This Country Has the Real Apprentice: Germany’s approach to worker training allows people to enjoy a middle-class lifestyle.

WUPPERTAL, Germany — Edgar Wingert, a 39-year-old-year material specialist, had always wanted a career in the German military. But when, after nearly a year in the service, his relatively poor eyesight forced him to abandon his dream career, he went to work as an untrained worker in the local paper mill. After the financial crisis hit and he was laid off, Wingert thought for the first time about doing his "Ausbildung," the German name for the professional training approach that involves both theoretical learning and on-the-job training – an apprenticeship. Passing both would get him his journeyman's letter, the technical qualification that allows millions of Germans without a university degree to do challenging and rewarding work, earn a good income and know that they can easily find new work, if they are laid off or otherwise want to leave their employers. "By the time I started thinking about doing an apprenticeship, I was 30 and it was too late," he says, taking a break from cleaning the laser printing nozzle used to inscribe the name of the German manufacturer Knipex onto the insulating grip on hundreds of pliers stacked neatly in boxes by his side. Germany, which is currently enjoying its lowest unemployment rate in 37 years, is well known for a system of standardized, superior training qualifications, which allow primarily young people to train and get recognized for specific jobs. In Germany, everything from selling cars to building pianos and harpsichords has its own practical technical schooling, testing and qualifications. It is a system that experts say allows a highly capable workforce to earn middle-class wages, enjoy job security and bring a high level of expertise to jobs that increasingly rely on more than just muscle, nimble fingers and endurance. "The key to the success of the German model is interlocking of practical training and theoretical learning," says professor Justin J.W. Powell at the University of Luxembourg, who has studied apprenticeship systems both in German and the United States. Worker training will surely be discussed at the July 7-8 summit of Group of 20 leading rich and developing nations, which will be held in the northern German port city of Hamburg. Much of the media attention will focus on Trump's meeting with Russian leader Vladimir Putin, and on climate change, where the American leader has departed from allies by announcing his country's withdrawal from the Paris climate accords. But economic issues such as trade remain the heart of the G20's work, and worker training is a major issue for wealthy nations, whose aging populations continue to grapple with rapidly changing economic currents. Training is a hot topic in many countries. In the United States, for example, debate is intensifying over how best to create jobs for adults lacking a four-year college degree. Despite U.S. President Donald Trump's criticism of Germany and its trade practices, he announced a boosting of the apprenticeship programs that many experts say is an attempt to emulate Germany's success in closing the so-called skills gap – the gulf between companies' need for a high-trained workforce and the job seekers who are not adequately trained for the jobs on offer. "For decades, Germany has been a model for highly successful apprenticeship – that's a name I like, apprentice – apprenticeship programs," Trump reportedly said during a roundtable discussion with the chancellor of Germany, Angela Merkel. Wingert's big chance to do a formal apprenticeship came in 2012, when Knipex, the company he still works for, offered him and some of his colleagues the chance to get trained. He would be excused from the factory floor for a week each month to pursue a yearlong course that, after a series of two written tests and one practical test, would earn him the official title of machine and systems operator. That professional qualification allows him to apply to higher-paying jobs in the factory, but also lets him more easily enter other manufacturing businesses at a higher pay. The cost of the tuition at the trade college and the 12 weeks of missed work are payed by the federal employment office under a program designed to train older adults. In 2015 the program helped train more than 24,000 people in Germany all over at a cost of roughly 180 million euros, or about $206 million. "You should see what it means for people to get the letter of acceptance," says Sandra Urspruch, a member of the company's human resources department. "It's like getting the golden ticket." At Knipex less than 40 percent of those working on the factory floor have professional qualifications. The balance, who are untrained, execute relatively straightforward tasks on pre-set machines and pre-determined routines; they are more likely to be let go if orders decrease. A fairly typical story of German prowess in small and mid-sized manufacturing companies, Knipex was founded in the second half of the 19th century, well after the industrial revolution had reached the German Ruhr-area, still the heartland of the biggest manufacturing economy in Europe. The Knipex factory, a sprawling series of buildings and halls that now employs about 800 workers who make about 45,000 pliers a day, stands on the site of the original factory, where the founder, who was the current director's great grandfather, was making about 120 pliers a day. Despite its history, the plier factory is aggressively modern. Robots now handle some of the heavy industrial forges. Most of the factory halls are lit with natural light. Small glass-enclosed cabinets ensure that smokers do not affect the indoor-air quality. One section of one floor – where the tools are neatly sorted and the machines look especially modern – is dedicated entirely to training the young who will spend up to three years getting professional qualifications. Knipex was also fairly forward-thinking in starting the program that allows older adults, like Wingert, to go through professional training. While the company itself does not carry any of the cost, it does have to reorganize schedules and in some cases hire extra workers to fill-in for the time Wingert and his peers miss on the factory floor. Besides, now trained and certified, nothing stops them from going up the road to look for better employment opportunities. For the company such inconvenience is paid off by the loyalty it brings, explains Urspruch. Besides, at a time when many workers are retiring and when the jobs become technically more complex, the measure guarantees the manufacturer a steady supply of well-trained employees. For the government-run national employment agency, footing the bill is a way to make sure unemployment numbers stay low. "Employees without a professional qualification or diploma are usually more vulnerable to unemployment, or in cases where they don't have jobs, have a harder time finding employment," says Paul Ebsen, a spokesperson for the German national employment agency. "That's why the employment agency puts so much stake in professional qualifications." Johann Fortwengel, who has extensively studied German firms who come to America looking for locally trained professional manufacturing technicians to hire – or failing that try to help develop an apprentice system to help train workers – says many Americans don't understand the German concept of apprenticeships. For one, many Americans don't realize that the vast majority of Germans who enter into the system are under 20. "In the States, most people who enter apprenticeships seem to be in the 20s, or even early 30s," says Fortwengel, a lecturer in International Management at Kings College in London. There's also a stigma attached to apprenticeship and technical colleges that is less pronounced in Germany, adds Fortwengel. "Everyone wants to do a bachelor's degree," he says of American culture. But according to experts, the core difference between Germany and the U.S. is how many people and businesses rely on the national apprenticeship system. In the U.S., where the Department of Labor promotes "ApprenticeshipUSA," many – if not most – manufacturing companies still tend to train and evaluate workers themselves, a practice that can leave workers with the kind of narrow training that makes changing jobs difficult. "The German system is so special because it is so standardized," says Fortwengel. According to the University of Luxembourg's Powell, the German system also differs from the American one because of the stakeholders involved: "What makes the system so unique is corporatism; the tripartite of unions, government and companies." Such a structure is one of the reasons that Fortwengel doesn't believe the German system can be easily transplanted into America. "Even in a hundred years, it won't be like the German system," he says. More likely, it will be a training system with a distinctly American flavor.

