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Parise C.A.,Sutter Institute for Medical Research | Hoffman M.D.,University of California at Davis
International Journal of Sports Physiology and Performance | Year: 2011

Background: Even pacing has been recommended for optimal performances in running distances up to 100 km. Trail ultramarathons traverse varied terrain, which does not allow for even pacing. Purpose: This study examined differences in how runners of various abilities paced their efforts in the Western States Endurance Run (WSER), a 161 km trail ultramarathon in North America, under hot vs cooler temperatures. Method: Temperatures in 2006 (hot) and 2007 (cooler) ranged from 7-38°C and 2-30°C, respectively. Arrival times at 13 checkpoints were recorded for 50 runners who finished the race in both years. After stratification into three groups based on finish time in 2007 (<22, 22-24, 24-30 h), paired t tests were used to compare the difference in pace across checkpoints between the years within each group. The χ2 test was used to compare differences between the groups on the number of segments run slower in the hot vs cooler years. Results: For all groups, mean pace across the entire 161 km race was slower in 2006 than in 2007 (9:23 ± 1:13 min/km vs 8:42 ± 1:15 min/km, P < .001) and the pace was slower from the start of the race when temperatures were still relatively cool. Overall, the <22 h cohort ran slower in 2006 than 2007 over 12 of the 14 segments examined, the 22-24 h cohort was slower across 10 of the segments, and the >24 h cohort was slower across only 6 of the segments χ2 2 = 6.00, P = .050). Comparable pacing between the 2 y corresponded with onset of nighttime and cooling temperatures. Conclusions: Extreme heat impairs all runners' ability to perform in 161 km ultramarathons, but faster runners are at a greater disadvantage compared with slower competitors because they complete a greater proportion of the race in the hotter conditions. © 2011 Human Kinetics Inc.


Hoffman M.D.,University of California at Davis | Parise C.A.,Sutter Institute for Medical Research
International Journal of Sports Physiology and Performance | Year: 2015

Purpose: This work longitudinally assesses the influence of aging and experience on time to complete 161-km ultramarathons. Methods: From 29,331 finishes by 4066 runners who had completed 3 or more 161-km ultramarathons in North America from 1974 through 2010, independent cohorts of men (n = 3,092), women (n = 717), and top-performing men (n = 257) based on age-group finish place were identified. Linear mixed-effects regression was used to assess the effects of aging and previous 161-km finish number on finish time adjusted for the random effects of runner, event, and year. Results: Men and women up to 38 y of age slowed by 0.05-0.06 h/y with advancing age. Men slowed 0.17 h/y from 38 through 50 y and 0.23 h/y after 50 y. Women slowed 0.20-0.23 h/y with advancing age from 38 y. Top-performing men under 38 y did not slow with increasing age but slowed by 0.26 and 0.39 h/y from 38 through 50 y and after 50 y, respectively. Finish number was inversely associated with finish time for all 3 cohorts. A 10th or higher finish was 1.3, 1.7, and almost 3 h faster than a first finish for men, women, and top-performing men, respectively. Conclusions: High-level performances in 161-km ultramarathoners can be sustained late into the 4th decade of life, but subsequent aging is associated with declines in performance. Nevertheless, the adverse effects of aging on performance can be offset by greater experience in these events. © 2015 Human Kinetics, Inc.


Parise C.A.,Sutter Institute for Medical Research | Caggiano V.,Sutter Institute for Medical Research
Critical Reviews in Oncology/Hematology | Year: 2010

Background: Both age and race have been identified as independent predictors of breast cancer subtype but the association of age with subtype within each race is not well understood. This study assesses the association of age with the eight breast cancer subtypes as defined by ER/PR/HER2 among white, African-American, Hispanic, and Asian/Pacific Islander women. Methods: This study included 69,358 women with primary invasive breast cancer. Logistic regression was used to assess the association of age with each of the ER/PR/HER2 subtypes for each race adjusted for socioeconomic status, stage, grade, and tumor size. Results: The odds of African-American women having a triple-negative tumor were not statistically significantly increased for women under 46 when compared to the African-American women aged 46-69 (OR. = 0.96; 95% CI. = 0.80-1.16). A similar pattern was observed for the ER-/PR-/HER2+ subtype. Hispanic women under age 46 (OR. = 0.83; 95% CI. = 0.71-0.97) and over age 70 (OR. = 0.71; 95% CI. = 0.57-0.89) were less likely to have the ER-/PR-/HER2+ subtype. Asian/Pacific Islander women under age 46 also had reduced odds (OR. = 0.67; 95% CI. = 0.55-0.82) of the ER-/PR-/HER2+ subtype. Conclusions: The ER/PR/HER2 subtypes vary with age and differences in this variation depend on race. It is important to define breast cancer using the ER/PR/HER2 subtype and the significance of age and race should not be overlooked. © 2009 Elsevier Ireland Ltd.


