to brand loyalty. However, previous studies have also found that many of these emails remain unopened in the receiver’s inbox, and the content of the marketing action does not fulfill its marketing purpose. In addition, other existing literature claim that dialogical communication between firms and their customers increase customer satisfaction. A gap in the existing knowledge has therefore been found, as there are no studies conducted that focus on the effects of dialogical marketing communication on brand loyalty. In order to fulfill the purpose of this study, a quantitative research method has been utilized. Therefore, a web-based survey has been sent to active Facebook users, that had joined different beauty communities on this social media platform.Theregression analyses showed that the drivers of one-way marketing communication that had positive effects on attitudinal loyalty were direct emails and text messages. Further, the drivers of two-way marketing communication that had positive effects on attitudinal loyalty were interpersonal communication and social media interaction. Direct emails was the only driver of one-way communication that had a positive effect on behavioral loyalty, and other positive effects found was the drivers of two-way marketing communication, identified as interpersonal communication and social media interaction, on behavioral loyalty. The only driver of relationship quality that was found to have a positive effect on the two loyalty behaviors was relationship commitment. The conclusion of the study is that marketing communication in general has positive effects on both attitudinal loyalty and behavioral loyalty. However, as some drivers of marketing communication did not have any effect on brand loyalty, it is evident that firms must adapt their communication channels to fit their customer segments and to emerging technology. Practical recommendations were also presented for SEPHORA Scandinavia, which proposed that networks and communities should be the future targets in order to find the profitable customers

The One- or Two- Way Route? : A quantitative study on the effects of one-way and two-way marketing communication on brand loyalty among members of loyalty programs in the beauty industry.

Marketing communication has been a widely researched area throughout recent years, due to the emergence of the internet. The different marketing communication channels used by customer loyalty programs in order to reach members efficiently, must be adapted to fit the consumer’s demand in order to deliver the message of the marketing actions. The marketing communication matrix claims that marketing communication can be divided into two perspectives, where one-way marketing communication is the communication actions that creates a monologue from a firm, and two-way marketing communication is the communicative action that creates a dialogue between companies and their loyal members. In order to test this, the communication channels for one-way communication have been identified as direct emails, text messages and catalogue send outs. The drivers of two-way communication have been further identified as tangible rewards, interpersonal communication and social media interaction. Thereby, the purpose of this study has been to test the effects of one-way marketing communication and two-way marketing communication on attitudinal loyalty and behavioral loyalty, among members of a loyalty program within the beauty industry. In addition, the effects of relationship quality have also been tested on brand loyalty. The findings have been applied foranalysis on the big cosmetics chain SEPHORA on their operations in Scandinavia. Therefore, the population has been found within Sweden and Denmark.Prior research has found that standardized, non-personalized marketing communication, which is often conducted via emails, led to brand loyalty. However, previous studies have also found that many of these emails remain unopened in the receiver’s inbox, and the content of the marketing action does not fulfill its marketing purpose. In addition, other existing literature claim that dialogical communication between firms and their customers increase customer satisfaction. A gap in the existing knowledge has therefore been found, as there are no studies conducted that focus on the effects of dialogical marketing communication on brand loyalty. In order to fulfill the purpose of this study, a quantitative research method has been utilized. Therefore, a web-based survey has been sent to active Facebook users, that had joined different beauty communities on this social media platform.Theregression analyses showed that the drivers of one-way marketing communication that had positive effects on attitudinal loyalty were direct emails and text messages. Further, the drivers of two-way marketing communication that had positive effects on attitudinal loyalty were interpersonal communication and social media interaction. Direct emails was the only driver of one-way communication that had a positive effect on behavioral loyalty, and other positive effects found was the drivers of two-way marketing communication, identified as interpersonal communication and social media interaction, on behavioral loyalty. The only driver of relationship quality that was found to have a positive effect on the two loyalty behaviors was relationship commitment. The conclusion of the study is that marketing communication in general has positive effects on both attitudinal loyalty and behavioral loyalty. However, as some drivers of marketing communication did not have any effect on brand loyalty, it is evident that firms must adapt their communication channels to fit their customer segments and to emerging technology. Practical recommendations were also presented for SEPHORA Scandinavia, which proposed that networks and communities should be the future targets in order to find the profitable customers