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Abstract Purpose The therapeutic landscape of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (mBC) has evolved considerably with the introduction of newer targeted agents and their combinations with endocrine therapies. In this scenario, optimizing treatment selection and sequencing is daunting for clinicians. The purpose of this review is to provide evidence-based answers to key clinical questions on treatment selection and sequencing for the management of HR + HER2 − mBC. Design A panel of nine key opinion leaders from Argentina, Brazil, Colombia, Mexico, Moscow, Singapore, South Korea, Taiwan, and UAE convened in October 2018. They reviewed the literature and formulated answers to clinical questions on optimizing the management of HR + HER2 − mBC. Results Evidence-based answers were formulated for: (1) optimal initial treatment choice; (2) ovarian function suppression, optimal endocrine partner, and role of cyclin-dependent kinase 4/6 (CDK4/6) inhibitors (in premenopausal women); (3) better first-line standard of care than aromatase inhibitors; (4) preferred second-line treatment; (5) treatment of oligometastatic disease; (6) factors influencing first-line single-agent endocrine therapy choice; (7) influence of endocrine resistance on treatment selection; (8) optimal maintenance regimen in visceral crisis; and (9) need for a breast cancer registry for patients with HR + HER2 − mBC. The panel also proposed a treatment-sequencing algorithm for the management of HR + HER2 − mBC. Conclusion The current article will serve as a comprehensive guide for optimizing the management of HR + HER2 − mBC. The proposed breast cancer registry will help identify unmet needs and develop strategic regional policies to help improve access to optimized care for HR + HER2 − mBC.

Objective: To describe and assess the experience of the HospitalAlbert Einstein on the treatment of early-stage breast cancer withintraoperative radiotherapy. Methods: Twenty-two patients withinvasive breast cancer, older than 45 years, with tumors ≤ 2.5 cm andwith clinically normal axillary lymph nodes at intraoperative evaluation,who underwent quadrantectomy with sentinel lymph node biopsyand intraoperative radiotherapy. Clinical characteristics, histologicalfindings and intraoperative radiotherapy technique were assessed.Results: The mean age of patients was 60.4 years and 90.9% of themwere post-menopausal. Mean tumor diameter was 1.5 cm, with 81%being of the invasive ductal type; 89% were hormonal receptor positiveand Her-2/neu negative. Clinical stage I was found in 86.4%. Sentinellymph node was negative in 81.8%. The radiation dose was 21 Gy inall patients, with a mean radiation time of 9.65 minutes, mean surgerytime of 234 minutes and mean depth of breast tissue irradiated of 1.72cm. Conclusion: Our preliminary results are similar to those of theliterature, demonstrating that intraoperative radiotherapy is a feasibletechnique in our setting, safe and equivalent to conventional externalbeam radiotherapy, with potential radiobiological, technical, clinical,psychosocial and economic advantages.

O estudo teve como objetivo comparar as compras públicas realizadas pelos entes federativos estaduais em resposta à pandemia de Covid-19 nas áreas da saúde, educação e segurança pública. A base teórica para o artigo é a literatura sobre o federalismo brasileiro na pandemia. Foi realizada uma pesquisa de abordagem quantitativa dos dados com análise exploratória descritiva das compras públicas realizadas pelos 26 entes subnacionais estaduais nos anos de 2020 e 2021. Ao trazer os entes estaduais para o centro da análise, o estudo contribui com a recente literatura sobre o papel dos estados na produção de políticas públicas e no enfrentamento à emergência da Covid-19. A síntese dos resultados reforça a literatura recente ao indicar que a falta de coordenação nas políticas públicas resultou na heterogeneidade das compras públicas em resposta à Covid-19.

Resumo O conhecimento sobre a relação entre políticas públicas, partidos e voto para presidente no Brasil está fortemente concentrado em análises de programas de transferência de renda, o que limita a compreensão sobre como diferentes aspectos do desenho e implementação das políticas se relacionam com o jogo partidário-eleitoral. Neste artigo, por meio de regressões lineares aplicadas a todos os municípios brasileiros, analisamos a dinâmica eleitoral da política habitacional Programa Minha Casa Minha Vida, considerando desde sua criação até as eleições de 2014, com resultados detalhados por modalidades, fases de implementação e aderência ao deficit habitacional. As estimativas mostram que cidades governadas por partidos pertencentes à coalizão do governo federal não receberam mais unidades habitacionais, à exceção da modalidade direcionada para o eleitorado mais pobre. Além disso, o retorno eleitoral obtido pelo PT foi positivo quando a implementação do programa esteve relacionada com o deficit habitacional, particularmente em 2010.

The SARS-CoV-2 pandemic, known as the new coronavirus, is one of the biggest health crisis in history. Some governments characterized as far-right populists, have adopted speeches and public policies in favor of a drug kit that is supposed to slow the clinical worsening of patients infected with the virus. This article combined analyses from the scope of pharmacology, virology and human sciences to highlight the lack of scientific proof for these drugs effectiveness and the interpretations for these leaders behavior, notably Bolsonaro and Trump, as well as some evidence that this kind of politicization in combating the pandemic implies, directly or indirectly, failure to comply with protective measures and an increase in the number of infection cases and deaths by COVID-19.

