| 1. |
- Çakanlar, Aylin, 1991-, et al.
(författare)
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How economic system justification shapes demand for peer-to-peer providers
- 2023
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Ingår i: Journal of Consumer Pshychology. - : John Wiley & Sons. - 1057-7408 .- 1532-7663. ; 33:3, s. 602-612
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Tidskriftsartikel (refereegranskat)abstract
- With the proliferation of peer-to-peer (P2P) exchanges in the marketplace, understanding which consumer factors drive demand for P2P providers is important. We examine the role of consumers' economic system justification (ESJ) beliefs (about the fairness of existing economic arrangements and outcomes), which, despite their growing salience in the marketplace, have been overlooked in extant P2P research. We show that high (vs. low) ESJ increases consumers' interest in purchasing from P2P providers because it heightens perceptions of these providers' entrepreneurial spirit. The effect emerges in the laboratory and in the field with measured and manipulated ESJ, and it is attenuated for traditional commercial providers. The findings offer novel insights and implications for practice and emerging research on P2P exchanges, system justification, and ideological consumption more broadly.
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| 2. |
- Galozy, Alexander, 1991-, et al.
(författare)
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Prediction and pattern analysis of medication refill adherence through electronic health records and dispensation data
- 2020
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Ingår i: Journal of Biomedical Informatics: X. - New York, NY : Elsevier. - 2590-177X .- 1532-0464. ; 6-7
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Tidskriftsartikel (refereegranskat)abstract
- Background and purposeLow adherence to medication in chronic disease patients leads to increased morbidity, mortality, and healthcare costs. The widespread adoption of electronic prescription and dispensation records allows a more comprehensive overview of medication utilization. In combination with electronic health records (EHR), such data provides new opportunities for identifying patients at risk of nonadherence and provide more targeted and effective interventions. The purpose of this article is to study the predictability of medication adherence for a cohort of hypertensive patients, focusing on healthcare utilization factors under various predictive scenarios. Furthermore, we discover common proportion of days covered patterns (PDC-patterns) for patients with index prescriptions and simulate medication-taking behaviours that might explain observed patterns.ProceduresWe predict refill adherence focusing on factors of healthcare utilization, such as visits, prescription information and demographics of patient and prescriber. We train models with machine learning algorithms, using four different data splits: stratified random, patient, temporal forward prediction with and without index patients. We extract frequent, two-year long PDC-patterns using K-means clustering and investigate five simple models of medication-taking that can generate such PDC-patterns.FindingsModel performance varies between data splits (AUC test set: 0.77–0.89). Including historical information increases the performance slightly in most cases (approx. 1–2% absolute AUC uplift). Models show low predictive performance (AUC test set: 0.56–0.66) on index-prescriptions and patients with sudden drops in PDC (Recall: 0.58–0.63). We find 21 distinct two-year PDC-patterns, ranging from good adherence to intermittent gaps and early discontinuation in the first or second year. Simulations show that observed PDC-patterns can only be explained by specific medication consumption behaviours.ConclusionsPrediction models developed using EHR exhibit bias towards patients with high healthcare utilization. Even though actual medication-taking is not observable, consumption patterns may not be as arbitrary, provided that medication refilling and consumption is linked. © 2020 The Authors. Published by Elsevier Inc.
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| 3. |
- Gorbach, Tetiana, 1991-, et al.
(författare)
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Contrasting Identifying Assumptions of Average Causal Effects : Robustness and Semiparametric Efficiency
- 2023
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Ingår i: Journal of machine learning research. - : Microtome Publishing. - 1532-4435 .- 1533-7928. ; 24:197, s. 1-65
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Tidskriftsartikel (refereegranskat)abstract
- Semiparametric inference on average causal effects from observational data is based on assumptions yielding identification of the effects. In practice, several distinct identifying assumptions may be plausible; an analyst has to make a delicate choice between these models. In this paper, we study three identifying assumptions based on the potential outcome framework: the back-door assumption, which uses pre-treatment covariates, the front-door assumption, which uses mediators, and the two-door assumption using pre-treatment covariates and mediators simultaneously. We provide the efficient influence functions and the corresponding semiparametric efficiency bounds that hold under these assumptions, and their combinations. We demonstrate that neither of the identification models provides uniformly the most efficient estimation and give conditions under which some bounds are lower than others. We show when semiparametric estimating equation estimators based on influence functions attain the bounds, and study the robustness of the estimators to misspecification of the nuisance models. The theory is complemented with simulation experiments on the finite sample behavior of the estimators. The results obtained are relevant for an analyst facing a choice between several plausible identifying assumptions and corresponding estimators. Our results show that this choice implies a trade-off between efficiency and robustness to misspecification of the nuisance models.
