Overview of adjuvant treatment in early breast cancer

El beneficio del tratamiento adyuvante del cáncer de mama ha sido bien establecido en las últimas décadas, logrando reducir el riesgo de recidiva sistémica. La finalidad de dicha terapia consiste en eliminar la enfermedad micrometastásica. Sin embargo, las opciones terapéuticas en este contexto se han incrementado con un mejor conocimiento de la historia natural del cáncer de mama y sus mecanismos moleculares involucrados, complicando así el árbol de decisión terapéutico. La quimioterapia ha constituido el armamentario fundamental del tratamiento complementario del cáncer de mama, consiguiéndose avances notables en el pronóstico de estas pacientes. Del mismo modo, el tratamiento hormonal juega un papel esencial en el tratamiento adyuvante del cáncer de mama con receptores hormonales positivos. Cuatro grandes ensayos randomizados llevados a cabo con trastuzumab, ha permitido mejorar la supervivencia en pacientes con tumores HER2 positivos.The benefits of adjuvant systemic therapy in reducing risk of distant relapse from breast cancer have been recognized for several de¬cades. The intent of adjuvant therapy is to eli¬minate the occult micrometastatic breast can¬cer burden before it progresses into clinically apparent disease. Decisions regarding adjuvant therapy are increasingly complex with the ad¬vent of new therapeutic strategies, a growing body of literature on the molecular biology and natural history of breast cancer, and ad¬vances in therapeutic techniques and early de¬tection. Systemic chemotherapy is an integral component of the adjuvant treatment strategy for women who have early-stage breast can¬cer and accounts for significant improvements in breast cancer-specific mortality. Endocri¬ne therapy plays a pivotal role in the early treatment of estrogen receptor (ER)-positive breast cancer. Successful delivery of effective adjuvant systemic therapy as a complement to surgical management of breast cancer has con¬tributed to the steady declines in breast can¬cer mortality observed internationally over the past 2 decades. Four large randomized trials to assess efficacy and toxicity of trastuzumab in adjuvant systemic therapy of breast cancer have been initiated. Results clearly demonstra¬te, that adjuvant treatment of trastuzumab sig¬nificantly improves outcomes for women with HER2 positive breast cancer

Bisemivalues for bicooperative games

We introduce bisemivalues for bicooperative games and we also provide an interesting characterization of this kind of values by means of weighting coefficients in a similar way as it was given for semivalues in the context of cooperative games. Moreover, the notion of induced bisemivalues on lower cardinalities also makes sense and an adaptation of Dragan’s recurrence formula is obtained. For the particular case of (p, q)-bisemivalues, a computational procedure in terms of the multilinear extension of the game is given.Peer ReviewedPostprint (author's final draft

The environmental Kuznets curve at the thermoelectricity-water nexus: empirical evidence from Spain

Energy and water are essential resources for ensuring economic growth. Both sectors are closely interrelated. Electricity generation is one of the most water-intensive activities worldwide and the cooling of thermoelectric power stations represents one of the largest uses of water within the energy sector. This study provides evidence on the existence of an Environmental Kuznets Curve (EKC) for water withdrawal at the thermoelectricity sector in Spain, one of the most arid countries in Europe, for the period 1970–2019, using the ARDL model. Our results show a direct rela- tionship between per capita income and water withdrawal until an estimated turning point is reached. In the Spanish case, further development has led to a reduction in water needs for the following reasons: 1) the use of less water-intensive cooling systems, 2) changes in generation technology.This publication has been supported by the grant HAR2017-860086-R funded by MCIN/AEI/10.13039/501100011033 and by ¨"ERDF A way of making Europe". Puente-Ajovín must acknowledge the Regional Government of Aragon through the research project reference S39_20R. This research is also funded by the Ministerio de Ciencia e Innovación (references PID2020-114354RA-I00 and PID2020-112773GB-I00). Sesma-Martín also benefits from the post-doctoral research fellowship reference 1295/2019, assigned to the History and Economics Group at Universidad Publica de Navarra (UPNA

Analysis of the relationship between the adoption of the OHSAS 18001 and business performance in different organizational contexts

