Business forecasting methods: Impressive advances, lagging implementation

Reliable forecasts are key to decisions in areas ranging from supply chain management to capacity planning in service industries. It is encouraging then that recent decades have seen dramatic advances in forecasting methods which have the potential to significantly increase forecast accuracy and improve operational and financial performance. However, despite their benefits, we have evidence that many organizations have failed to take up systematic forecasting methods. In this paper, we provide an overview of recent advances in forecasting and then use a combination of survey data and in-depth semi-structured interviews with forecasters to investigate reasons for the low rate of adoption. Finally, we identify pathways that could lead to the greater and more widespread use of systematic forecasting methods.

Saliva-based SARS-CoV-2 serology using at-home collection kits returned via mail

Serology provides tools for epidemiologic studies, and may have a role in vaccine prioritization and selection. Automated serologic testing of saliva, especially specimens that are self-collected at home and sent to a laboratory via the mail without refrigeration, could be a highly-scalable strategy for population-wide testing. In this prospective study, non-vaccinated patients were recruited after PCR testing to self-collect saliva and return their specimens via mail. Longitudinal specimens were analyzed in order to monitor seroconversion in the weeks after a diagnostic PCR test for SARS-CoV-2. Diverse users self-collected saliva and returned specimens via mail in compliance with shipping regulations. At our pre-established threshold (0.963 AU/mL), salivary IgG reactivity to full-length spike protein achieved 95.8% sensitivity and 92.4% specificity at 2–4 weeks after diagnostic testing, which is comparable to the typical sensitivity and specificity achieved for serum testing. Reactivity to N antigen also was detected with 92.6% sensitivity and 90.7% specificity at 4–8 weeks after diagnostic testing. Moreover, serologic testing for endemic coronaviruses performed in multiplex with SARS-CoV-2 antigens has the potential to identify samples that may require retesting due to effects of pre-analytical factors. The easy-to-use saliva collection kit, coupled with thresholds for positivity and methods of flagging samples for retest, provides a framework for large-scale serosurveillance of SARS-CoV-2.

Quantitative serology for SARS-CoV-2 using self-collected saliva and finger-stick blood

Convenient and widespread serology testing may alter the trajectory of the COVID-19 pandemic. This study seeks to leverage high-throughput, multiplexed serologic assays, which have been adopted as benchmarks for vaccine efficacy, to support large-scale surveys of SARS-CoV-2 immunity using finger-stick blood and/or saliva. Specifically, we optimized MSD’s serology assays, which were analytically validated for serum, to test self-collected finger-stick blood and saliva samples to identify prior infection. We show that these assays can be used with FDA-registered specimen collection devices to obtain quantitative measurements for self-collected samples. First, we show that salivary antibodies are stable without refrigeration or preservatives for at least 5 days. We selected classification thresholds for antibodies against SARS-CoV-2 N, RBD and Spike in finger-stick blood and saliva that provided 98% specificity in a set of individuals without known COVID-19 exposure. Using matched samples, we show that testing of saliva and finger-stick blood equivalently identified individuals with humoral responses to CoV-2 antigens. Moreover, we piloted a simple saliva collection kit that can be used to safely send samples through the mail using written instructions only. This work establishes key parameters to robustly assay self-collected finger-stick blood and saliva using quantitative immunoassays that could support large-scale serology testing.

Abstract SP054: Obesity and Breast Cancer: Body Composition, Metabolic Mediators and Inflammation

