bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of advanced prostate cancer: can we improve on androgen deprivation therapy?
Authors: Anderson John , Abrahamsson Per‐Anders , Crawford David , Miller Kurt , Tombal Bertrand
Published: March 2008

Gonadotrophin‐releasing hormone (GnRH) agonists are currently the mainstay in the management of advanced prostate cancer. Used either as monotherapy or combined with antiandrogens, GnRH agonists suppress serum testosterone levels and thus slow the growth of the tumour cells that depend on testosterone for growth. GnRH agonists have largely replaced orchidectomy in the management of advanced prostate cancer, because patients are reluctant to undergo surgical castration. However, can we do better in androgen‐deprivation therapy? There is some evidence to suggest that GnRH agonists do not achieve the level of testosterone suppression attained with orchidectomy, or as rapidly, factors which could be expected to affect overall survival. Together, these observations highlight the need to develop newer agents that can achieve rapid, profound and sustained testosterone suppression, equivalent to that with orchidectomy. Preliminary data for the GnRH blocker, degarelix, suggest that this new agent might overcome the shortcomings associated with GnRH agonists. Further clinical data are therefore awaited with much interest.
The prognostic role of the pathological T2 subclassification for prostate cancer in the 2002 Tumour‐Nodes‐Metastasis staging system
Authors: Van Oort Inge M. , Witjes J. Alfred , Kok Dieuwertje E.G. , Kiemeney Lambertus A.L.M. , Hulsbergen‐Van De Kaa Christina A.
Published: March 2008

OBJECTIVE

To evaluate the prognostic role of the 2002 Tumour‐Nodes‐Metastasis (TNM) pT2 subclassification for biochemical recurrence (BCR) after radical prostatectomy (RP) for prostate cancer.

PATIENTS AND METHODS

The 1997 TNM staging system is based on one subdivision for organ‐confined prostate tumours (T2a, unilateral; T2b, bilateral involvement). The 2002 TNM staging system subdivides unilateral involvement into T2a (half of one lobe or less) and T2b (more than one half of one lobe), while bilateral involvement is classified as T2c. In all, 542 patients were treated with RP at our institute; the RP specimens were completely embedded and histopathologically evaluated for Gleason grade, tumour volume and anatomical extent, and were staged according to the 2002 TNM staging criteria. Patients were followed for a median of 39.5 months. BCR was defined as two subsequent increasing prostate‐specific antigen (PSA) levels of >0.10 ng/mL. Kaplan‐Meier and proportional hazards regression analyses were used to evaluate the univariable and multivariable prognostic effect of tumour stage.

RESULTS

According to the 2002 TNM staging system, 360 specimens were found to have pT2 tumours; 79 (22%) of the RP specimens were staged as pT2a and 281 (78%) as pT2c; no pT2b specimens were identified. Patients with unilateral involvement (pT2a) had a 5‐year risk of BCR of 13%, while those with bilateral involvement (pT2c) had a risk of 23% (log rank test, P = 0.056). Patients with pT2c disease were more likely to have a larger tumour volume (Mann–Whitney U‐test P < 0.001) and positive surgical margins (Fishers’ exact test, P = 0.001)than those with pT2a tumours. Mann–Whitney U‐tests showed no differences between the groups for preoperative PSA levels (P = 0.167). Also, the RP Gleason score was no different between groups (Pearson chi‐square, P = 0.807). In the multivariable analyses, positive surgical margins appeared to increase the risk of BCR (hazard ratio 4.4, 95% confidence interval 2.5–7.9); pT2c vs pT2a had only a marginally (insignificant) additional effect (1.3, 0.6–2.7).