Recent controversies in the literature on the electoral effects of cash transfer programs reveal the limitations of traditional models associating public policies to voting. Why would beneficiaries reward parties for programmatic policies when the government has no control over the distribution of the benefits? Are they guided by short-term retrospective voting in favor of the incumbent without forming durable links? By studying the Brazilian case, based on the Bolsa Escola-Program, formulated by the PSDB, and the Bolsa-Família Program, formulated by the PT, I test different theories and propose an alternative approach. My thesis is that the long-term electoral effect of programmatic policies is a consequence of credit-claiming efforts made by the competing parties, resulting in reciprocity from voters. My argument is built on the examination of parliamentary deliberations throughout the formulation of these programs and on the analysis of public opinion surveys conducted in 2005, a transitional moment when there were beneficiaries of both programs, and in 2018, the year of the first presidential election with the Bolsa-Família Program being implemented with the PT as an opposition party. The data show that party leaders came to the defense of these social programs to varying degrees and in different moments of their terms in office and that these different mobilization strategies reflected on voting behavior.

A dimensão do federalismo fiscal é central na eficácia da resposta estatal aos desafios trazidos pela Covid-19. Analisamos a atuação da União no auxílio financeiro a entes subnacionais por meio de abordagem qualitativa e quantitativa, e argumentamos que o governo Bolsonaro emprega uma estratégia de coordenação conflitiva e negativa, prejudicando o funcionamento do federalismo cooperativo, padrão que caracterizara o Brasil desde 1988. A omissão do Executivo fez com que a clivagem regional fosse predominante, e acabou levando a resultados subótimos mesmo para as preferências dos atores situados no governo federal. Assim, o artigo chama atenção para a importância das escolhas e estratégias do Executivo federal, para além do arranjo institucional, no funcionamento do federalismo cooperativo.

The Black Sea bottom is well known to be earth’s largest anaerobic methane source, hosting a huge amount of cold seeps releasing significant volumes of methane of both thermogenic and biogenic origin. Taking into account the well-known effects of methane concerning global warming, including the warming up of the oceans, an effective monitoring of its output from the Black Sea is nowadays an essential target for interdisciplinary studies. We discuss the results achieved during monitoring campaigns aimed to detect and track methane flares from the seafloor of the Romanian sector of the Black Sea, in order to better constrain the possible mechanisms responsible for its injection from the marine sediments, through the water column, into the atmosphere. In the mainframe of the ENVRI-Plus project, we deployed a multidisciplinary seafloor observatory for short, mid and long time monitoring and collected samples of the water column. The multidisciplinary seafloor observatory was equipped with probes for passive acoustic signals, dissolved CH4 and chemical-physical parameters. The collected data showed a high concentration of dissolved methane up to values of 5.8 micromol/L. Passive acoustics data in the frequencies range 40–2,500 Hz allow us to discriminate different degassing mechanisms and degassing styles. The acoustic energy associated with gas bubbling is interpreted as a consequence of the gas dynamics along the water column while the acoustic range 2–20 Hz reveals vibration mechanisms generated by gas dynamic’s along the cracks and inside the sediments.

O que explica a volta do fenômeno de formação de novos partidos relevantes no Brasil? Como ela se relaciona com a institucionalização do sistema partidário ou a estrutura da competição? Avançamos nessa discussão a partir da análise do PSD (Partido Social Democrata). Reconstituímos seu processo de formação, sublinhando atores, estratégias e conjunturas; analisamos o comportamento legislativo na Câmara dos Deputados dos parlamentares que migraram para o partido e exploramos sua performance eleitoral em 2012 e 2014, ressaltando lançamento de candidaturas e o perfil local de votação no partido. Chamamos atenção para o fato de que a estrutura da competição partidária federal e local conferem lógica aos fenômenos analisados. Além disso, defendemos que são centrais para entender a formação e força do PSD, e dos demais novos partidos, as decisões e interpretações do Judiciário sobre as leis partidárias-eleitorais, elemento não previsto nas teorias comparadas de formação de novos partidos.

PURPOSE: Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). METHODS: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson’s χ2 test. RESULTS: Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married (P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis (P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2–positive, luminal B, and triple-negative subtypes. CONCLUSION: Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.

The objective of this article is to discuss the theory of popularization of the social profile of Brazilian parliamentarians, emphasizing that the literature on the subject, by ignoring the asymmetric relations of institutional power among legislators, may be biased in its diagnosis of the characteristics of political representation in Brazil. Based on an analysis of the temporal distribution of educational, occupational and gender profiles of deputies and senators between 1995 and 2010, it concludes that popularization occurs at different levels in the profiles of individual parliamentarians, parliamentary groups and legislative bodies. Furthermore, it suggests that in some situations it would be more appropriate to qualify these processes as a diversification of the social profile of legislators, rather than a popularization as such.