Obesity has been associated with an increased risk of postmenopausal breast cancer (predominantly ER+), as well as triple negative premenopausal breast cancer. It has also been associated with an increased risk of breast cancer distant recurrence and death, regardless or menopausal status or IHC defined breast cancer subtype. Obesity effects on recurrence and death are modest, with HRs for either outcome approximating 1.3. Obesity is linked to metabolic alterations that include insulin resistance (with associated high insulin and reduced glucose tolerance), altered lipids and adipokines, hypertension, central obesity, inflammation and increased risks of type 2 diabetes (T2DM) and cardiovascular disease - this constellation of attributes comprises the insulin resistance or metabolic syndrome. There is growing appreciation that BMI [weight (kg)/height (m)2] ≥ 30 kg/m2 is an imperfect measure of both body composition and underlying metabolic status. Recent research has focused on body composition (e.g. central obesity/sarcopenic obesity) and metabolic health (“healthy” obese, “unhealthy” normal weight) as predictors of breast cancer outcomes. Many of the inter-related physiologic changes associated with obesity (including higher levels of insulin, glucose, altered adipokines and, less consistently, circulating inflammatory factors) have individually been associated with increased breast cancer risk and/or poor breast cancer outcomes. These circulating factors, and obesity per se, have, in turn, been associated with changes in breast tissue and tumor micro-environment, including crown-like structures (dying adipocytes surrounded by inflammatory cells) as well as increased infiltration of inflammatory cells, cytokines and chemokines - all of which have been linked to cancer risk and progression in preclinical and/or clinical research. Evidence linking obesity/body composition, circulating obesity-associated physiologic and inflammatory factors to breast cancer outcomes will be discussed as will interventions (notably weight loss, metformin) targeting these factors in breast cancer patients. Recent findings linking breast inflammation to obesity/obesity-associated physiology and breast cancer outcomes will be reviewed. The inter-relatedness of these factors and the likelihood that the breast cancer-obesity link is complex and multifactorial will be highlighted.

Citation Format: P Goodwin. Obesity and Breast Cancer: Body Composition, Metabolic Mediators and Inflammation [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP054.

Fungal Composition and Diversity of the Tobacco Leaf Phyllosphere During Curing of Leaves

Rhizopus oryzae causes tobacco pole rot in China during tobacco flue-curing. Flue-curing is a post-harvest process done to prepare tobacco leaves and involves three different stages: the yellowing stage has the lowest temperatures and highest humidity, then the color-fixing stage has higher temperatures and medium humidity, and finally the stem-drying stage has the highest temperatures and lowest humidity. In this study, fungal culturing and IonS5XL high-throughput sequencing techniques were used to reveal the fungal community of the petioles and lamina of tobacco leaves infected with pole rot during flue-curing. A total of 108 fungal isolates belonging to 6 genera were isolated on media. The most common fungal species isolated was the pathogen, R. oryzae, that was most often found equally on petioles and laminas in the color-fixing stage, followed by saprotrophs, mostly Aspergillus spp. High-throughput sequencing revealed saprotrophs with Alternaria being the most abundant genus, followed by Phoma, Cercospora, and Aspergillus, whereas Rhizopus was the tenth most abundant genus, which was mostly found on petioles at the yellowing stage. Both culturable fungal diversity and fungal sequence diversity was higher at stem-drying stage than the yellowing and color-fixing stages, and diversity was higher with leaf lamina than petioles revealing that the changes in fungal composition and diversity during the curing process were similar with both methods. This study demonstrates that the curing process affects the leaf microbiome of tobacco during the curing process, and future work could examine if any of these saprotrophic fungi detected during the curing of tobacco leaves may be potential biocontrol agents for with pole rot in curing chambers.

Volatile organic compound (VOC) emissions of CHO and T cells correlate to their expansion in bioreactors

Volatile organic compound (VOC) emissions were measured from Chinese Hamster Ovary (CHO) cell and T cell bioreactor gas exhaust lines with the goal of non-invasively metabolically profiling the expansion process. Measurements of cellular 'breath' were made directly from the gas exhaust lines using polydimethylsiloxane (PDMS)-coated magnetic stir bars, which underwent subsequent thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) analysis. Baseline VOC profiles were observed from bioreactors filled with only liquid media. After inoculation, unique VOC profiles correlated to cell expansion over the course of 8 d. Partial least squares (PLS) regression models were built to predict cell culture density based on VOC profiles of CHO and T cells (R ² = 0.671 and R ² = 0.769, respectively, based on a validation data set). T cell runs resulted in 47 compounds relevant to expansion while CHO cell runs resulted in 45 compounds; the 20 most relevant compounds of each cell type were putatively identified. On the final experimental days, sorbent-covered stir bars were placed directly into cell-inoculated media and into media controls. Liquid-based measurements from spent media containing cells could be distinguished from media-only controls, indicating soluble VOCs excreted by the cells during expansion. A PLS-discriminate analysis (PLS-DA) was performed, and 96 compounds differed between T cell-inoculated media and media controls with 72 compounds for CHO cells; the 20 most relevant compounds of each cell line were putatively identified. This work demonstrates that the volatilome of cell cultures can be exploited by chemical detectors in bioreactor gas and liquid waste lines to non-invasively monitor cellular health and could possibly be used to optimize cell expansion conditions 'on-the-fly' with appropriate control loop systems. Although the basis for statistical models included compounds without certain identification, this work provides a foundation for future research of bioreactor emissions. Future studies must move towards identifying relevant compounds for understanding of underlying biochemistry.