Wortman M.,University of Rochester | Cholkeri A.,University of Illinois at Chicago | McCausland A.M.,University of California at Davis | McCausland V.M.,Sutter Institute for Medical Research
Journal of Minimally Invasive Gynecology | Year: 2015

This review summarizes the history and demographics of nonresectoscopic endometrial ablation and global endometrial ablation procedures as well as the presentation, etiology, risk factors, treatment options, and prevention of late-onset endometrial ablation failures. © 2015 AAGL.


Weber S.C.,Sacramento Knee and Sports Medicine | Kauffman J.I.,Orthopedic Associates of Dutchess County | Parise C.,Sutter Institute for Medical Research | Weber S.J.,Sacramento Knee and Sports Medicine | Katz S.D.,Coastal Orthopedics and Sports Medicine
American Journal of Sports Medicine | Year: 2013

Background: Intra-articular hip injuries are thought to be common in professional ice hockey; however, injury incidence and missed playing time have not been previously documented. Furthermore, it is not known if injury incidence differs between player positions. Hypothesis: The incidence of symptomatic intra-articular hip injuries in goaltenders is higher than that of other position players. Study Design: Cohort study; Level of evidence, 3. Methods: A database containing the injury surveillance of National Hockey League (NHL) players from the years 2006 to 2010 was used to identify athletes who had sustained a hip or groin injury. From this database, players diagnosed with an intra-articular hip injury were identified. The incidence of intra-articular hip injuries per 1000 player-hours played and per 1000 player-game appearances was compared between goaltenders, defensemen, and forwards. Results: Ninety-four hip injuries, accounting for 10.6% (94/890) of all hip and groin injuries, were identified as intra-articular in nature during the time of the surveillance. Most injuries occurred during the regular season (71.2%; 67/94) and during a game (44.6%; 42/94). Players who sustained intra-articular hip injuries had significantly higher total man-games missed compared with those with all other groin injuries (mean ± SD, 8.5 ± 23.0 vs 1.2 ± 4.2 missed games; P = .0001). The most frequent intra-articular hip diagnoses made in this cohort were hip labral tear (69.1%), followed by hip osteoarthritis (13.8%), hip loose body (6.3%), and hip femoroacetabular impingement (5.3%). The incidence of intra-articular hip injuries per 1000 player-game hours was not different between goaltenders (1.97) and other on-ice players (defensemen, 1.43; forwards, 1.38) (relative risk [RR], 1.40; 95% CI, 0.86-1.40; P = .22). However, injuries per 1000 player-game appearances were significantly higher in goaltenders (1.84) compared with other on-ice players (defensemen, 0.47; forwards, 0.34) (RR, 4.78; 95% CI, 2.94-7.76; P<.0001). Conclusion: Hip labral tears are the most frequently encountered intra-articular hip injury in the NHL player and can lead to an average of 8 man-games missed per injury. Goaltenders were not at higher risk when measuring injuries per hours played but were at significantly greater risk of an intra-articular hip injury than other on-ice players (RR, 4.7) when measured per game played.


Bauer K.,Public Health Institute | Parise C.,Sutter Institute for Medical Research | Caggiano V.,Sutter Institute for Medical Research
BMC Cancer | Year: 2010