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| 4. |
- Hedlund, Jakob, 1991-, et al.
(författare)
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Student Nurse Anesthetists' and Supervisors' Perspectives of Learning in the Operating Room : An Integrative Review
- 2024
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 39:2, s. 303-310.e8
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Forskningsöversikt (refereegranskat)abstract
- PURPOSE: The purpose of this review was to identify supporting and hindering factors for student nurse anesthetists' (SNAs') learning in the operating room during clinical practice, from students' and supervisors' perspectives.DESIGN: An integrative review.METHODS: Systematic searches were conducted in Medline, Cinahl, PsycInfo, and ERIC. Search terms were related to nurse anesthetist, education, operating room context, and clinical setting. Searches were performed at three points in time and in total 1,530 unique articles were identified. After screening using Covidence and using Joanna Briggs Institute appraisal tools, 34 articles remained. These were analyzed inductively using a constant comparison method.FINDINGS: Supporting factors include preparation before clinical practice, clearly stated expectations, a respectful relationship with the supervisor, daily planning and communication, and constructive feedback. Hindering factors include lack of time, disruptive behavior from supervisors or other team members, and environmental factors such as a high room temperature and noisy environment.CONCLUSIONS: SNAs' learning situation in the operating room resembles undergraduate nurses' learning during clinical practice. Educators and supervisors can take several actions to promote SNAs' learning. Further research is warranted on the effect of teamwork on SNAs' learning.
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| 5. |
- Larsson, Hanna, 1991, et al.
(författare)
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“It’s a New Chapter Now”: Establishing Commitments in the Romantic Domain during Young Adulthood
- 2020
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Ingår i: Identity. - : Informa UK Limited. - 1528-3488 .- 1532-706X. ; 20:1, s. 37-57
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Tidskriftsartikel (refereegranskat)abstract
- This longitudinal study examines identity development in the domain of romantic relationships during young adulthood and what the process of establishing commitments without exploration in this domain involves. Identity status in the romantic relationships domain was assessed for 118 Swedish individuals at the ages of 29 and 33, using the Identity Status Interview. Identity diffusion was less common at age 33 than at age 29, whereas foreclosure, moratorium, and identity achievement were equally common at both ages. The majority of those assigned to identity diffusion at age 29 had transitioned to identity foreclosure by age 33. These nine participants were selected as a subsample for further analysis of the process of commitment-making, and changes in their identity narratives between age 29 (before establishing commitments) and age 33 (after establishing commitments) were examined using case-based thematic analysis. The results suggest that the commitment-making process involves changes in identity content, such as having more elaborate and positive views on romantic relationships, as well as changes related to identity processes, including narrating one’s experiences and views concerning romantic relationships in a more temporally integrated way.
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| 6. |
- Wallin, Nicole, 1991, et al.
(författare)
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Pregnancy-associated cardiovascular risks and postpartum care; an opportunity for interventions aiming at health preservation and disease prevention
- 2024
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Ingår i: Baillière's Best Practice & Research. - : Elsevier. - 1521-6934 .- 1532-1932. ; 92
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Tidskriftsartikel (refereegranskat)abstract
- Cardiovascular disease (CVD) is the leading cause of premature death and disability for female individuals around the world and the rates are increasing in those aged 35-44 years. Certain pregnancy complications (Pregnancy-associated Cardiovascular Risks (P-CVR))are linked to an increased risk of future CVD making pregnancy and the postpartum period as an ideal time to screen individuals for underlying, often unrecognized, cardiovascular risk factors. Pregnancy complications associated with an increased risk of future CVD including the hypertensive disorders of pregnancy, gestational diabetes, idiopathic preterm birth, delivery of a growth restricted baby and a placental abruption that leads to delivery. A number of guidelines and research groups recommend postpartum CVR screening, counseling and lifestyle intervention for all those who have had one or more of P-CVRs starting within the first six months postpartum. An individualized plan for postpartum screening should be created with the individual and lifestyle interventions discussed.