De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017

The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.

Descriptive analysis of a 1:1 physiotherapy outpatient intervention post primary lumbar discectomy: one arm of a small-scale parallel randomised controlled trial across two UK sites

OBJECTIVE

There is a lack of high-quality evidence for physiotherapy post lumbar discectomy. Substantial heterogeneity in treatment effects may be explained by variation in quality, administration and components of interventions. An optimised physiotherapy intervention may reduce heterogeneity and improve patient benefit. The objective was to describe, analyse and evaluate an optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy, to provide preliminary insights.

DESIGN

A descriptive analysis of the intervention embedded within an external pilot and feasibility trial.

SETTING

Two UK spinal centres.

PARTICIPANTS

Participants aged ≥18; post primary, single level, lumbar discectomy were recruited.

INTERVENTION

The intervention encompassed education, advice, mobility and core stability exercises, progressive exercise, and encouragement of early return to work/activity. Patients received ≤8 sessions for ≤8 weeks, starting 4 weeks post surgery (baseline).

OUTCOMES

Blinded outcome assessment at baseline and 12 weeks (post intervention) included the Roland Morris Disability Questionnaire. STarT Back data were collected at baseline. Statistical analyses summarised participant characteristics and preplanned descriptive analyses. Thematic analysis grouped related data.

FINDINGS

Twenty-two of 29 allocated participants received the intervention. STarT Back categorised n=16 (55%) participants 'not at low risk'. Physiotherapists identified reasons for caution for 8 (36%) participants, commonly risk of overdoing activity (n=4, 18%). There was no relationship between STarT Back and physiotherapists' evaluation of caution. Physiotherapists identified 154 problems (mean (SD) 5.36 (2.63)). Those 'not at low risk', and/or requiring caution presented with more problems, and required more sessions (mean (SD) 3.14 (1.16)).

CONCLUSIONS

Patients present differently and therefore require tailored interventions. These differences may be identified using clinical reasoning and outcome data.

TRIAL REGISTRATION NUMBER

ISRCTN33808269; post results.

Development of an optimised 1:1 physiotherapy intervention post first-time lumbar discectomy: a mixed-methods study

OBJECTIVES

To develop an optimised 1:1 physiotherapy intervention that reflects best practice, with flexibility to tailor management to individual patients, thereby ensuring patient-centred practice.

DESIGN

Mixed-methods combining evidence synthesis, expert review and focus groups.

SETTING

Secondary care involving 5 UK specialist spinal centres.

PARTICIPANTS

A purposive panel of clinical experts from the 5 spinal centres, comprising spinal surgeons, inpatient and outpatient physiotherapists, provided expert review of the draft intervention. Purposive samples of patients (n=10) and physiotherapists (n=10) (inpatient/outpatient physiotherapists managing patients with lumbar discectomy) were invited to participate in the focus groups at 1 spinal centre.

METHODS

A draft intervention developed from 2 systematic reviews; a survey of current practice and research related to stratified care was circulated to the panel of clinical experts. Lead physiotherapists collaborated with physiotherapy and surgeon colleagues to provide feedback that informed the intervention presented at 2 focus groups investigating acceptability to patients and physiotherapists. The focus groups were facilitated by an experienced facilitator, recorded in written and tape-recorded forms by an observer. Tape recordings were transcribed verbatim. Data analysis, conducted by 2 independent researchers, employed an iterative and constant comparative process of (1) initial descriptive coding to identify categories and subsequent themes, and (2) deeper, interpretive coding and thematic analysis enabling concepts to emerge and overarching pattern codes to be identified.