Selinexor in Advanced, Metastatic Dedifferentiated Liposarcoma: A Multinational, Randomized, Double-Blind, Placebo-Controlled Trial

PURPOSE Antitumor activity in preclinical models and a phase I study of patients with dedifferentiated liposarcoma (DD-LPS) was observed with selinexor. We evaluated the clinical benefit of selinexor in patients with previously treated DD-LPS whose sarcoma progressed on approved agents. METHODS SEAL was a phase II-III, multicenter, randomized, double-blind, placebo-controlled study. Patients age 12 years or older with advanced DD-LPS who had received two-five lines of therapy were randomly assigned (2:1) to selinexor (60 mg) or placebo twice weekly in 6-week cycles (crossover permitted). The primary end point was progression-free survival (PFS). Patients who received at least one dose of study treatment were included for safety analysis (ClinicalTrials.gov identifier: ). RESULTS Two hundred eighty-five patients were enrolled (selinexor, n = 188; placebo, n = 97). PFS was significantly longer with selinexor versus placebo: hazard ratio (HR) 0.70 (95% CI, 0.52 to 0.95; one-sided P = .011; medians 2.8 v 2.1 months), as was time to next treatment: HR 0.50 (95% CI, 0.37 to 0.66; one-sided P < .0001; medians 5.8 v 3.2 months). With crossover, no difference was observed in overall survival. The most common treatment-emergent adverse events of any grade versus grade 3 or 4 with selinexor were nausea (151 [80.7%] v 11 [5.9]), decreased appetite (113 [60.4%] v 14 [7.5%]), and fatigue (96 [51.3%] v 12 [6.4%]). Four (2.1%) and three (3.1%) patients died in the selinexor and placebo arms, respectively. Exploratory RNA sequencing analysis identified that the absence of CALB1 expression was associated with longer PFS with selinexor compared with placebo (median 6.9 v 2.2 months; HR, 0.19; P = .001). CONCLUSION Patients with advanced, refractory DD-LPS showed improved PFS and time to next treatment with selinexor compared with placebo. Supportive care and dose reductions mitigated side effects of selinexor. Prospective validation of CALB1 expression as a predictive biomarker for selinexor in DD-LPS is warranted. (C) 2022 by American Society of Clinical Oncolog

ARTICLEAssociation of the CHEK2 c.1100delC variant, radiotherapy, and systemic treatment with contralateral breast cancer risk and breast cancer-specific survival

