This article is devoted to the explanation of the influence of social origins on student achievement. Using the data of the Project for International Student Assessment on 25 nations, I show that ...cultural capital provides a relevant but far from exhaustive, account of schooling inequalities; furthermore, the explanatory power of Bourdieu's theory seems impressively similar across countries. I also try to argue that in order to elaborate a more satisfactory explanation, we need to take into account at least two more factors: occupational aspirations and economic resources. Finally, I discuss whether the above mentioned factors can be integrated into a coherent theoretical framework to achieve a better understanding of educational inequalities.
Abstract
This work presents a direct empirical test of the Breen–Goldthorpe (BG) rational choice model applied to social inequalities in access to university in Italy. In particular, we assess to ...what extent secondary effects of social background on university enrolment are accounted for by families’ economic resources and relative risk aversion (RRA), among a recent cohort of high school graduates. We also assess the role played by students’ numeric expectations and general perceptions of university costs, the returns to university degrees, and their chances of successfully completing university. Compared with existing research, our contribution is based on a large-scale longitudinal study covering different areas of a new national case, includes a larger set of indicators measuring rational choice mechanisms, and proposes a novel measurement strategy for the indicator of RRA. The core finding is that rational choice mechanisms account for around one fifth of secondary effects of social origin in university enrolment. Family’s economic resources and RRA, the two explanatory mechanisms of the BG model, have a limited explanatory power, whereas the perception of the indirect costs associated to attending university is more important. Overall, high school track plays the most prominent role, thereby indicating that—despite the formal ‘openness’ of the system—a large part of inequalities in access to university in Italy are already produced when tracking first occurs in upper secondary education.
‘Salvare l’università italiana’ is a short essay on the crisis of the Italian university system written by three major experts of the field. Using updated statistics, the authors document the ...different aspects of this crisis (enrolments & dropouts, social inequalities, poor labor market outcomes of tertiary graduates, territorial disequilibria, under-financing, etc.). Their main argument is that this crisis reflects a lack of regulation of this system on the side of policy-makers which has resulted in an insufficient horizontal and vertical differentiation of Higher Education, which is essential in the context of a transition to mass Higher Education. In the concluding chapter of this informed and well-written essay, the authors suggest a few pragmatic, feasible remedies to the crisis.
Summary Background No treatment options are available for patients with metastatic colorectal cancer that progresses after all approved standard therapies, but many patients maintain a good ...performance status and could be candidates for further therapy. An international phase 3 trial was done to assess the multikinase inhibitor regorafenib in these patients. Methods We did this trial at 114 centres in 16 countries. Patients with documented metastatic colorectal cancer and progression during or within 3 months after the last standard therapy were randomised (in a 2:1 ratio; by computer-generated randomisation list and interactive voice response system; preallocated block design (block size six); stratified by previous treatment with VEGF-targeting drugs, time from diagnosis of metastatic disease, and geographical region) to receive best supportive care plus oral regorafenib 160 mg or placebo once daily, for the first 3 weeks of each 4 week cycle. The primary endpoint was overall survival. The study sponsor, participants, and investigators were masked to treatment assignment. Efficacy analyses were by intention to treat. This trial is registered at ClinicalTrials.gov , number NCT01103323. Findings Between April 30, 2010, and March 22, 2011, 1052 patients were screened, 760 patients were randomised to receive regorafenib (n=505) or placebo (n=255), and 753 patients initiated treatment (regorafenib n=500; placebo n=253; population for safety analyses). The primary endpoint of overall survival was met at a preplanned interim analysis; data cutoff was on July 21, 2011. Median overall survival was 6·4 months in the regorafenib group versus 5·0 months in the placebo group (hazard ratio 0·77; 95% CI 0·64–0·94; one-sided p=0·0052). Treatment-related adverse events occurred in 465 (93%) patients assigned regorafenib and in 154 (61%) of those assigned placebo. The most common adverse events of grade three or higher related to regorafenib were hand-foot skin reaction (83 patients, 17%), fatigue (48, 10%), diarrhoea (36, 7%), hypertension (36, 7%), and rash or desquamation (29, 6%). Interpretation Regorafenib is the first small-molecule multikinase inhibitor with survival benefits in metastatic colorectal cancer which has progressed after all standard therapies. The present study provides evidence for a continuing role of targeted treatment after disease progression, with regorafenib offering a potential new line of therapy in this treatment-refractory population. Funding Bayer HealthCare Pharmaceuticals.