RESULTS

The intervention reflected best available evidence and provided flexibility to ensure patient-centred care. The intervention comprised up to 8 sessions of 1:1 physiotherapy over 8 weeks, starting 4 weeks postsurgery. The intervention was acceptable to patients and physiotherapists.

CONCLUSIONS

A rigorous process informed an optimised 1:1 physiotherapy intervention post-lumbar discectomy that reflects best practice. The developed intervention was agreed on by the 5 spinal centres for implementation in a randomised controlled trial to evaluate its effectiveness.

Natural course of pain and disability following primary lumbar discectomy: protocol for a systematic review and meta-analysis

INTRODUCTION

Knowledge about the natural clinical course is needed to improve understanding of recovery postsurgery as outcome is poor for some patients. Knowledge of the natural clinical course of symptoms and disability will inform optimal timing and the nature of rehabilitation intervention. The objective of this study is to provide first evidence synthesis investigating the natural clinical course of disability and pain in patients aged >16 years post primary lumbar discectomy.

METHODS AND ANALYSIS

A systematic review and data synthesis will be conducted. Prospective cohorts that include a well-defined inception cohort (point of surgery) of adult participants who have undergone primary lumbar discectomy/microdiscectomy will be included. Outcomes will include measurements reported on 1 or more outcomes of disability and pain, with a baseline presurgery measurement. Following development of the search strategy, 2 reviewers will independently search information sources, assess identified studies for inclusion, extract data and assess risk of bias. A third reviewer will mediate on any disagreement at each stage. The search will employ sensitive topic-based strategies designed for each database from inception to 31 January 2016. There will be no language or geographical restrictions. Risk of bias will be assessed using a modified QUality In Prognostic Studies (QUIPS) tool . Data will be extracted for time points where follow-up was at least 80%. Means and 95% CIs will be plotted over time for pain and disability. All results will be reported in the context of study quality.

ETHICS AND DISSEMINATION

This review will provide the first rigorous summary of the course of pain and disability across all published prospective cohorts. The findings will inform our understanding of when to offer and how to optimise rehabilitation following surgery. Results will be published in an open access journal. The study raises no ethical issues.

PROSPERO REGISTRATION NUMBER

CRD42015020806.

Image reconstruction for structured-illumination microscopy with low signal level

We report a new image processing technique for the structured illumination microscopy designed to work with low signals, with the goal of reducing photobleaching and phototoxicity of the sample. Using a pre-filtering process to estimate experimental parameters and total variation as a constraint to reconstruct, we obtain two orders of magnitude of exposure reduction while maintaining the resolution improvement and image quality compared to a standard structured illumination microscopy. The algorithm is validated on both fixed and live cell data with results confirming that we can image more than 15x more time points compared to the standard technique.

A randomized double-blind placebo-controlled cross-over trial of the impact on quality of life of continuing dexamethasone beyond 24 h following adjuvant chemotherapy for breast cancer

Uncertainty remains about the optimal anti-emetic regimen for control of delayed nausea and vomiting after adjuvant chemotherapy for breast cancer. Many patients receive dexamethasone but complain of insomnia, anxiety/agitation, and indigestion. The aim was to determine if patients receiving chemotherapy for breast cancer prefer treatment with dexamethasone or placebo for prophylaxis against delayed nausea and vomiting, and to compare quality of life (QOL) between the two treatments. In this randomized, double-blind, cross-over trial, we compared oral dexamethasone (4 mg twice daily for 2 days) versus placebo for chemotherapy-naïve patients with breast cancer. All patients received intravenous granisetron and dexamethasone pre-chemotherapy and oral granisetron on day 2. Primary endpoints were: (i) patient preference; (ii) difference between cycles in change of QOL from days 1 to 8. Median age of the 94 women was 51 years (range 27-76): 79 received fluorouracil/epirubicin/cyclophosphamide and 15 received doxorubicin/cyclophosphamide. Thirteen withdrew pre-cycle 2 with no differences between arms. Of 80 patients stating a preference, 31 preferred placebo (39 %, 95 % CI: 28-50 %) and 37 (46 %, 95 % CI: 35-58 %) preferred dexamethasone; 12 had no preference. There were no differences in intensity of vomiting, nausea, or time to onset of vomiting. There was greater decrease in global QOL (p = 0.06) when patients received dexamethasone. No other symptom/QOL domains differed significantly. In conclusion, no significant difference was found in patient preference, QOL, or symptoms regardless of whether dexamethasone or placebo was used after adjuvant chemotherapy.