CONCLUSION

The absence of a true unilateral pathological T2b tumour in a series of 360 pT2 RP specimens questions the relevance of substaging unilateral disease. The limited differences in BCR and in pathological features of unilateral vs bilateral pT2 prostate cancer justify modifying the TNM staging system to one with no subclassification of pT2 disease, or at most as only one subdivision into unilateral (T2a) and bilateral (T2b) disease, combining the T2b and T2c substages.
Renal cell carcinoma metastatic to the stomach: single‐centre experience and literature review
Authors: Pollheimer Marion J. , Hinterleitner Thomas A. , Pollheimer Verena S. , Schlemmer Andrea , Langner Cord
Published: March 2008

OBJECTIVES

To investigate the incidence, clinical presentation and therapy of gastric metastases, an uncommon finding, in a large group of patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

We systematically searched the computerized RCC database of our institute, covering 2082 patients (1180 men and 902 women) who had surgery between January 1984 and September 2005, to identify those with a synchronous and/or metachronous diagnosis of cancer in gastric biopsies or resection specimens. The histopathological slides of both renal and gastric cancer probes, and the clinical presentation, treatment and outcome of affected patients, were reassessed.

RESULTS

Twelve patients with primary gastric cancer, one with local RCC recurrence affecting the antrum and five with clear cell RCC (three men and two women; mean age 73 years, range 65–83) with haematogenous cancer spread to the stomach were detected. The mean (range) time to gastric metastasis was 6.9 (1.7–13.1) years. There were metastases to other organs, most often the lung, in all patients. Three patients presented with symptoms of gastrointestinal bleeding, which was successfully controlled by local endoscopic therapy. Four patients died from disease at 3–19 months after diagnosis. One patient is still alive with disease after ≈2 years.

CONCLUSIONS

Gastric metastasis in patients with RCC appears to be a late event in the course of the disease. Most patients show concomitant tumour spread to other organs, and the outcome is generally poor. The use of targeted drugs might offer a new perspective for affected patients.
A conversation on diverse perspectives of spirituality in nursing literature
Authors: Pesut Barbara
Published: March 2008

Abstract  Spirituality has long been considered a dimension of holistic palliative care. However, conceptualizations of spirituality are in transition in the nursing literature. No longer rooted within religion, spirituality is increasingly being defined by the universal search for meaning, connectedness, energy, and transcendence. To be human is to be spiritual. Some have argued that the concept of spirituality in the nursing literature has become so generic that it is no longer meaningful. A conceptualization that attempts to be all‐encompassing of what it means to live a human life has a tendency to render invisible the differences that make life meaningful. For palliative patients in particular, a generic approach may obscure and relativize the important values and beliefs that inform the critical questions that many patients grapple with at end of life. A different approach to conceptualizing spirituality can be achieved through the use of typologies. Rather than obscuring difference, categories are constructed to illuminate how spirituality is understood within a diverse society and how those understandings might influence patient–provider relationships. What follows in this article is a dialogue illustrating one typology of spirituality constructed from a review of selected nursing literature. The hypothetical narrator and three participants, representing the positions of theism, monism, and humanism, discuss their understandings of spirituality and religion, and how those understandings influence the intersections between nursing ontology, epistemology, and spiritual care.
The dying person: an existential being until the end of life
Authors: Lavoie Mireille , Blondeau Danielle , De Koninck Thomas
Published: March 2008

Abstract  This article explores the experience of death from the perspective of existential philosophy, for the purpose of finding ways to humanize end‐of‐life nursing care. A person in his or her final days is seen by the caregiver as a being seeking the continual creation of his human becoming, from the experience of sickness to death. From the moment the torment of suffering begins, a person needs a presence of humanistic professionalism that embraces the values of the nursing profession.
Gender Dimensions to the Incidence of Tariff Liberalization
Authors: Daniels Reza C.
Published: March 2008

Abstract:  This paper evaluates a topic in the globalization and poverty debate that is often difficult to measure, namely the transmission of price changes associated with tariff liberalization to households. Furthermore, it raises the question of whether there are discernible differences between male‐ and female‐headed households that affect this consumption‐trade link. It is a partial analysis as a consequence, but one that demonstrates the importance of such a focus for continued research and policy development surrounding the impacts of globalization. Specifically, the paper evaluates how tariff changes impacted male‐ and female‐headed households in South Africa over the discrete periods 1995, 2000, and 2004. The analysis of consumption trends by sex of household head shows statistically significant differences which confirm that resources are managed differently between the sexes, and these are transmitted through to the tariff incidence analysis. On the whole, it was found that: (1) male‐headed households almost always bear a greater share of the tariff incidence compared to female‐headed; (2) both male‐ and female‐headed households — across all expenditure quantiles other than the most wealthy — bear a greater share of the tariff burden compared to their share of total expenditure; and (3) changes to the incidence over 1995, 2000, and 2004 between the sexes mimicked the trends for the population as a whole, but showed crucial differences at the bottom end of the expenditure distribution. This suggests that the sex of the household head matters, and must be considered in addition to other household identifying factors (e.g. socio‐economic status) when evaluating the impacts of tariff liberalization.
Graduates' Views on Working in the Public Sector: A Comparative Analysis of the Three Tiers of Government
Authors: Taylor Jeannette
Published: March 2008

