38 research outputs found

    Surveillance for pancreatic cancer in high-risk individuals

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    Background: Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods: A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results: Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion: A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC

    Dispute resolution mechanisms and teacher bargaining outcomes

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    This study investigates the impact of dispute resolution mechanisms on the wages and hours of public school teachers. The 43-state analysis presents evidence that (1) a permissible right to strike increases teacher wages by 11.5 percent and reduces class hours by 37 minutes per day; (2) a de facto right to strike increases salaries by 5.7 percent and reduces class hours by 44 minutes per day; (3) arbitration availability is associated with a wage effect of 3.6 percent and 70 fewer class minutes per day; and (4) factfinding and voluntary arbitration have no significant influences on outcomes. A direct comparison of the right to strike and the right to arbitrate indicates that a legal right to strike affords teachers greater power to increase the dollar value of their work
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