Live cell imaging of yeast

The development of cloning vectors for green fluorescent protein (GFP) and the simplicity of yeast reverse genetics allow straightforward labeling of yeast proteins in living cells. Budding and fission yeast are therefore attractive organisms in which to study dynamic cellular processes such as growth, cell division, and morphogenesis using live cell fluorescence microscopy. This article focuses on methods to culture, mount, and observe budding yeast cells using three-dimensional (3D) microscopy, but the methods are broadly applicable to other types of cells and other imaging techniques. The emphasis is on 3D imaging, because yeast cells are roughly spherical, and most organelles in yeast move in three dimensions. Three-dimensional imaging also makes it possible to apply image restoration methods (e.g., deconvolution) to obtain sharper images with better definition. This is important, because yeast cells are small (haploid Saccharomyces cerevisiae cells have a diameter of ~4-5 µm) relative to the resolution of even the best optical microscope (~0.25 µm).

Abstract PD03-03: Metformin and Cancer Risk in Diabetic Patients: A Systematic Review and Meta-Analysis, with Special Emphasis to Breast Cancer

Background: Metformin (M), an insulin-lowering agent, has been associated with decreased cancer risk in epidemiological studies in diabetic patients in comparison with other antidiabetic treatments. Methods: We performed a comprehensive literature search and meta-analysis of epidemiological studies to assess the effect of M on cancer incidence and mortality in diabetic patients, using Pubmed, ISI-Web of Science (Science Citation Index Expanded), Embase, and the Cochrane library until June 2010, with no language or time restrictions. A manual search was also done for references cited in the selected articles, reviews or books. Published independent reports with sufficient information to allow adequate risk estimation of cancer risk/mortality and a corresponding measure of uncertainty after M use compared with other diabetic treatments were reviewed. Association between M and cancer incidence/mortality was computed as a summary relative risk (SRR) with 95% confidence intervals. Random effects models were applied to take into account heterogeneity. Sensitivity analyses were carried out to verify stability of the estimates. Publication bias was investigated using funnel plots and the Macaskill regression test.

Results: Eleven studies were selected for relevance in terms of intervention, population studied, independence and reporting of cancer incidence or mortality data, reporting 4042 cancer events and 529 cancer deaths. A significant 31% reduction (overall SRR=0.69, 95%CI, 0.61-0.79) was found in subjects taking M compared with other antidiabetic drugs. The protective effect was significant for pancreatic and hepatocellular cancer, and non-significant trends were noted for colon, and prostate and breast cancer (BC).

A non significant protective effect of M on BC incidence was found (SRR=0.75, 95% CI, 0.44-1.29; p for heterogeneity = 0.09, I2=59%). Conclusion: Among diabetics, M use is associated with a significant inverse association with any cancer incidence and a promising trend on BC incidence as compared with other diabetic treatments, including insulin. Further prospective studies of M as a cancer preventive agent are warranted.

For breast cancer, Libby et al (Diabetes Care 2009;32:1620-25) found a non-significant trend for a protective effect on M users vs. not users (HR=0.6, 0.32-1.10), whereas Currie et al (Diabetologia 2009;52:1766- 77) noted a weak trend when M was a concomitant treatment among glargine users vs. all other insulin regimens (HR=0.88, 0.48-1.63), or when metformin was given as a monotherapy vs. insulin-based regimens (HR=0.93, 0.69-1.27). No effect was found when M monotherapy was compared with sulphonylureas (HR=1.02, 0.71-1.45). Bodmer et al (Diabetes Care 2010;33:1304-8) found a significant protective effect (OR=0.44, 0.24-0.82) only with a long term use of M, defined as equal to approximately 5+ years. The SRR for M and BC risk is plotted in figure.