This article examines how girls and boys choose their tertiary field of study and how the different factors driving their choices contribute to gender segregation in higher education (GSHE) in ...France. We present seven theoretical explanations for GSHE, review the relevant literature and discuss their applicability to the French context. Using rich longitudinal data combining administrative sources, students, parents and school head questionnaires, we assess the heuristic value of these explanations. We employ multinomial logit models as well as decomposition techniques for categorical outcome variables. Our results refute explanations arguing that GSHE reflects gender differences in skills or girls' lower career ambitions. We conclude that curricular differentiation and occupational plans are key drivers of GSHE, even when controlling for ability selection into secondary curricula and for parental and teachers' gender-stereotypical influences.
Supplemental data for this article is available online at
https://doi.org/10.1080/01425692.2021.1875199
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Abstract Introduction Systemic inflammation has been proven to play a crucial role in promoting cancer progression and metastasis in many cancer types, including colorectal cancer (CRC). The aim of ...the present review is to provide an overview of the studies regarding the prognostic value of inflammation-based markers in patients with CRC. Methods A literature search was made for articles reporting the prognostic value of Glasgow prognostic score (GPS) and modified GPS (mGPS), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) in relation to colorectal cancer outcomes. Discussion In resectable early stage CRC, high GPS scores seems significantly associated with cancer-specific survival (CSS); it has also been suggested that adjuvant chemotherapy in stage II CRC could improve CSS in patients with high GPS scores. In patients both with resectable and unresectable mCRC and higher GPS score, all studies suggest a poorer overall survival. In early stage and resectable mCRC, NLR value seems related to OS, whilst data about DFS are discordant. In metastatic disease, a possible correlation between higher NLR and poorer response to bevacizumab has been suggested. Data concerning the prognostic and predictive role of PLR and LMR in CRC are to date insufficient. Conclusions In patients with unresectable metastatic disease, inflammation markers can be used as a marker for predicting chemotherapeutic outcome and monitoring tumor progression, whereas further prospective studies may lead to a better risk stratification in patients eligible for curative surgery restricting the administration of neo-adjuvant and adjuvant therapy to high risk candidates.
Mutations within the KRAS proto-oncogene have predictive value but are of uncertain prognostic value in the treatment of advanced colorectal cancer. We took advantage of PETACC-3, an adjuvant trial ...with 3,278 patients with stage II to III colon cancer, to evaluate the prognostic value of KRAS and BRAF tumor mutation status in this setting.
Formalin-fixed paraffin-embedded tissue blocks (n = 1,564) were prospectively collected and DNA was extracted from tissue sections from 1,404 cases. Planned analysis of KRAS exon 2 and BRAF exon 15 mutations was performed by allele-specific real-time polymerase chain reaction. Survival analyses were based on univariate and multivariate proportional hazard regression models.
KRAS and BRAF tumor mutation rates were 37.0% and 7.9%, respectively, and were not significantly different according to tumor stage. In a multivariate analysis containing stage, tumor site, nodal status, sex, age, grade, and microsatellite instability (MSI) status, KRAS mutation was associated with grade (P = .0016), while BRAF mutation was significantly associated with female sex (P = .017), and highly significantly associated with right-sided tumors, older age, high grade, and MSI-high tumors (all P < 10(-4)). In univariate and multivariate analysis, KRAS mutations did not have a major prognostic value regarding relapse-free survival (RFS) or overall survival (OS). BRAF mutation was not prognostic for RFS, but was for OS, particularly in patients with MSI-low (MSI-L) and stable (MSI-S) tumors (hazard ratio, 2.2; 95% CI, 1.4 to 3.4; P = .0003).