Aim To assessed the associations of CHEK2 c.1100delC, radiotherapy, and systemic treatment with CBC risk and BCSS. Methods Analyses were based on 82,701 women diagnosed with a first primary invasive BC including 963 CHEK2 c.1100delC carriers; median follow-up was 9.1 years. Differential associations with treatment by CHEK2 c.1100delC status were tested by including interaction terms in a multivariable Cox regression model. A multi-state model was used for further insight into the relation between CHEK2 c.1100delC status, treatment, CBC risk and death. Results There was no evidence for differential associations of therapy with CBC risk by CHEK2 c.1100delC status. The strongest association with reduced CBC risk was observed for the combination of chemotherapy and endocrine therapy [HR (95% CI): 0.66 (0.55–0.78)]. No association was observed with radiotherapy. Results from the multi-state model showed shorter BCSS for CHEK2 c.1100delC carriers versus non-carriers also after accounting for CBC occurrence [HR (95% CI): 1.30 (1.09–1.56)]. Conclusion Systemic therapy was associated with reduced CBC risk irrespective of CHEK2 c.1100delC status. Moreover, CHEK2 c.1100delC carriers had shorter BCSS, which appears not to be fully explained by their CBC risk

Association of the CHEK2 c.1100delC variant, radiotherapy, and systemic treatment with contralateral breast cancer risk and breast cancer-specific survival

Background: Breast cancer (BC) patients with a germline CHEK2 c.1100delC variant have an increased risk of contralateral BC (CBC) and worse BC-specific survival (BCSS) compared to non-carriers.Aim: To assessed the associations of CHEK2 c.1100delC, radiotherapy, and systemic treatment with CBC risk and BCSS.Methods: Analyses were based on 82,701 women diagnosed with a first primary invasive BC including 963 CHEK2 c.1100delC carriers; median follow-up was 9.1 years. Differential associations with treatment by CHEK2 c.1100delC status were tested by including interaction terms in a multivariable Cox regression model. A multi-state model was used for further insight into the relation between CHEK2 c.1100delC status, treatment, CBC risk and death. Results: There was no evidence for differential associations of therapy with CBC risk by CHEK2 c.1100delC status. The strongest association with reduced CBC risk was observed for the combination of chemotherapy and endocrine therapy [HR (95% CI): 0.66 (0.55-0.78)]. No association was observed with radiotherapy.Results from the multi-state model showed shorter BCSS for CHEK2 c.1100delC carriers versus non-carriers also after accounting for CBC occurrence [HR (95% CI): 1.30 (1.09-1.56)].Conclusion: Systemic therapy was associated with reduced CBC risk irrespective of CHEK2 c.1100delC status. Moreover, CHEK2 c.1100delC carriers had shorter BCSS, which appears not to be fully explained by their CBC risk.Peer reviewe

Doxorubicin plus evofosfamide versus doxorubicin alone in locally advanced, unresectable or metastatic soft-tissue sarcoma (TH CR-406/SARC021): an international, multicentre, open-label, randomised phase 3 trial

Evofosfamide is a hypoxia-activated prodrug of bromo-isophosphoramide mustard. We aimed to assess the benefit of adding evofosfamide to doxorubicin as first-line therapy for advanced soft-tissue sarcomas.status: publishe

Association of the CHEK2 c.1100delC variant, radiotherapy, and systemic treatment with contralateral breast cancer risk and breast cancer-specific survival.

Funder: Fondation du cancer du sein du Québec; doi: http://dx.doi.org/10.13039/100016328Funder: FP7 Ideas: European Research Council; doi: http://dx.doi.org/10.13039/100011199; Grant(s): HEALTH‐F2‐2009‐223175Funder: Genome Canada; doi: http://dx.doi.org/10.13039/100008762Funder: Genome QuébecFunder: Government of Canada; doi: http://dx.doi.org/10.13039/501100000023BACKGROUND: Breast cancer (BC) patients with a germline CHEK2 c.1100delC variant have an increased risk of contralateral BC (CBC) and worse BC-specific survival (BCSS) compared to non-carriers. AIM: To assessed the associations of CHEK2 c.1100delC, radiotherapy, and systemic treatment with CBC risk and BCSS. METHODS: Analyses were based on 82,701 women diagnosed with a first primary invasive BC including 963 CHEK2 c.1100delC carriers; median follow-up was 9.1 years. Differential associations with treatment by CHEK2 c.1100delC status were tested by including interaction terms in a multivariable Cox regression model. A multi-state model was used for further insight into the relation between CHEK2 c.1100delC status, treatment, CBC risk and death. RESULTS: There was no evidence for differential associations of therapy with CBC risk by CHEK2 c.1100delC status. The strongest association with reduced CBC risk was observed for the combination of chemotherapy and endocrine therapy [HR (95% CI): 0.66 (0.55-0.78)]. No association was observed with radiotherapy. Results from the multi-state model showed shorter BCSS for CHEK2 c.1100delC carriers versus non-carriers also after accounting for CBC occurrence [HR (95% CI): 1.30 (1.09-1.56)]. CONCLUSION: Systemic therapy was associated with reduced CBC risk irrespective of CHEK2 c.1100delC status. Moreover, CHEK2 c.1100delC carriers had shorter BCSS, which appears not to be fully explained by their CBC risk