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| 7. |
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| 8. |
- Melander, Nils, 1989-, et al.
(författare)
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Non-surgical patient characteristics best predict outcome after 6 months in patients surgically treated for chronic subdural haematoma
- 2023
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Ingår i: Journal of clinical neuroscience. - : Elsevier. - 0967-5868 .- 1532-2653. ; 114, s. 151-157
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic subdural haematoma (CSDH) is one of the most common conditions encountered in neurosurgical practice. After surgery, the patients often improve dramatically; but their long-term outcome is more uncertain. The purpose of this study was to investigate predictors of outcome 6 months after surgery.METHODS: Retrospective data were collected on patients in Orebro County, Sweden, who had undergone surgery for CSDH at the Orebro University Hospital between 2013 and 2019. The outcomes were defined as favourable or unfavourable in terms of the modified Rankin Scale (mRS). A favourable outcome was defined as either mRS 0-2 or an unchanged mRS score in patients scoring 3-5 before surgery. From the variables in the data collected, a multiple logistic regression model was constructed.RESULTS: The study comprised 180 patients, of whom 134 (74.4%) were male. Median age was 79.2 years (IQR 71.7-85.5), and 129 (71.7%) patients had a favourable outcome at 6 months. In the group with an unfavourable outcome, 18 (10%) had died and 33 (18.3%) had either lost their independence in daily living or become somewhat less independent. The final multiple logistic regression model consisted of pre-surgery variables only: age (OR 0.92, 95% CI 0.87-0.97), CRP (OR 0.96, 95% CI 0.94-0.99), GCS > 13 (OR 3.66, 95% CI 1.09-12.3), Hb (OR 1.03, 95% CI 1.00-1.05), and ASA score < 3 (OR 2.58, 95% CI 0.98-6.79). The whole model had an AUC of 0.88.CONCLUSION: CSDH requiring surgery is associated with high morbidity and mortality at 6 months after surgery. Age, CRP, GCS, Hb and ASA score on admission for surgery are the variables that best predicts outcome. This knowledge can help to identify the patients at greatest risk for an unfavourable outcome, who may need additional support from the health care system.UNSTRUCTURED ABSTRACT: Chronic subdural haematoma (CSDH) is one of the most common conditions encountered in neurosurgical practice. After surgery, the patients often improve dramatically; but their long-term outcome is more uncertain. The purpose of this study was to investigate predictors of outcome, in terms of the modified Rankin Scale (mRS), 6 months after surgery. The study comprised 180 patients, of whom 134 (74.4%) were male. Median age was 79.2 years (IQR 71.7-85.5), and 129 (71.7%) patients had a favourable outcome at 6 months. In the group with an unfavourable outcome, 18 (10%) had died and 33 (18.3%) had either lost their independence in daily living or become somewhat less independent. The final multiple logistic regression model consisted of pre-surgery variables only: age (OR 0.92, 95% CI 0.87-0.97), CRP (OR 0.96, 95% CI 0.94-0.99), GCS > 13 (OR 3.66, 95% CI 1.09-12.3), Hb (OR 1.03, 95% CI 1.00-1.05), and ASA score < 3 (OR 2.58, 95% CI 0.98-6.79). The whole model had an AUC of 0.88. In conclusion, CSDH requiring surgery is associated with high morbidity and mortality at 6 months after surgery. Age, CRP, GCS, Hb and ASA score on admission for surgery are the variables that best predicts outcome. This knowledge can help to identify the patients at greatest risk for an unfavourable outcome, who may need additional support from the health care system.
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| 9. |
- Ménard, Delphine, et al.