Why do university graduates choose to work for one level of government but not the others? This article examines the comparative appeal of government jobs across the three tiers of government – federal, state and local – in Australia. When asked to indicate their employer of choice, a majority of graduates in this case study ranked the federal and state governments close to each other. This article also compares and analyses the pre‐employment views and motivations of the graduates with varying interests in working for the different tiers of government.
Reforming Social Services in Hong Kong: The Role of Contracting and Performance Management in the Non‐Profit Sector
Authors: Wong H. K.
Published: March 2008

Contracts and performance management, along with the concept of consumerism, have become the fundamental metaphors for New Public Management (NPM) and key changes in the public service. ‘Doing well while doing good’ and finding generally acceptable accountability measures for social services have become the perennial aspirations of planners, service providers and funders. This article examines the contingent factors and rationales behind the quality movement and recontracting exercise in reforming the delivery of personal social service programs in Hong Kong within the framework of New Public Management (NPM). It explains the use of long‐term relational contracts rather than the standard business contracts between the government as funder and non‐profit organisations as service providers. It also deals with the complex relationships among quality issues, quality standards, consumerism, accountability, performance indicators, and performance management.
WITTGENSTEIN'S LATER PICTURE “THEORY” OF MEANING
Authors: GENOVA JUDITH
Published: March 2008

Recently, commentators such as Kenny and Hacker have disagreed about whether Wittgenstein's early picture theory of meaning is at all compatible with his later theory of “meaning‐as‐use”. Arguing in favor of their compatibility, Kenny finds that meaning‐as‐use supplements, rather than rivals the earlier conception of meaning:
“IT'S ON THE MIDDLE OF MY TONGUE”
Authors: SLATER B. H.
Published: March 2008

In a previous issue of Philosophical Investigations Professor Radford provides a counterexample to the equation1: a word is on the tip of a man's tongue IFF (a) he can recognize the word and (b1) he believes he may be able to produce It (fairly soon).
CONCEPTS AND OBJECTIVITY
Authors: SCHWYZER HUBERT
Published: March 2008

Some philosophers—indeed, a large number—have presented us with a picture of human knowledge which makes it problematic as to whether we can ever be acquainted with an objective world. Given the nature of perception and thought as characterized by, e.g., Descartes and Hume, there is a problem about how anything I can be aware of can have any sort of objective status; there is a problem of how my awareness of anything can amount to anything other than its merely seeming to me that things are thus and so. And of course many of these same philosophers, and other philosophers, have tried in all sorts of different ways to counter this skeptical thrust. Some, like Descartes, have argued that although human perceiving and human thinking are themselves purely subjective affairs, nevertheless the content of some of our thoughts and ideas is such that it (the content) could not exist if there did not also exist certain things of a quite objective nature. Another way of putting Descartes' thesis is to say that although all our concepts of things are, as concepts, purely subjective entities, nevertheless the content of some of our concepts requires that there exist certain objective entities.
EMPIRICAL REALISM AND OTHER MINDS
Authors: HYDE WILLIAM H.
Published: March 2008

In apparent vogue, perhaps as a reaction against excesses on the part of certain Wittgensteinians, is the idea that the existence and nature of other people's mental lives are things known to us on broadly empirical grounds. A particularly unabashed version of this idea is to be found in Hilary Putnam's “Other Minds”1. Therein Putnam defines empirical realism as the “position that the existence of the external world is supported by experience in much the way that any scientific theory is supported by observational data,”2 His concern in this article is to defend, after entering some criticism of detail, Paul Ziff's attempt to show that the same general sort of position is the proper one to adopt with regard to the traditional problem of other minds. I wish to argue here that the empirical realist's solution to the problem of other minds offered by Ziff and defended by Putnam is wrong.
IT STICKS IN MY THROAT
Authors: RADFORD COLIN
Published: March 2008