In stage II-III colon cancer, the KRAS mutation status does not have major prognostic value. BRAF is prognostic for OS in MS-L/S tumors.
Summary Background Tumour mutational status is an important determinant of the response of metastatic colorectal cancer to targeted treatments. However, the genotype of the tissue obtained at the ...time of diagnosis might not accurately represent tumour genotype after multiple lines of treatment. This retrospective exploratory analysis investigated the clinical activity of regorafenib in biomarker subgroups of the CORRECT study population defined by tumour mutational status or plasma protein levels. Methods We used BEAMing technology to identify KRAS, PIK3CA , and BRAF mutations in DNA obtained from the plasma of 503 patients with metastatic colorectal cancer who enrolled in the CORRECT trial. We quantified total human genomic DNA isolated from plasma samples for 503 patients using a modified version of human long interspersed nuclear element-1 (LINE-1) quantitive real-time PCR. We also measured the concentration of 15 proteins of interest—angiopoietin 2, interleukin 6, interleukin 8, placental growth factor, soluble TIE-1, soluble VEGFR1, VEGF-A, VEGF-C, VEGF-D, VEGF-A isoform 121, bone morphogenetic protein 7, macrophage colony-stimulating factor, stromal cell-derived factor-1, tissue inhibitor of metalloproteinase 2, and von Willebrand factor—in plasma samples from 611 patients. We did correlative analyses of overall survival and progression-free survival in patient subgroups based on mutational status, circulating DNA concentration, and protein concentrations. The CORRECT trial was registered with ClinicalTrials.gov , number NCT01103323. Findings Tumour-associated mutations were readily detected with BEAMing of plasma DNA, with KRAS mutations identified in 349 (69%) of 503 patients, PIK3CA mutations in 84 (17%) of 503 patients, and BRAF mutations in 17 (3%) of 502 patients. We did not do correlative analysis based on BRAF genotype because of the low mutational frequency detected for this gene. Some of the most prevalent individual hot-spot mutations we identified included: KRAS ( KRAS G12D, 116 28% of 413 mutations; G12V, 72 17%; and G13D, 67 16%) and PIK3CA ( PIK3CA E542K, 27 30% of 89 mutations; E545K, 37 42%; and H1047R, 12 14%). 41 (48%) of 86 patients who had received anti-EGFR therapy and whose archival tumour tissue DNA was KRAS wild-type in BEAMing analysis were identified as having KRAS mutations in BEAMing analysis of fresh plasma DNA. Correlative analyses suggest a clinical benefit favouring regorafenib across patient subgroups defined by KRAS and PIK3CA mutational status (progression-free survival with regorafenib vs placebo: hazard ratio HR 0·52, 95% CI 0·35–0·76 for KRAS wild-type; HR 0·51, 95% CI 0·40–0·65 for KRAS mutant KRAS wild type vs mutant, pinteraction =0·74; HR 0·50, 95% CI 0·40–0·63 for PIK3CA wild-type; HR 0·54, 95% CI 0·32–0·89 for PIK3CA mutant PIK3CA wild-type vs mutant, pinteraction =0·85) or circulating DNA concentration (progression-free survival with regorafenib vs placebo: HR 0·53, 95% CI 0·40–0·71, for low circulating DNA concentrations; HR 0·52, 95% CI 0·40–0·70, for high circulating DNA concentrations; low vs high circulating DNA, pinteraction =0·601). With the exception of von Willebrand factor, assessed with the median cutoff method, plasma protein concentrations were also not associated with regorafenib activity in terms of progression-free survival. In univariable analyses, the only plasma protein that was associated with overall survival was TIE-1, high concentrations of which were associated with longer overall survival compared with low TIE-1 concentrations. This association was not significant in multivariable analyses. Interpretation BEAMing of circulating DNA could be a viable approach for non-invasive analysis of tumour genotype in real time and for the identification of potentially clinically relevant mutations that are not detected in archival tissue. Additionally, the results show that regorafenib seems to be consistently associated with a clinical benefit in a range of patient subgroups based on mutational status and protein biomarker concentrations. Funding Bayer HealthCare Pharmaceuticals.