(författare)
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Plant biomechanics and resilience to environmental changes are controlled by specific lignin chemistries in each vascular cell type and morphotype
- 2022
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Ingår i: The Plant Cell. - : Oxford University Press. - 1040-4651 .- 1532-298X. ; 34:12, s. 4877-4896
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Tidskriftsartikel (refereegranskat)abstract
- The biopolymer lignin is deposited in the cell walls of vascular cells and is essential for long-distance water conduction and structural support in plants. Different vascular cell types contain distinct and conserved lignin chemistries, each with specific aromatic and aliphatic substitutions. Yet, the biological role of this conserved and specific lignin chemistry in each cell type remains unclear. Here, we investigated the roles of this lignin biochemical specificity for cellular functions by producing single cell analyses for three cell morphotypes of tracheary elements, which all allow sap conduction but differ in their morphology. We determined that specific lignin chemistries accumulate in each cell type. Moreover, lignin accumulated dynamically, increasing in quantity and changing in composition, to alter the cell wall biomechanics during cell maturation. For similar aromatic substitutions, residues with alcohol aliphatic functions increased stiffness whereas aldehydes increased flexibility of the cell wall. Modifying this lignin biochemical specificity and the sequence of its formation impaired the cell wall biomechanics of each morphotype and consequently hindered sap conduction and drought recovery. Together, our results demonstrate that each sap-conducting vascular cell type distinctly controls their lignin biochemistry to adjust their biomechanics and hydraulic properties to face developmental and environmental constraints.
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| 10. |
- Wells, M. B., et al.
(författare)
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Partner and professional support are associated with father-infant bonding : A cross-sectional analysis of mothers, midwives, and child health nurses’ influence on primiparous and multiparous fathers of infants in Sweden
- 2024
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Ingår i: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 136
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess if received professional and social support are associated with father-infant bonding among primiparous (first-time) and multiparous (multi-time) fathers. Background: Early father-infant bonding predicts several positive child outcomes. However, while received professional and social support positively impacts fathers’ transition into parenthood, little research has tested if these factors are associated with a stronger father-infant bond. Methods: In total, 499 fathers (296 primiparous and 203 multiparous) of infants (aged 0–12 months) completed a cross-sectional online survey between November 2018 and March 2020. The survey included items related to socio-demographics, having a planned pregnancy, postnatal midwifery support, child health nurse support, child health center attendance, and social support. The parent-infant bonding questionnaire (PBQ) was used to assess the father-infant bond. Multiple linear regression models were estimated for the total sample and based on paternal parity. Missing data were managed through multiple imputation procedures. Findings: Fathers reported fewer bonding disturbances if they received support from their partners, postnatal midwives, child health nurses, and attended more child health visits. Primiparous fathers reported fewer bonding disturbances when receiving support from their partners, postnatal midwives, and the child health nurse. However, multiparous fathers had more bonding disturbances than primiparous fathers and received less professional and partner support. Conclusions: Receiving more partner and professional support is associated with less father-infant bonding disturbances. To encourage a better father-infant bond, clinicians should invite and support all fathers, regardless of parity, as they transition to parenthood. © 2024 The Authors
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| 11. |
- Aperia, Anita, et al.
(författare)
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Mending Fences : Na,K-ATPase signaling via Ca2+ in the maintenance of epithelium integrity
- 2020
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160 .- 1532-1991. ; 88
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Tidskriftsartikel (refereegranskat)abstract
- Na,K-ATPase is a ubiquitous multifunctional protein that acts both as an ion pump and as a signal transducer. The signaling function is activated by ouabain in non-toxic concentrations. In epithelial cells the ouabain-bound Na,K-ATPase connects with the inositol 1,4,5-trisphosphate receptor via a short linear motif to activate low frequency Ca2+ oscillations. Within a couple of minutes this ouabain mediated signal has resulted in phosphorylation or dephosphorylation of 2580 phospho-sites. Proteins that control cell proliferation and cell adhesion and calmodulin regulated proteins are enriched among the ouabain phosphor-regulated proteins. The inositol 1,4,5-trisphosphate receptor and the stromal interaction molecule, which are both essential for the initiation of Ca2+ oscillations, belong to the ouabain phosphor-regulated proteins. Downstream effects of the ouabain-evoked Ca2+ signal in epithelial cells include interference with the intrinsic mitochondrial apoptotic process and stimulation of embryonic growth processes. The dual function of Na,K-ATPase as an ion pump and a signal transducer is now well established and evaluation of the physiological and pathophysiological consequences of this universal signal emerges as an urgent topic for future studies.
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| 12. |
- Moparthi, Lavanya, et al.