Obesity, Insulin Resistance and Insulin

There is growing acceptance that overweight and obesity are associated with poor outcomes in early stage breast cancer. This effect has been reported in pre-and postmenopausal women, regardless of hormone receptor status. Postulated mechanisms have included presentation of cancer at a more advanced stage, underdosing of chemotherapy and higher levels of endogenous estrogens in overweight and obese women. Recent research has provided strong evidence that insulin may play a key role in mediating these prognostic effects. Overweight and obesity are associated with insulin resistance (and resulting hyperinsulinemia) in both the general population and in breast cancer patients; both insulin resistance and high insulin levels have been associated with increased risk of breast cancer recurrence or death, independent of traditional prognostic factors. Breast cancer cells commonly overexpress insulin receptors (frequently a fetal form of the receptor that may hybridize with the IGF-1 receptor), providing a biologic basis for a prognostic effect of insulin. These receptors are not downregulated by circulating insulin; as a result, cancer cell growth may be stimulated by high circulating insulin levels, leading to poor prognosis. Preclinical work provides strong evidence for a mitogenic role of insulin in breast cancer. Taken together, these observations have led to the development of lifestyle interventions targeting insulin and/or insulin resistance in breast cancer patients. Interventions include weight loss (which reduces insulin levels in the general population) and physical activity (which has been shown to reduce insulin in breast cancer patients). Randomized trials of weight loss are ongoing and planned. One completed trial (Women's Intervention Nutrition Study, J Natl Cancer Inst 2006;98:1767-1776) reported improved relapse free survival in breast cancer patients randomized to a reduced fat diet (that was associated with significant weight loss). Effects were greatest in hormone receptor negative breast cancer. Recent interest has focused on the use of metformin, a biguanide commonly used to treat type 2 diabetes. Metformin reduces insulin resistance and lowers insulin levels in many populations, including early stage breast cancer patients. In addition to this indirect (insulin lowering) effect, metformin may also exert direct anti-tumor effects via mTOR inhibition. Studies using metformin in the neoadjuvant setting in breast cancer are ongoing. The effect of metformin on breast cancer outcomes (with embedded correlative studies that will examine direct and indirect effects of the drug) will be examined in NCIC MA.32, a randomized trial of metformin versus placebo involving 3582 women with early breast cancer that will be activated in early 2010. Together, these lifestyle and pharmacologic studies will provide important information on the effect of modification of a key host factor (obesity with associated hyperinsulinemia) on breast cancer outcomes.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr MS2-1.

Prognosis in BRCA1, BRCA2 associated breast cancer (BC): a prospective Breast Cancer Family Registry (BCFR) international population-based cohort study

Abstract #2072

Hereditary BC occurs at a younger age and is associated with more adverse tumor-related features than sporadic breast cancer (BC) (defined here as BC in those with no 1st or 2nd degree family history of breast or ovarian cancer). Using pre-specified criteria, we assembled a population-based cohort of newly diagnosed BC at 3 centers: Ontario, Canada (1996-98), San Francisco Bay area, USA (1995-2000), Melbourne/Sydney, Australia (1991-1998). Medical information was obtained from medical records; women were followed prospectively for recurrence, new cancers and death. Pathology data were obtained from central review or pathology reports. BRCA1 and BRCA2 mutation testing was performed on 77% and 70% of cases, respectively (sporadic BC cases were not tested at 2 centers). Hereditary and sporadic BC cases were compared using Cox proportional hazards (stratified by center). 3215 eligible cases were enrolled in the BCFR, with a mean age at diagnosis of 46.9 years. Median follow-up was 7.61 years; 565 women had distant recurrences and 547 died. There were 92 cases with BRCA1 and 72 with BRCA2 mutations; 1549 (48.2%) had sporadic BC; the remainder had familial BC as defined above. BRCA1 mutations were associated with young age, estrogen and progesterone receptor (ER and PgR) negativity and high grade; BRCA2 mutations were associated with node positivity and high grade. Distant disease-free survival (DDFS) and overall survival (OS) did not differ significantly between BRCA1 carriers and sporadic cases in univariate or multivariate analyses. DDFS and OS were worse in BRCA2 carriers than in sporadic cases (HR 1.6, p=0.04 and HR 1.8, p=0.01, respectively) in univariate analyses but not in multivariate analyses (DDFS HR 1.0, p=0.98; OS HR 1.13, p=0.61). The small group of BRCA2 carriers who did not receive adjuvant chemotherapy had a significantly worse OS (multivariate HR 3.63, p = 0.005). Furthermore, BRCA2 carriers who received adjuvant tamoxifen had significantly worse OS than women with sporadic BC (HR=2.0, p=0.03). We conclude that BRCA1 and BRCA2 mutations do not independently impact DDFS or OS. Significantly worse outcomes were seen in BRCA2 carrier subgroups defined by adjuvant treatment; this requires further investigation and may have implications for clinical practice.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2072.

