CA 15-3 is predictive of response and disease recurrence following treatment in locally advanced breast cancer

BACKGROUND: Primary chemotherapy (PC) is used for down-staging locally advanced breast cancer (LABC). CA 15-3 measures the protein product of the MUC1 gene and is the most widely used serum marker in breast cancer. METHODS: We retrospectively investigated the role of CA 15-3 in conjunction with other clinico-pathological variables as a predictor of response and time to disease recurrence following treatment in LABC. Pre and post primary chemotherapy serum concentrations of CA 15-3 together with other variables were reviewed and related to four outcomes following primary chemotherapy (clinical response, pathological response, time to recurrence and time to progression). Persistently elevated CA 15-3 after PC was considered as consecutively high levels above the cut off point during and after PC. RESULTS: 73 patients were included in this study. Patients received PC (AC or AC-T regimen) for locally advanced breast cancer. 54 patients underwent surgery. The median follow up was 790 days. Patients with high concentrations of CA 15-3 before PC treatment had a poor clinical (p = 0.013) and pathological (p = 0.044) response. Together with Her-2/neu expression (p = 0.009) and tumour lympho-vascular space invasion (LVI) (p = 0.001), a persistently elevated CA 15-3 post PC (p = 0.007) was an independent predictive factor of recurrence following treatment in LABC. CONCLUSION: Elevated CA 15-3 level is predictive of a poor response to chemotherapy. In addition, persistently elevated CA 15-3 levels post chemotherapy in conjunction with lympho-vascular invasion and HER2 status predict a reduced disease free survival following treatment in locally advanced breast cancer

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Altruistic behavior and social influence in the dictator game

We run Dictators experiments in Southern Italy, a western country with a matrilineal culture, introducing - at the same time- social influence in the design. Our goal is to test whether the institutional culture and the role women have in the society are important factors in determining gender differences in altruism and generosity, compared to the different responses of men and women to social influence and "social clues" (Croson and Gneezy, 2009). We find more support to the hypothesis on the cultural role in shaping preferences, rather than the effects of social influence

A digitalização dos serviços públicos de emprego e a transição escola-trabalho: problemas, tendências e percursos

Os jovens estão a demorar mais tempo a estabelecer as suas identidades profissionais e a definir os seus percursos profissionais nos países desenvolvidos, particularmente em países do sul da Europa, como Portugal. Atualmente, esta transição é definida por constantes avanços e recuos, passando por diferentes experiências educativas e de emprego. Estes percursos mais longos e incertos que medeiam a passagem do papel de estudante ao papel de trabalhador estão cada vez mais a ocorrer fora do âmbito do apoio institucional, incluindo o apoio disponibilizado pelos serviços públicos de emprego (Simões, 2022).info:eu-repo/semantics/publishedVersio

Gone for Good? Determinants of School Dropout in Southern Italy

Dropping out of school has recently become a major issue of policy concern in Italy. A series of reforms of secondary school objectives, programmes and organizational design have been proposed to adapt the public school system to evolutions in the labour market and to increase overall educational attainment. The aim of our work is to gain some understanding of the causes of dropping out of school and, more generally, of the factors that induce parents to review their choices about their child’s schooling careers. To this end we make use of data from the “school dropout survey” undertaken in Salerno Province by the Centre for Labour Economics and Economic Policy (CELPE). The survey collected a range of information on adolescent young people and their families over the period 2004-06. The paper proposes a model of sequential decision making by parents where the decision can be reviewed in the light of new information emerging about the ability and opportunities of the child in profiting from education relative to her outside (in the unskilled market). The model allows interpretation of such dropout and return behaviour and emphasises both the role of economic capacity (opportunity costs) as well as cultural capacity (ability to disentangle signals about future opportunities) for equilibrium decision making. Analysis of the data confirms the role of both economic and cultural capacity of the family of origin in shaping observed choices about drop-out and return to school by individuals in our sample. Interestingly we find that whilst poor performance at, and low attachment to, school – measured by repetition of the school year through end of year failure and attendance records - is a key determinant of initial dropping out, the former is also strongly positively associated with a subsequent return to education. An important implication of this finding is that “initial” dropping out behaviour is often determined by a mismatch between school and student rather than poor performance per se. The answer to the question in the title of this paper, interpreted in its normative sense, therefore is no: the process of allocation of talents to school tracks is subject to many trial errors and revisions by families and many of those who live school return to it