(författare)
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Calcium activates purified human TRPA1 with and without its N-terminal ankyrin repeat domain in the absence of calmodulin
- 2020
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160 .- 1532-1991. ; 90
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Tidskriftsartikel (refereegranskat)abstract
- Extracellular influx of calcium or release of calcium from intracellular stores have been shown to activate mammalian TRPA1 as well as to sensitize and desensitize TRPA1 electrophilic activation. Calcium binding sites on both intracellular N- and C-termini have been proposed. Here, we demonstrate based on Förster resonance energy transfer (FRET) and bilayer patch-clamp studies, a direct calmodulin-independent action of calcium on the purified human TRPA1 (hTRPA1), causing structural changes and activation without immediate subsequent desensitization of hTRPA1 with and without its N-terminal ankyrin repeat domain (N-ARD). Thus, calcium alone activates hTRPA1 by a direct interaction with binding sites outside the N-ARD.
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| 13. |
- Moparthi, Lavanya, et al.
(författare)
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Human TRPA1 is an inherently mechanosensitive bilayer-gated ion channel
- 2020
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160 .- 1532-1991. ; 91
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Tidskriftsartikel (refereegranskat)abstract
- The role of mammalian Transient Receptor Potential Ankyrin 1 (TRPA1) as a mechanosensor is controversial. Here, we report that purified human TRPA1 (hTRPA1) with and without its N-terminal ankyrin repeat domain responded with pressure-dependent single-channel current activity when reconstituted into artificial lipid bilayers. The hTRPA1 activity was abolished by the thiol reducing agent TCEP. Thus, depending on its redox state, hTRPA1 is an inherent mechanosensitive ion channel gated by force-from-lipids.
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| 14. |
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| 15. |
- Theopold, Ulrich, et al.
(författare)
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TRP channels, the missing link for Ca2+ tuning by a unicellular eukaryotic parasite?
- 2021
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160 .- 1532-1991. ; 98
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Tidskriftsartikel (refereegranskat)abstract
- Sensing and responding to changes in the cellular environments are essential for the diverse family of Apicomplexan parasites, which undergo complex life cycles comprised of both extracellular and obligate intracellular stages. Despite evidence of paramount roles for Ca2+, the molecular players behind how parasites sense Ca2+ and initiate Ca2+ signaling cascades have remained enigmatic. In a recent publication, Marquez-Nogueras et al., identify a transient receptor potential (TRP)-like channel in Toxoplasma gondii and show its implication in the crucial processes of parasite invasion and egress from host cells.
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| 16. |
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| 17. |
- Barghouth, Mohammad, et al.
(författare)
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The T-type calcium channel CaV3.2 regulates insulin secretion in the pancreatic β-cell
- 2022
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160. ; 108
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Tidskriftsartikel (refereegranskat)abstract
- Voltage-gated Ca2+ (CaV) channel dysfunction leads to impaired glucose-stimulated insulin secretion in pancreatic β-cells and contributes to the development of type-2 diabetes (T2D). The role of the low-voltage gated T-type CaV channels in β-cells remains obscure. Here we have measured the global expression of T-type CaV3.2 channels in human islets and found that gene expression of CACNA1H, encoding CaV3.2, is negatively correlated with HbA1c in human donors, and positively correlated with islet insulin gene expression as well as secretion capacity in isolated human islets. Silencing or pharmacological blockade of CaV3.2 attenuates glucose-stimulated cytosolic Ca2+ signaling, membrane potential, and insulin release. Moreover, the endoplasmic reticulum (ER) Ca2+ store depletion is also impaired in CaV3.2-silenced β-cells. The linkage between T-type (CaV3.2) and L-type CaV channels is further identified by the finding that the intracellular Ca2+ signaling conducted by CaV3.2 is highly dependent on the activation of L-type CaV channels. In addition, CACNA1H expression is significantly associated with the islet predominant L-type CACNA1C (CaV1.2) and CACNA1D (CaV1.3) genes in human pancreatic islets. In conclusion, our data suggest the essential functions of the T-type CaV3.2 subunit as a mediator of β-cell Ca2+ signaling and membrane potential needed for insulin secretion, and in connection with L-type CaV channels.
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| 18. |
- Borges, R., et al.