In challenging the implications of my putative counter‐example to Wittgenstein's claim that “It's on the tip of my tongue” (TT) is not the expression of an experience (cf. Philosophical Investigations, p.219)1, Professor Slater writes2

… the obvious way in which to meet the threat to the adequacy of (b1) [which is that the speaker should believe that he may be able to produce the missing word (fairly soon)] is to claim that the utterer of “It's on the tip of my tongue” must not merely believe that he may recall the word fairly soon, he must also believe, i.e., not rule out the possibility that, he may do so without any treatment, i.e., without being prompted by an external source such as cues, pills, or shock, (p.51)
The Idea of the Tragic
Authors: MARCHANT ROBERT
Published: March 2008

For tragedy is a representation, not of man, but of actions and of life; the good or evil condition of men lies in action; and the telos is an action, not a characteristic. “The way people are” means their makeup; whether they are good or happy or the opposite means what they do. It is not in order to represent the human characteristics that performances are put on: characteristics, rather, are what are assumed in the dramatic performance of actions; since the deeds or story is the telos of tragedy, the telor being the most important thing.
Critical Notice
Authors: FLEW ANTONY
Published: March 2008

K. R. Popper The Open Universe: An Argument for Indeterminism

K. R. Popper Quantum Theory and the Schism in Physics
THE U.S. MULTINATIONAL ENTERPRISE AND THE NATION‐STATE
Authors: Keohane Robert O.
Published: March 2008

National Interests and the Multinational Enterprise: Tensions Among the North Atlantic Countries. Jack N. Behrman (Englewood Cliffs, N.J.: Prentice‐Hall, 1970), 198 pp.

The International Corporation: A Symposium. Charles P. Kindleberger, ed., (Cambridge, Mass.: M.I.T. Press, 1970), vii + 415 pp.

Silent Surrender: The Multinational Corporation in Canada. Kari Levitt (Toronto: Macmillan Company of Canada Limited), 1970. Preface by Mel Watkins. xxi + 185 pp.

The Emergence of Multinational Enterprise,: American Business Abroad from the Colonial Era to 1914. Mira Wilkins (Cambridge, Mass.: Harvard University Press), 1970. xiv + 310 pp.

Sovereignty at Bay: The Multinational Spread of US Enterprises. Raymond Vernon (New York: Basic Books, 1971), x+326 pp.
WEST EUROPEAN STUDIES AT THE NEW UNIVERSITY OF ULSTER, COLERAINE
Authors: Edwards Gwyneth E.
Published: March 2008

By their very nature, area studies are not easy to devise or to carry out in practice. They are still experimental and developing and the need the full support of the institution where they are taught and that of the subjects which contribute to the programme. West European Studies in Coleraine has been fortunate in many respects. The university appointed staff specifically for the core units and encouraged them to experiment. The staff appointed, although themselves products of language and literary courses, were eager to extend their range of interest into history and the social sciences and to experiment with new teaching methods. All subjects contributing options have made at least one staff appointment who has a strong interest in Western Europe and wishes to contribute to the programme. A number of those appointed have a good knowledge of French or German and have spent long periods in Western Europe. The staff from the optional and the core units are working closely together and some joint seminars and lectures are given so that there can be cross‐fertilization between the disciplines and, in particular, through this the West European staff can seriously learn the techniques of the social sciences and history. This latter aspect is further strengthened by staff from different disciplines working together on common research projects. Staff involved in West European Studies, whether in the core or the options, seem to feel increasingly that they represent a new ‘discipline’, albeit one which is not yet ready for formal definition, but which is as real to them as a social science, history or literature discipline. Similarly, the students identify strongly with West European Studies rather than with its individual components.