Descriptive study on the lost productivity in breast cancer patients

6542

Background: There is a paucity of data assessing the potential impact of breast cancer diagnosis on the productivity of affected women. The objective was to identify and quantify lost productivity, health utilities and quality of life experienced in women diagnosed with breast cancer. Methods: A consecutive cross-sectional cohort of women with breast cancer (at any stage) attending outpatient clinics at Mount Sinai Hospital/Princess Margaret Hospital were eligible and consented to participate in the study. Women completed questionnaires assessing demographic and disease related information, work productivity and activity impairment utility (EQ5D VAS) and quality of life (FACT-B). Results: Data from 103 patients age 56.5 ± 11.9 years (mean +SD) were collection. Distribution of stage at diagnosis was as follows: 0 (31%), I (26%), II (10%), III (5%), IV (17%), unknown (11%). Time since diagnosis was 30.0 ± 39.1 months. Most women had recently been on active treatment for their breast cancer: chemotherapy (47%), hormone manipulation (23%), herceptin (6%), radiation (27%) and unknown (15%). 9% of women had metastatic disease, 35% had an income between $0 and $30,000. 58% of women were working full time for pay before their diagnosis, whereas only 19% were working full time for pay at the time of the assessment. At the time of the assessment, 18% were on disability leave. 8.7% of the women retired between the times of their diagnosis to the current assessment. Of those still working, a mean of 8.7 ± 11.6 days were missed from work in the previous 30 days due to problems related to breast cancer. The average number of days that employed patients actually worked (N=27) was 16.0 ± 9.0 days (range 4–30 days). 8% of patients required paid health care assistance during the past 4 weeks. 44% of patients had a spouse as an unpaid caregiver, followed by child/parent (20%) and friend (13%). Mean overall health rated by the respondents using the EQ5D VAS was 73.2 ± 16.3. The FACT-B mean was 68.0 ± 12.5 (range 27 to 98). Conclusion: Breast cancer negatively impacts work productivity and overall activity. The significant use of both paid and unpaid assistance would amount to significant societal costs which are currently not included in most cost-effectiveness analyses.

No significant financial relationships to disclose.

Evidence that TRPC4 supports the calcium selective I(CRAC)-like current in human gingival keratinocytes

We previously demonstrated that high external [Ca(2+)] activated two Ca(2+) currents in human gingival keratinocytes (HGKs): an initial small I(CRAC)-like current and a second large nonspecific cation current (Fatherazi S, Belton CM, Cai S, Zarif S, Goodwin PC, Lamont RJ, Izutsu KT; Pflugers Arch 448:93-104, 2004). It was recently shown that TRPC1, a member of the transient receptor potential protein family, is a component of the store-operated calcium entry mechanism in keratinocytes. To further elucidate the molecular identity of these channels, we investigated the expression of TRPC4 in gingival tissue and in cultured keratinocytes, and the effect of knockdown of TRPC4 expression on the Ca(2+) currents and influx. Immunohistochemistry showed TRPC4 was present in gingival epithelium as well as in HGKs cultured in different [Ca(2+)]s. Results from tissue and cultured HGKs demonstrated TRPC4 expression decreased with differentiation. Knockdown of TRPC4 in proliferating HGKs with antisense oligonucleotides significantly reduced the intracellular [Ca(2+)] increase obtained upon exposure to high external [Ca(2+)]. Antisense knockdown of TRPC4 expression was confirmed by reverse transcriptase polymerase chain reaction, Western blot, and immunofluorescence microscopy of transfected HGKs. Immunofluorescence microscopy and patch clamp measurements in Lucifer-yellow-tagged, antisense-treated HGKs showed attenuation of TRPC4 expression levels as well as attenuation of the I(CRAC)-like current in the same cell, whereas the large nonspecific cation current was unchanged but significantly delayed. Cells transfected with a scrambled TRPC4 oligonucleotide showed no change in either the I(CRAC)-like or nonspecific currents. The results indicate that TRPC4 is an important component of the I(CRAC)-like channel in HGKs.