(författare)
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The dynamic nature of exocytosis from large secretory vesicles. A view from electrochemistry and imaging
- 2023
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Ingår i: Cell Calcium. - : Elsevier BV. - 0143-4160. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- In this brief review, we discuss the factors that modulate the quantum size and the kinetics of exocytosis. We also discuss the determinants which motivate the type of exocytosis from the so-called kiss-and-run to full fusion and along the intermediate mode of partial release. Kiss-and-run release comprises the transient opening of a nanometer (approx. 2 nm diameter) fusion pore between vesicle and plasma membrane allowing a small amount of release. Partial release comprises a larger more extended opening of the pore to allow a larger fraction of released vesicle content and is what is observed as normal full release in most electrochemical measurements. Partial release appears to be dominant in dense core vesicles and perhaps synaptic vesicles. The concept of partial release leads to the fraction released as a plastic component of exocytosis. Partial vesicular distension and the kinetics of exocytosis can be modulated by second messengers, physiological modulators, and drugs. This concept adds a novel point of regulation for the exocytotic process.
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| 19. |
- Mogensen, Hanna, et al.
(författare)
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Number of siblings and survival from childhood leukaemia : a national register-based cohort study from Sweden
- 2021
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Ingår i: British Journal of Cancer. - Stockholm : Karolinska Institutet, Institute of Environmental Medicine. - 0007-0920 .- 1532-1827.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies suggest worse leukaemia survival for children with siblings, but the evidence is sparse, inconsistent and does not consider clinical factors. We explored the associations between number of siblings in the household, birth order, and survival from childhood acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML). Methods: In this nationwide register-based study we included all children aged 1-14, diagnosed with ALL and AML between 1991-mid 2015 in Sweden (n=1692). Using Cox regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) according to number of siblings and birth order, adjusting for known prognostic and sociodemographic factors. Results: A tendency towards better ALL survival among children with one, or ≥2, siblings was observed, adjHRs (95% CI): 0.73 (0.49-1.10) and 0.63 (0.40-1.00), respectively. However, this was mainly limited to children with low risk profiles. An indication of better AML survival among children with siblings was seen, adjHRs (95% CI) 0.68 (0.36-1.29) and 0.71 (0.34-1.48) but diminished after adjusting for birth order. Conclusion: Our results do not support previous findings that a larger number of siblings is associated with poorer survival. Inconsistencies might be explained by underlying mechanisms that differ between settings, but chance cannot be ruled out.
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| 20. |
- Jurrius, Patriek, et al.
(författare)
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Invasive breast cancer over four decades reveals persisting poor metastatic outcomes in treatment resistant subgroup - the "ATRESS" phenomenon
- 2020
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Ingår i: Breast. - : CHURCHILL LIVINGSTONE. - 0960-9776 .- 1532-3080. ; 50, s. 39-48
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Tidskriftsartikel (refereegranskat)abstract
- Background: Major advances in breast cancer treatment have led to a reducuction in mortality. However, there are still women who are not cured. We hypothesize there is a sub-group of women with treatment-resistant cancers causing early death.Methods: Between 1975 and 2006, 5392 women with invasive breast cancer underwent surgery at Guy's Hospital, London. Data on patient demographics, tumour characteristics, treatment regimens, local recurrence, secondary metastasis, and death were prospectively recorded. We considered four time periods (1975-1982, 1983-1990, 1991-1998, 1999-2006). Risks and time to event analysis were performed with Cox proportional hazards model and Kaplan-Meier estimation.Results: Unadjusted hazard ratios for developing metastasis and overall mortality relative to the 1975-1982 cohort decreased steadily to 0.23 and 0.63, respectively in 1999-2006. However, metastasis-free interval shortened, with the proportion of women developing metastasis <= 5 years increasing from 73.9% to 83.0%. Furthermore, median post-metastatic survival decreased from 1.49 years to 0.94 years. Applying our risk criteria identified the presence of +/- 200 patients in each cohort who developed metastasis early and died within a much shorter time frame.Conclusions: Advances in treatment have decreased the risk of metastasis and improved survival in women with invasive breast cancer over the last 40 years. Despite this, a subpopulation with shorter metastasis-free and post-metastatic survival who are unresponsive to available treatment remains. This may be due to the ATRESS phenomenon (adjuvant therapy-related shortening of survival) secondary to preselection inherent in adjuvant therapy, successful treatment of less malignant tumour cells and treatment-induced resistance in the remaining tumour clones.
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