Adjuvant early breast cancer systemic therapies according to daily used technologies.

Prognosis of early breast cancer patients is significantly improved with the use of adjuvant therapies. Various guidelines have been proposed to select patients who will derive the most benefit from such treatments. However, classifications have limited usefulness in subsets of patients such as those with node negative breast cancer. The 2007 St. Paul de Vence Clinical Practice Recommendations proposed to consider adjuvant therapy in accordance with the 10-year relapse-free survival reduction estimated by Adjuvant! Online. However, many limitations remain regarding the use of Adjuvant! Online. Among them, adverse prognostic and/or predictive factors such as vascular invasion, mitotic activity, progesterone receptor negativity, and HER-2 expression are not incorporated in the routine clinical decision process. Our group has therefore issued guidelines based on the consideration of both Adjuvant! Online calculations and the prognostic and/or predictive effects of these markers. In addition, web-accessible comprehensive tables summarizing these recommendations are provided.

The newly defined "Greenstone Unit'' of the Aiguilles Rouges massif (western Alps): remnant of an Early Palaeozoic oceanic island-arc ?

In the southwestern part of the Aiguilles Rouges massif (pre-Alpine basement of the Helvetic realm, western Alps), a metavolcanic sequence, newly defined as the ``Greenstone Unit'',is exposed in two NS trending belts of several 100 metres in thickness. It consists of epidote amphibolites, partly epidote and/or calcic amphibole-bearing greenschists, and small amounts of alkali feldspar-bearing greenschists, which underwent low- to medium-grade metamorphism during Visean oblique collision. Metamorphic calcic amphiboles and epidotes show strong chemical zoning, whereas metamorphic plagioclase is exclusively albitic in composition (An 1-3). The SiO2 content of the subalkaline tholeiitic to calc-alkaline suite ranges continuously from 44 wt% to 73 wt%,but andesitic rocks predominate. The majority of samples have chemical compositions close to recent subduction-related lavas; some are even restricted to recent oceanic arcs (extremely low Ta and Nb contents, high La/Nb and Th/Ta ratios). But several basaltic to basalto-andesitic samples resemble continental tholeiites (low Th/Ta, La/Nb ratio). As it is very probable that both lava types are to some extent contemporaneous, it is proposed that the Greenstone Unit represents a former oceanic volcanic are which temporarily underwent extension during which emplacement of continental tholeiite-like rocks occurred. The cause of the extension remains ambiguous. Considering palaeotectonic significance and age of other metavolcanic units in the Aiguilles Rouges massif, the Greenstone Unit most likely formed in the Early Palaeozoic.

Early Alphabetic Inscriptions from Eretria, Greece: 8th Cent. BC Graffiti from the Sanctuary of Apollo Daphnephoros

La transmission de l'alphabet aux Grecs est un sujet encore très débattu. Les plus anciennes inscriptions alphabétiques grecques datent du VIIIe s. av. J.-C. et une majorité d'entre elles a été trouvée dans des sites eubéens. Une trentaine a été mise au jour à Erétrie, dont 26 proviennent du sanctuaire d'Apollon Daphnéphoros. Ces inscriptions, pour la plupart inscrites sur des coupes à boire, contribuaient à personnaliser des offrandes ou à leur donner de la valeur. Le sanctuaire et les pratiques rituelles qui s'y déroulaient offraient un cadre propice à l'usage précoce de l'écriture, au moment où la polis grecque se constituait.

Intervention précoce dans les troubles psychotiques: quel rôle pour les praticiens de premier recours [Early intervention in psychotic disorders: which role for primary care practitioners?]

The development of early intervention in psychotic disorders has allowed a more optimistic approach and the development of more adapted and more efficient treatments. Primary care practitioners are often the first professional contact for patients developing psychosis, but diagnostic difficulties and patients' reluctance to engage in treatment are often an obstacle to private practice treatment. It is therefore important to provide more information to primary care practitioners on specific characteristics of these disorders and about locally available treatment structures in order to allow them to suspect this relatively rare diagnosis, facilitate the collaboration with flexible and accessible specialist services, that ideally should provide home treatment, and to improve prognosis.

The Corrosion of Career? - Occupational Trajectories of Business Economists and Engineers in Switzerland

Achievement careers are regarded as a distinctive element of the post-war period in occidental societies. Such a career was at once a modal trajectory of the modern parts of middleclass men and a social emblem for progress and success. However, if the achievement career came to be a biographical pattern with great normative power, its precise sequential course remained vague. Theories of the 1960s and 1970s described it as an orderly advancement within large firms. By the 1990s, scholars postulated an erosion of the organizational structures that once contributed to the institutionalization of careers, accompanied by a weakening of the normative weight of the achievement career by management discourse. We question the thesis of the corrosion of achievement career by analysing the trajectories of 442 engineers and business economists in Switzerland in regard to their orderliness, loyalty, and temporal rhythm. An inspection of types of careers and cohorts reveals that even if we face a decline of loyalty over time, hierarchical orderliness is not touched by those changes. Foremost, technical-industrial careers fit the loyal and regular pattern. Hence, this trajectory-type represents only a minority and is by far the slowest and least successful in terms of hierarchical ascension.