In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study ...identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study.
PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT).
Of patients enrolled (
1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg).
Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.
Summary Background Phosphatidylinositol 3-kinase (PI3K) pathway activation in squamous cell carcinoma of the head and neck contributes to treatment resistance and disease progression. Buparlisib, a ...pan-PI3K inhibitor, has shown preclinical antitumour activity and objective responses in patients with epithelial malignancies. We assessed whether the addition of buparlisib to paclitaxel improves clinical outcomes compared with paclitaxel and placebo in patients with recurrent or metastatic squamous cell carcinoma of the head and neck. Methods In this multicentre, randomised, double-blind, placebo-controlled phase 2 study (BERIL-1), we recruited patients aged 18 years and older with histologically or cytologically confirmed recurrent and metastatic squamous cell carcinoma of the head and neck after disease progression on or after one previous platinum-based chemotherapy regimen in the metastatic setting. Eligible patients were enrolled from 58 centres across 18 countries and randomly assigned (1:1) to receive second-line oral buparlisib (100 mg once daily) or placebo, plus intravenous paclitaxel (80 mg/m2 on days 1, 8, 15, and 22) in 28 day treatment cycles. Randomisation was done via a central patient screening and randomisation system with an interactive (voice and web) response system and stratification by number of previous lines of therapy in the recurrent and metastatic setting and study site. Patients and investigators (including local radiologists) were masked to treatment assignment from randomisation until the final overall survival analysis. The primary endpoint was progression-free survival by local investigator assessment per Response Evaluation Criteria In Solid Tumors (version 1.1) in all randomly assigned patients. Efficacy analyses were done on the intention-to-treat population, whereas safety was analysed in all patients who received at least one dose of study drug and had at least one post-baseline safety assessment according to the treatment they received. This trial is registered with ClinicalTrials.gov , number NCT01852292 , and is ongoing but no longer enrolling patients. Findings Between Nov 5, 2013, and May 5, 2015, 158 patients were enrolled and randomly assigned to receive either buparlisib plus paclitaxel (n=79) or placebo plus paclitaxel (n=79). Median progression-free survival was 4·6 months (95% CI 3·5–5·3) in the buparlisib group and 3·5 months (2·2–3·7) in the placebo group (hazard ratio 0·65 95% CI 0·45–0·95, nominal one-sided p=0·011). Grade 3–4 adverse events were reported in 62 (82%) of 76 patients in the buparlisib group and 56 (72%) of 78 patients in the placebo group. The most common grade 3–4 adverse events (occurring in ≥10% of patients in the buparlisib group vs the placebo group) were hyperglycaemia (17 22% of 76 vs two 3% of 78), anaemia (14 18% vs nine 12%), neutropenia (13 17% vs four 5%), and fatigue (six 8% vs eight 10%). Serious adverse events (regardless of relation to study treatment) were reported for 43 (57%) of 76 patients in the buparlisib group and 37 (47%) of 78 in the placebo group. On-treatment deaths occurred in 15 (20%) of 76 patients in the buparlisib group and 17 (22%) of 78 patients in the placebo group; most were caused by disease progression and none were judged to be related to study treatment. Interpretation On the basis of the improved clinical efficacy with a manageable safety profile, the results of this randomised phase 2 study suggest that buparlisib in combination with paclitaxel could be an effective second-line treatment for patients with platinum-pretreated recurrent or metastatic squamous cell carcinoma of the head and neck. Further phase 3 studies are warranted to confirm this phase 2 finding. Funding Novartis Pharmaceuticals Corporation.