Background: The 2007 St Gallen international expert consensus statement describes three risk categories and provides recommendations for treatment of early breast cancer. The set of recommendations on how to best treat primary breast cancer is recognized and used by clinicians worldwide. We now examine the variability of five-year survival of the 2007 St Gallen Risk Classifications utilizing the ER/PR/HER2 subtypes.Methods: Using the population-based California Cancer Registry, 114,786 incident cases of Stages 1-3 invasive breast cancer diagnosed between 2000 and 2006 were identified. Cases were assigned to Low, Intermediate, or High Risk categories. Five-year-relative survival was computed for the three St Gallen risk categories and for the ER/PR/HER2 subtypes for further differentiation.Results and Discussion: There were 9,124 (13%) cases classified as Low Risk, 44,234 (65%) cases as Intermediate Risk, and 14,340 (21%) as High Risk. Within the Intermediate Risk group, 33,735 (76%) were node-negative (Intermediate Risk 2) and 10,499 (24%) were node-positive (Intermediate Risk 3). For the High Risk group, 6,149 (43%) had 1 to 3 positive axillary lymph nodes (High Risk 4) and 8,191 (57%) had four or more positive lymph nodes (High Risk 5).Using five-year relative survival as the principal criterion, we found the following: a) There was very little difference between the Low Risk and Intermediate Risk categories; b) Use of the ER/PR/HER2 subtypes within the Intermediate and High Risk categories separated each into a group with better five-year survival (ER-positive) and a group with worse survival (ER-negative), irrespective of HER2-status; c) The heterogeneity of the High Risk category was most evident when one examined the ER/PR/HER2 subtypes with four or more positive axillary lymph nodes; (d) HER2-positivity did not always translate to worse survival, as noted when one compared the triple positive subtype (ER+/PR+/HER2+) to the triple negative subtype (ER-/PR-/HER2-); and (e) ER-negativity appeared to be a stronger predictor of poor survival than HER2-positivity.Conclusion: The use of ER/PR/HER2 subtype highlights the marked heterogeneity of the Intermediate and High Risk categories of the 2007 St Gallen statements. The use of ER/PR/HER2 subtypes and correlation with molecular classification of breast cancer is recommended. © 2010 Bauer et al; licensee BioMed Central Ltd.


Parise C.A.,Sutter Institute for Medical Research | Bauer K.R.,Public Health Institute | Caggiano V.,Sutter Institute for Medical Research
Cancer | Year: 2012

BACKGROUND: Incidence and mortality of breast cancer vary according to demographic factors such as age, race/ethnicity, socioeconomic status (SES), and geographic region. This study assesses the variation of these factors in the use of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS) among 8 regions of California. METHODS: The authors identified 85,574 cases of first primary female invasive breast cancer with complete data diagnosed between January 1, 2000 and December 31, 2007. Logistic regression was used to determine the association between race/ethnicity, age, SES, and receipt of RT after BCS within each of the regions of California. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed. RESULTS: Age was a significant predictor of receipt of RT after BCS in all regions. In Los Angeles (LA), lower SES was associated with decreasing odds of RT. Racial disparities were evident only in LA, where black (OR, 0.85; 95% CI, 0.74-0.97) and Hispanic (OR, 0.86; 95% CI, 0.78-0.96) women were about 15% less likely to receive RT than white women. CONCLUSIONS: Racial disparities in the receipt of RT after BCS exist only in LA, where African American and Hispanic women are less likely to receive this form of adjuvant treatment. Lower SES was also associated with a reduced likelihood of receipt of RT in LA. Women age 70 years and older are less likely to receive RT after BCS in all regions of California. Copyright © 2011 American Cancer Society.


Parise C.,Sutter Institute for Medical Research | Caggiano V.,Sutter Institute for Medical Research
Cancer Epidemiology | Year: 2014

Background: Population-based studies of breast cancer often aggregate all Asians into a single category termed Asian/Pacific Islander (API). Purpose: (1) Describe the demographic and clinicopathologic features of early breast cancer utilizing all eight ER/PR/HER2 subtypes among white, black, Hispanic, American Indian, seven Asian ethnicities, and the aggregate API category; (2) ascertain the risk of the ER+/PR+/HER2+, ER-/PR-/HER2-, and ER-/PR-/HER2+ subtypes when compared with the ER+/PR+/HER2- subtype, among seven Asian ethnicities versus non-Hispanic white women and (3) contrast the results with the risk of these same subtypes when using the aggregate API category. Methods: Using the California Cancer Registry, we identified 225,441 cases of stages 1-4 first primary female invasive breast cancer. Logistic regression was used to assess the association of race with the ER+/PR+/HER2+, ER-/PR-/HER2- (triple-negative), and the ER-/PR-/HER2+ subtypes versus the ER+/PR+/HER2- when adjusted for stage, age, tumor grade, and socioeconomic status. Models were fit separately for each subtype. Odds ratios for the seven Asian ethnicities and the aggregate API category using non-Hispanic white women as the reference category were computed. Results: There was an increased risk of the ER+/PR+/HER2+ subtype for the combined API category (OR = 1.16; 95% CI = 1.09-1.23). But only Southeast Asians (OR = 1.17; 95% CI = 1.04-1.31), Filipino (OR = 1.23; 95% CI = 1.12-1.36), and Korean (OR = 1.63; 95% CI = 1.38-1.99) women had an increased risk of this subtype. The reduced risk of the triple-negative subtype seen in APIs (OR = 0.84; 95% CI = 0.79-0.90) was only noted in Chinese (OR = 0.80; 95% CI = 0.70-0.91) and Filipino (OR = 0.65; 95% CI = 0.58-0.73) women whereas Indian Continent (OR = 1.25; 95% CI = 1.01-1.53) women had an increased risk of the triple-negative subtype. The race × stage interaction was statistically significant for the ER-/PR-/HER2+ subtype (p < 0.05). When stratified by stage, there was no statistically significant association of race with subtype in stages 3 and 4. APIs had an increased risk of the ER-/PR-/HER2+ subtype in stage 1 (OR = 1.59; 95% CI = 1.37-1.75) and stage 2 (OR = 1.42; 95% CI = 1.28-1.58) but this risk was not seen in Pacific Islander, Indian Continent, and Japanese women for either stage. Conclusions: Among the Asian ethnicities, there is marked variability in the demographic and clinicopathologic features of breast cancer. Use of the ER/PR/HER2 subtypes reveals that the risk of the ER-/PR-/HER2-, ER+/PR+/HER2+, and ER-/PR-/HER2+ subtypes varies among the Asian population. The API category, is sometimes, but not always reflective of all Asian women. © 2014 Elsevier Ltd. All rights reserved.