Some of the most positive aspects are the enthusiasm expressed by the students for the programme, the high level of linguistic attainment achieved, even in the second language, and the high standards attained in the history, economics and social science options where the students are in direct competition with students whose main studies are in those disciplines. The flexibility given by the student having eight optional units allows him to plan a coherent, integrated course which meets his individual interests and needs. Finally, the experiences of the first four years of graduates show that the West Euroan Studies degree is a good qualification for posts in industry and commerce, the Civil Service, the social services, teaching and post‐graduate research work.
THE DOMINANT DOLLAR: WESTERN ECONOMIC RELATIONS IN THE 1960s
Authors: Twitchett Carol Cosgrove
Published: March 2008

International Economic Relations of the Western World 1959–1971, edited by Andrew Shonfield. Volume I: ‘Politics and Trade’ by Andrew Shonfield, G. and V. Curzon, T. K. Warley and George Ray, 459 pp.; Volume II: ‘International Monetary Relations’ by Susan Strange, 416 p. London, New York, Toronto; Oxford University Press for the Royal Institute of International Affairs, 1976. Both volumes 11.50 each.
COMMUNITY DECISION‐MAKING ON EXCHANGE RATES AND MONEY—*
Authors: Thygesen Niels
Published: March 2008

Some reflections on the launching of the European Monetary System and the first direct elections to the European Parliament
Book Reviews
Authors: Harrison R.
Published: March 2008

Book reviewed in this article:

The State in Capitalist Europe

Competition and Industrial Policy in the European Community

Europe's Industries: Public and Private Strategies for Change

Poverty and Dependence in the European Community

Regional Development and the European Community

The European Community Transport Policy

Planning in Europe: Urban and Regional Planning in the EEC

Sterling in Decline. The Devaluations of 1931, 1949 and 1967

The Red Market: Industrial Co‐operation and Specialisation in Comecon

Economies of Scale, Competitiveness and Trade Patterns within the European Communicy

Strategies and Policies of the European Economic Communig to Improve the Competitiveness of European Industry

In Search of a Common Fisheries Policy

Strikes in Europe and the United States, Measurement and Incidence

Official Publicatiotrc of Western Europe. Volume I: Denmark, Finland, France, Ireland, Italy, Luxembourg, Netherlands, Spain and Turkey

The Pilkington Library, Loughborough University of Technology Grants for Europe: How to Get Money and lnfuence Policy
Excise Duties and the Internal Market
Authors: SMITH STEPHEN
Published: March 2008

As part of the programme to create a single Community market by 1992, the European Commission has brought forward proposals which would require substantial changes in the excise duties levied on mineral oils, tobacco products and alcoholic drinks. This article considers the arguments for harmonization of the system and levels of excise duties within the Internal Market of the Community. It argues that the elimination of duty differentials between Member States is not essential for the completion of the Internal Market.
Paradigms for the Monetary Union of Europe
Authors: GROS DANIEL
Published: March 2008

The notion of a European Monetary Union can be interpreted in different ways. To most non‐economists it probably implies a single European currency and a European central bank. To economists, however, a monetary union implies only (in the words of the 1970 Werner Plan): ‘the irrevocable fixing of parities and the total liberalization of capital movements’. To others still a monetary union might be reached if there is a widely used European parallel currency. This article argues that these paradigms imply different degrees of monetary integration, and that the benefits that can be expected from a monetary union for Europe depend on the degree of monetary integration. Which paradigm should be chosen, therefore, depends on the reasons for which a monetary union for Europe is deemed desirable.
Renegotiating Dependency: the Case of the Southern African Customs Union*
Authors: WALTERS JON
Published: March 2008

The Southern African Customs Union Agreement (SAGUA) between Botswana, Lesotho and Swaziland (BLS) and South Africa has generated a considerable literature. The present article seeks to extend the debate by clarifying some of the concepts underlying the Agreement and by examining some key features of the actual workings of the Customs Union.

In the context of the current renegotiation of SACUA several proposals for modification are made. Particular attention is paid to (i) the political background to SACUA; (ii) protection of infant industries; (iii) agricultural protection; (iv) the implications for BLS of South Africa's import policies; (v) South Africa's regional policy and BLS; (vi) fiscal harmonization; (vii) revenue sharing; (viii) alternatives to fiscal compensation.
Agriculture and the EC Environmental Assessment Directive: Lessons for Community Policy‐Making
Authors: SHEATE W.R. , MACRORY R. B.
Published: March 2008