This paper investigates how the characteristics of operational processes—systematic and project-based—affect the impact of adopting the safety management systems on different performance metrics. The proposed approach allows the development of a framework which matches safety problems and risks encompassed by organizational tasks with solutions generated by new safety knowledge linked to the adoption of the OHSAS 18001 standard. Our analysis of the effect over work accidents, as well as operational and economic performance of implementing the OHSAS 18001 in Spanish manufacturing, construction and professional services organizations during 2006–2009 shows that organizations modify existing safety practices to mitigate work accidents, and that safety learning effects widely vary across industry sectors. Organizations whose current knowledge is mostly codified and processes are highly systematic benefit more from safety knowledge and experience, whereas the effects of the OHSAS 18001 dilute in organizations whose knowledge is high in tacitness, and whose processes difficult the visibility of the consequences of work accidents. This study has important implications for managing knowledge acquisition processes. The findings offer valuable insights on how managers can develop communication and coordination actions to cope with the potential incompatibilities between safety management systems, the properties of knowledge and work environmental conditions.Preprin

Calidad de vida en alumnado con discapacidad intelectual y del desarrollo: Principales instrumentos de medida

[Resumen] La calidad de vida irrumpe en el campo de la discapacidad en los años setenta, incrementándose la producción científica que trata de operativizar este constructo y proveer de herramientas adecuadas para su evaluación. En la adolescencia con discapacidad, esta temática es todavía incipiente, como lo es el diseño de instrumentos que analicen su bienestar y satisfacción vital. El objetivo de este trabajo es aportar un análisis actualizado de los principales instrumentos diseñados para medir la calidad de vida en la adolescencia con discapacidad intelectual y del desarrollo, a través de la recogida y análisis de documentos procedentes de bases de datos internacionales. Se presentan las principales potencialidades y li mitaciones de uso de cada instrumento según los destinatarios y las necesidades de la investigación

On the parametric description of log-growth rates of cities' sizes of four European countries and the USA

We have studied the parametric description of the distribution of the log-growth rates of the sizes of cities of France, Germany, Italy, Spain and the USA. We have considered several parametric distributions well known in the literature as well as some others recently introduced. There are some models that provide similar excellent performance, for all studied samples. The normal distribution is not the one observed empirically

Validation of the construct of self-determination through the ARC-INICO scale for teenagers

Self-determination is a good predictor of quality of life, which is defined as a strategy that aims to increase and improve the educational practices focused on individuals’ needs at a global and life-long-term level. Hence, the evaluation of this construct has undergone notable advances in our country due to the acceptance of international theoretical models and the design of specific instruments for our context. The ARC-INICO scale (Verdugo et al., 2014) assesses four characteristics of self-determined behavior in teenagers: autonomy, self-regulation, empowerment and self-concept. This structure is based on the Wehmeyer’s Functional Model (1999, 2003). It has only been validated with Spanish students with intellectual and developmental disabilities. The purpose of this study is to assess the psychometrical properties of this scale in Galician population, checking its equivalence both for use with young people with neurological development disorders and without them. The sample was made up of 2 220 high school students. A Confirmatory Factor Analysis was conducted to test the scale structure using the original proposal based on a higher-order factor structure on a correlated four factor model, and a single-factor model which assumes the unidimensionality of self-determination. Regarding the reliability, high overall internal consistency and for its sections has been found. Although the unifactorial model offers an acceptable adjustment (Model 1: GFI = .958, AGFI = .941, RMSEA = .057), it is superior in the higher order model (Model 2: GFI = .970, AGFI = .954; RMSEA = .049). In addition, the factorial invariance measure shows the utility of model 2 to compare scores according to the presence or absence of neurological development disorders. In conclusion, the ARC-INICO scale provides an important basis for decisions making regarding the design of care programs, through the development of resources, guidelines and strategies, and provides information for the differential provision of said resources and supports.La autodeterminación se sitúa como un buen predictor de la calidad de vida, entendida como una estrategia que pretende incrementar y mejorar las prácticas educativas centradas en las necesidades de la persona a nivel global, y a lo largo de su desarrollo vital. De ahí que la evaluación de este constructo haya experimentado notables avances en nuestro país, fruto de la acogida de modelos teóricos internacionales y del diseño de instrumentos específicos para nuestro contexto. La escala ARC-INICO (Verdugo et al., 2014) evalúa cuatro características de la conducta autodeterminada en adolescentes: autonomía, autorregulación, empoderamiento y autoconcepto, basándose en el Modelo Funcional de Wehmeyer (1999, 2003). Ha sido validada únicamente con estudiantes españoles con discapacidad intelectual y del desarrollo. Este estudio pretende evaluar sus propiedades psicométricas con población adolescente gallega, comprobando su equivalencia tanto para su uso con jóvenes con Trastornos del Desarrollo Neurológico como sin ellos. Se emplea una muestra de 2 220 estudiantes. La estructura de la escala fue estudiada mediante Análisis Factorial Confirmatorio, usando la propuesta original con una estructura factorial de orden superior correlacionada con cuatro factores, y un modelo unifactorial que asume la unidimensionalidad de la autodeterminación. Respecto a la fiabilidad, presenta una elevada consistencia interna global y en sus secciones. Aunque el modelo unifactorial ofrece un ajuste aceptable (Modelo 1: GFI = .958, AGFI = .941; RMSEA = .057), es superior en el modelo de orden superior (Modelo 2: GFI = .970, AGFI = .954; RMSEA = .049). Además, la medida de invarianza factorial muestra la utilidad del modelo 2 para comparar puntuaciones según la presencia o no de Trastornos del Desarrollo Neurológico. En conclusión, la ARC-INICO ofrece una base importante para la toma de decisiones respecto al diseño de programas de atención, mediante el desarrollo de recursos, pautas y estrategias, y dota de información para la provisión diferencial de dichos recursos y apoyos