Parise C.A.,Sutter Institute for Medical Research | Caggiano V.,Sutter Institute for Medical Research
BMC Cancer | Year: 2013

Background: Racial disparities in breast cancer survival have been well documented. This study examines the association of race/ethnicity and socioeconomic status (SES) on breast cancer-specific mortality in a large population of women with invasive breast cancer.Methods: We identified 179,143 cases of stages 1-3 first primary female invasive breast cancer from the California Cancer Registry from January, 2000 through December, 2010. Cox regression, adjusted for age, year of diagnosis, grade, and ER/PR/HER2 subtype, was used to assess the association of race/ethnicity on breast cancer-specific mortality within strata of stage and SES. Hazard ratios (HR) and 95% confidence intervals were reported.Results: Stage 1: There was no increased risk of mortality for any race/ethnicity when compared with whites within all SES strata. Stage 2: Hispanics (HR = 0.85; 0.75, 0.97) in the lowest SES category had a reduced risk of mortality. Blacks had the same risk of mortality as whites in the lowest SES category but an increased risk of mortality in the intermediate (HR = 1.66; 1.34, 2.06) and highest (HR = 1.41; 1.15, 1.73) SES categories. Stage 3: Hispanics (HR = 0.74; 0.64, 0.85) and APIs (HR = 0.64; 0.50, 0.82) in the lowest SES category had a reduced risk while blacks had similar mortality as whites. Blacks had an increased risk of mortality in the intermediate (HR = 1.52; 1.20, 1.92) and highest (HR = 1.53; 1.22, 1.92) SES categories.Conclusions: When analysis of breast cancer-specific mortality is adjusted for age and year of diagnosis, ER/PR/HER2 subtype, and tumor grade and cases compared within stage and SES strata, much of the black/white disparity disappears. SES plays a prominent role in breast cancer-specific mortality but it does not fully explain the racial/ethnic disparities and continued research in genetic, societal, and lifestyle factors is warranted. © 2013 Parise and Caggiano; licensee BioMed Central Ltd.


Parise C.A.,Sutter Institute for Medical Research | Caggiano V.,Sutter Institute for Medical Research
Journal of Cancer Epidemiology | Year: 2014

Introduction. ER, PR, and HER2 are routinely available in breast cancer specimens. The purpose of this study is to contrast breast cancer-specific survival for the eight ER/PR/HER2 subtypes with survival of an immunohistochemical surrogate for the molecular subtype based on the ER/PR/HER2 subtypes and tumor grade. Methods. We identified 123,780 cases of stages 1-3 primary female invasive breast cancer from California Cancer Registry. The surrogate classification was derived using ER/PR/HER2 and tumor grade. Kaplan-Meier survival analysis and Cox proportional hazards modeling were used to assess differences in survival and risk of mortality for the ER/PR/HER2 subtypes and surrogate classification within each stage. Results. The luminal B/HER2- surrogate classification had a higher risk of mortality than the luminal B/HER2+ for all stages of disease. There was no difference in risk of mortality between the ER+/PR+/HER2- and ER+/PR+/HER2+ in stage 3. With one exception in stage 3, the ER-negative subtypes all had an increased risk of mortality when compared with the ER-positive subtypes. Conclusions. Assessment of survival using ER/PR/HER2 illustrates the heterogeneity of HER2+ subtypes. The surrogate classification provides clear separation in survival and adjusted mortality but underestimates the wide variability within the subtypes that make up the classification. © 2014 Carol A. Parise and Vincent Caggiano.

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