The 1985 EC Directive on Environmental Assessment introduces a common set of decision‐making procedures throughout the Community for authorizing specified classes of land‐use projects. During the development of the Directive, projects involving agricultural intensification received a high profile, but were marginalized in the final text, in no small part due to opposition by the United Kingdom. Even then, implementation of the Directive in the United Kingdom in respect of agriculture has proved peculiarly troublesome, not least because of presumptions firmly entrenched in the country's long‐established land‐use planning system. The history of the Directive and its effect in one country has wider implications for the future development of Community environmental policy, particularly in the light of current concerns to secure more effective policy integration in areas hitherto largely unaffected by such considerations.
Regulatory Competition in the Single Market
Authors: SUN JEANNE‐MEY , PELKMANS JACQUES
Published: March 2008

Although regulatory competition has been hailed in some quarters as a superior alternative to Council‐driven harmonization, little empirical investigation has been carried out to demonstrate how regulatory competition might work in actual EC practice, and therefore whether its expected benefits will, in fact, materialize.

We construct a framework stylizing the iterative process of regulatory competition, and illuminate its emergence from five elements of the regulatory strategy of the EC‐1992 internal market programme.

The framework presented shows that the process of regulatory competition is a complex and unpredictable one. Two case studies are provided to exemplify the difficulties. These practical limitations severely weaken the case for regulatory competition based on theoretical economic arguments. Moreover, a comparative cost‐benefit analysis of regulatory competition and harmonization suggests that, where relevant, regulatory competition and harmonization should be seen as complements, rather than substitutes. The demarcation between the two is best determined on a case‐by‐case basis according to the principle of subsidiarity.
Review Article: European Integration as a Field of Study in Denmark
Authors: JØRGENSEN KNUD ERIK
Published: March 2008

JCMS is pleased to be able to publish the first of a new series of assessments of work on integration in specific European countries. It hopes that readers will find this return to a practice of the 1960s helpful.
Telecommunications Policy in the European Union: Developing the Information Superhighway
Authors: CURWEN PETER
Published: March 2008

By the end of this century, the telecommunications market in the European Union will have been transformed from a collection of national monopolies providing little apart from basic voice telephony and Value‐Added Network Services (VANS) into a unified, competitive market for multimedia services ‐ or at least that is the intention behind a series of directives issued by the European Commission. This should open up enormous opportunities for service providers, whatever their origin, and the process of forming the necessary alliances for world‐wide coverage has begun in earnest. A first step, in many cases, is the privatization of the national monopoly provider. New forms of competition such as cable and mobile telephony are springing up with unprecedented speed ‐ so fast, indeed, that the consumer is being left in the wake of the technology.
Austria in the European Union
Authors: KAISER WOLFRAM
Published: March 2008

This article gives an overview of the process of domestic adjustment and of the formation of Austrian policy priorities within the European Union (EU). It argues that, while certain problems of economic and political adjustment, including the neutrality issue, are still being addressed, the coalition government of Social Democrats and Christian Democrats is basically determined to establish Austria in the integration core in Europe if and when differentiated integration processes emerge, and particularly in relation to Economic and Monetary Union.
The European Union and a Changing Europe: Establishing the Boundaries of Order
Authors: Smith Michael
Published: March 2008

This article seeks to explore the relationship between the European Union (EU) and the changing European order, with particular respect to the ways in which the EU structures and shapes the boundaries between itself and the broader European arena. It evaluates a range of available international relations theories, and adopts a ‘critical neoliberal‐institutionalist’ approach to the problem. It applies this approach by assessing the EU's boundary‐constructing and boundary‐maintaining behaviour in a number of areas, before developing two models of the EU's role: the ‘politics of exclusion’ and the ‘politics of inclusion’. After spending most of its life practising the ‘politics of exclusion’, the EU has moved towards a ‘politics of inclusion’ to reflect the changing demands of the European order. Nevertheless, the tensions between the two types of politics will continue to be a central feature of the EU's role.
State Power and Institutional Influence in European Integration: Lessons from the Packaging Waste Directive*
Authors: Golub Jonathan
Published: March 2008