Can Early Intervention Policies Improve Well-being? Evidence from a randomized controlled trial

Many authors have proposed incorporating measures of well-being into evaluations of public policy. Yet few evaluations use experimental design or examine multiple aspects of well-being, thus the causal impact of public policies on well-being is largely unknown. In this paper we examine the effect of an intensive early intervention program on maternal well-being in a targeted disadvantaged community. Using a randomized controlled trial design we estimate and compare treatment effects on global well-being using measures of life satisfaction, experienced well-being using both the Day Reconstruction Method (DRM) and a measure of mood yesterday, and also a standardized measure of parenting stress. The intervention has no significant impact on negative measures of well-being, such as experienced negative affect as measured by the DRM and global measures of well-being such as life satisfaction or a global measure of parenting stress. Significant treatment effects are observed on experienced measures of positive affect using the DRM, and a measure of mood yesterday. The DRM treatment effects are primarily concentrated during times spent without the target child which may reflect the increased effort and burden associated with additional parental investment. Our findings suggest that a maternal-focused intervention may produce meaningful improvements in experienced well-being. Incorporating measures of experienced affect may thus alter cost-benefit calculations for public policies.

The role of career adaptability and work conditions on general and professional well-being.

This study, conducted with a representative sample of employed and unemployed adults living in Switzerland (N = 2002), focuses on work conditions (in terms of professional insecurity and job demands), career adaptability, and professional and general well-being. Analyses of covariance highlighted that both unemployed and employed participants with low job insecurity reported higher scores on career adaptability and several dimensions (notably on control) than employed participants with high job insecurity. Moreover, structural equation modeling for employed participants showed that, independent of work conditions, adaptability resources were positively associated both with general and professional well-being. As expected professional outcomes were strongly related to job strain and professional insecurity, emphasizing the central role of the work environment. Finally, career adaptability partially mediated the relationship between job strain and professional insecurity, and the outcome well-being.

The Extent and Cyclicality of Career Changes: Evidence for the UK

Using quarterly data for the U.K. from 1993 through 2012, we document that in economic downturns a smaller fraction of unemployed workers change their career when starting a new job. Moreover, the proportion of total hires that involves a career change for the worker also drops in recessions. Together with a simultaneous drop in overall turnover, this implies that the number of career changes declines during recessions. These results indicate that recessions are times of subdued reallocation rather than of accelerated and involuntary structural transformation. We back this interpretation up with evidence on who changes careers, which industries and occupations they come from and go to, and at which wage gains.

The Extent and Cyclicality of Career Changes: Evidence for the UK

Using quarterly data for the U.K. from 1993 through 2012, we document that the extent of worker reallocation across occupations or industries (a career change, in the parlance of this paper) is high and procyclical. This holds true after controlling for workers' previous labour market status and for changes in the composition of who gets hired over the business cycle. Our evidence suggests that a large part of this reallocation reflect excess churning in the labour market. We also find that the majority of career changes come with wage increases. During the economic expansion wage increases were typically larger for those who change careers than for those who do not. During the recession this is not true for career changers who were hired from unemployment. Our evidence suggests that understanding career changes over the business cycle is important for explaining labour market ows and the cyclicality of wage growth.

Personality traits and behavioral and psychological symptoms in patients at an early stage of Alzheimer's disease.

OBJECTIVE: The origins of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) are still poorly understood. Focusing on individual personality structure, we explored the relationship between premorbid personality and its changes over 5 years, and BPS in patients at an early stage of AD. METHOD: A total of 54 patients at an early stage of AD according to ICD-10 and NINCDS-ADRDA criteria and 64 control subjects were included. Family members filled in the Neuropsychiatric Inventory Questionnaire to evaluate their proxies' current BPS and the NEO Personality Inventory Revised twice, the first time to evaluate the participants' current personality and the second time to assess personality traits as they were remembered to be 5 years earlier. RESULTS: Behavioral and psychological symptoms, in particular apathy, depression, anxiety, and agitation, are frequent occurrences in early stage AD. Premorbid personality differed between AD patients and normal control, but it was not predictive of BPS in patients with AD. Personality traits clearly change in the course of beginning AD, and this change seems to develop in parallel with BPS as early signs of AD. CONCLUSIONS: Premorbid personality was not associated with BPS in early stage of AD, although complex and non-linear relationships between the two are not excluded. However, both personality and behavioral changes occur early in the course of AD, and recognizing them as possible, early warning signs of neurodegeneration may prove to be a key factor for early detection and intervention. Copyright © 2012 John Wiley & Sons, Ltd.

Are relationship patterns with significant others reenacted with the therapist?: a study of early transference reactions.

This study examines how patients' relationship patterns are reenacted with the therapist during the first sessions of psychotherapy. Forty (N = 40) outpatients treated with a Brief Psychodynamic Intervention were included in the study. Their narratives of relationship episodes with significant others (e.g., mother, father, romantic partner, colleagues) were compared with relationship episodes with their therapist using the Core Conflictual Relationship Theme method. The Core Conflictual Relationship Theme focuses on 3 aspects of patients' relationship narratives: what the patient wants from others or from self; how others react to his/her wish; and how the patient consequently reacts. Results showed that 60% of patients display similar relationship patterns with their therapist and with significant others. The patterns that were reenacted with the therapist were not the most pervasive ones but were similar to those found in relationship episodes involving parents or romantic partners. These findings provide some support for the clinical concept of repetition of internalized relational patterns with the therapist very early in psychotherapy. Clinical implications are discussed.