Second consensus on medical treatment of metastatic breast cancer

The present consensus manuscript defines evidence-based recommendations for state-of-the-art treatment of metastatic breast cancer depending on disease-associated and biologic variables.

Aviation risk perception: a comparison between experts and novices

This article describes an exploratory investigation of the risk perceptions of experts and novices in relation to helicopter operations, under conditions where the participants are matched on various characteristics previously found to affect perceptions, such as demographic, gender, and background factors. The study reports considerable evidence of perceptual differences between the two participant groups (i.e., expert pilots and candidate pilots). We find that the experts' perceptions of relative risks are more veridical, in terms of their higher correlation with the true relative frequencies. A significant positive correlation between the flight hours and the contextual risk-taking tendency is also shown, leading the experienced pilots' choices toward risky alternatives in scenarios--a potential result of their overconfidence based on superior task performance. Possible explanations are offered for the findings and potential avenues for future research are identified.

PF-IND: probability algorithm and software for separation of plant and fungal sequences

The separation of plant and fungal sequences in EST pools by bioinformatic methods is difficult because of sequence similarities between plants and fungi, lack of enough sequence information, and the short length of the isolated fragments. An algorithm and software that utilize the differences in codon usage bias to discriminate between plant and fungal sequences are described. The software (PF-IND) includes five pairs of fungi and their host plants that can be used to analyze a large number of related species. Analysis of a sequence provides an arbitrary value that defines the likelihood that a sequence will be a fungal or a plant gene. The software can distinguish between homologous fungal and plant genes and it helps identify the correct reading frame of unknown expressed sequence tags (ESTs) for which BLAST analyses do not provide clear information. Short sequences of 100-150 bp can be analyzed with high confidence. PF-IND analysis of 100 sequences derived from fungal infected plants identified the origin of 94 sequences. Only 66 sequences were identified by a BLASTX analysis of the same 100 ESTs. Overall, PF-IND is a novel bioinformatic tool aimed at assisting the research of fungus-plant interactions.

A novel actin-related protein gene of Colletotrichum gloeosporioides f. sp. malvae shows altered expression corresponding with spore production

A novel actin-related protein (arp) was found in the plant pathogenic fungus, Colletotrichum gloeosporioides f. sp. malvae (Cgm), which causes anthracnose disease of round-leaved mallow (Malva pusilla). Sequence comparisons showed that this gene, arpA, belongs to the highly divergent 'other arps' category in the current arp classification system. ArpA is most similar to the arp11 gene of Mus musculus but has a unique structure with deletions at the C-terminus similar to that of the arp10 gene of Saccharomyces cerevisiae. A portion of another putative arp gene, arpB, was found immediately downstream of arpA. Expression of arpA was compared to the constitutively expressed Cgm actin gene, actA. In culture, the relative expression of arpA increased when growth conditions favored sporulation. During infection, arpA expression was greatest at the late necrotrophic phase, when sporulation occurred. Arps have been shown to be important in nuclear migration in fungal hyphae, and the expression pattern of arpA indicates that it may have a particular role during sporulation.

A prospective optical surface scanning and cephalometric assessment of the effect of functional appliances on the soft tissues

The aim of this study was to evaluate the effect of different functional appliances on the soft tissues as assessed by cephalometry and optical surface scanning. Forty-two patients were randomly allocated to Bass, Twin Block (TB), and Twin Block + Headgear (TB + Hg) groups. Lateral cephalograms and optical surface scans were recorded before and after the 10-month study period. ANOVA was used to test the cephalometric variables for differences at the 5 per cent level. The optical surface scanning and cephalometric results were consistent in the sagittal dimension. In the vertical dimension, however, the optical surface scans consistently recorded a greater increase compared with cephalometric values. No differences were detected with regard to cephalometric values at the 5 per cent level. However, the Bass appliance produced greater forward positioning of soft tissue pogonion as assessed by optical surface scanning.