Territorial efficiency: analysis of the role of public work safety controls

This study analyzes the efficiency of Spanish provinces in a model that incorporates occupational health and safety (OHS) policy controls and work accidents into the analysis. Building on productivity models rooted in nonparametric frontier methods, namely Data Envelopment Analysis, the proposed approach allows the development of a production function that accurately models the joint production of desirable (GDP) and undesirable (work accidents) outputs. The efficiency analysis of the 50 Spanish provinces during 2003–2012 reveals that territories that drastically cut resources dedicated to OHS controls—in our case, safety inspections and economic sanctions for safety violations—show higher inefficiency levels. Nevertheless, the changes in OHS policies introduced by Spanish provinces after the change in the state of the economy in 2008 had a heterogeneous impact on their efficiency level. Effective OHS policy is not necessarily linked to merely implementing more OHS policy controls, but rather to the capacity of territories to efficiently allocate their available OHS resources and monitor business activity. Policy implications and future research avenues are discussed.Peer ReviewedPostprint (author's final draft

Coaching practices in challenge-based learning:Characteristics in students' projects

Coaching students in CBL settings requires specific approaches. Although CBL has similar characteristics as Design-based learning (DBL), the educational concept and approach applied in the engineering programs at the Eindhoven University of Technology for over the past twenty years, CBL evolves from the DBL concept to emphasize the importance of addressing the sustainable development goals in education. Despite the fact that DBL coaching characteristics have been investigated, it becomes interesting to research these practices in CBL settings. The aim of this research study was to investigate coaching practices and explore differences among experienced coaches versus novice coaches, and the influence of the project set-up (e.g. group versus individual projects). The study was conducted in the department of Industrial Design, where students work on open- ended and hands-on challenges in groups or individually in the squad, an educational organizational form, where education and research come together. Project coaches and teacher coaches support the students to gain and apply knowledge and in the supervision of self-directed learning. The research method consisted of observations of coaching sessions (N=9), and semi-structured individual interviews with coaches (N=13 coaches) of various levels of experiences. Semistructured interviews with individual (N=14) and groups of students (N=3) took place. Data were analyzed using thematic analysis and categories within the framework of coaching in Design-based Learning by Gómez Puente (2013) and the theoretical framework of Cognitive Apprenticeship by Collins (1991). Results indicate that the 3 most frequently used coaching practices are a) asking open-ended questions; b) providing feedback on progress in technical design and design process; c) encouraging students to explore alternatives for problem solving using different perspectives. The results are in line with teaching the discipline as design process are embedded in uncertain and creative undertakings in which students are motivated to think big in proposing solutions. Novice coaches focused more on technical design while more experienced coaches encouraged students to reflect on their learning process and to become more self-regulated learners.</p