This study traces the development of the recently adopted packaging waste directive in order to illuminate the role of various actors in the integration process. While some of the findings about agenda‐setting and qualified majority voting presented in this study apply directly to the sector of environmental policy, or specifically to the chosen case, the broader conclusions suggest the need for additional case studies of EC legislation and offer a theoretical framework in which these studies may be used to test competing notions of European integration. To this end, the study uses lessons from the case of packaging waste to refine the ongoing debate between scholars who propose state‐centric models and those who advocate a view of Europe in which power is diffused to supranational institutions at the expense of state sovereignty.
Heading for Divergence? Regional Growth in Europe Reconsidered*
Authors: Fagerberg Jan , Verspagen Bart
Published: March 2008

This article analyses regional growth in the European Union (EU) in the postwar period. We examine the levels and growth of per capita GDP for a sample of 70 regions, covering six of the EU Member States. We find that after a slow, but steady reduction of differences in GDP per capita across European regions during most of the post‐war period, there are now some signs of a reversal in this trend. This does not imply that differences in levels of productivity and income across European regions are now reduced to a negligible level. Rather, the explanation is that other variables, notably R&D effort, investment support from the EU, the structure of GDP and differences in unemployment have had a diverging impact. We also find some support for the idea of a ‘Europe at different speeds’, with at least three different ‘growth clubs’ characterized by different dynamics, productivity and unemployment levels.
The European Union and the Irish Peace Process
Authors: Teague Paul
Published: March 2008

Northern Ireland is caught between war and peace. On the one hand, there is a widespread desire for a permanent end to violence, but on the other hand big political divisions continue to keep unionism and nationalism apart. One issue that divides the two blocs is the role of the EU in Northern Ireland's economic and political affairs. This article assesses the various arguments made on this issue and suggests that it would be inappropriate for the EU to have a permanent role in the internal governance of the region. The article goes on to show that the debates about neofunctionalism and intergovernmentalism long associated with European integration are now emerging in Ireland with regard to cross‐border economic co‐operation. It is argued that the EU could play an important role in creating a form of symbiotic co‐operation on the island whereby cross‐border economic links and political stability in a new Northern Ireland go hand‐in‐ hand.
Surrogate Alcohols and Their Metabolites Modify Histone H3 Acetylation: Involvement of Histone Acetyl Transferase and Histone Deacetylase
Authors: Choudhury Mahua , Shukla Shivendra D.
Published: March 2008

Background:  Ethanol increases histone H3 acetylation in the rat liver. However, the effect of other carbon chain length alcohols, consumed as surrogate alcohols and used in industry, on H3 acetylation is unknown. Hence, we investigated the effect of these alcohols on histone H3 acetylation, cell toxicity and HAT and HDAC activity.

Methods:  Primary cultures of rat hepatocytes were incubated with selected concentration (40 mM) of different chain length alcohols with or without inhibitors of alcohol metabolizing enzymes. Cells were also treated with low concentration (2.5 mM) of 1‐propanol or 1‐butanol or isopentanol, with or without 40 mM ethanol for 24 hours. Effects of the metabolites of these alcohols were also studied. Cytotoxicity was determined by lactate dehydrogenase (LDH) release and mitochondrial activity (MTT assay). The degree of histone H3 acetylation at specific lysine residues were monitored by western bloting using site specific antibodies. Histone acetyltransferase (HAT) and histone deacetylase (HDAC) activities were measured by enzyme‐linked immunosorbent assay (ELISA) and colorimetric assay respectively.

Results:  Alcohols with increasing carbon chain length exhibited a variable effect on the ratio of acetylated lys9 histone H3 to β‐actin. A graded increase (methanol < ethanol < 1‐propanol < 1‐butanol) followed by a gradual decrease (1‐butanol > 1‐pentanol > 1‐hexanol > 1‐octanol) in the ratio was observed. Other lysine sites were not affected. HAT activation also corresponded to the acetylation profile. These alcohols or their metabolites did not significantly alter HDAC activity in the hepatocytes. Low concentration (2.5 mM) of 1‐propanol alone did not affect acetylation, but sensitized the ethanol induced H3 acetylation at lysine 9 (H3AcK9). 1‐Butanol and isopentanol also increased the response of ethanol induced H3AcK9. Alcohol metabolizing inhibitors attenuated ethanol and propanol induced increase in H3AcK9. Carboxylic acid metabolites of these alcohols also increased HAT activity and histone H3 acetylation at lysine 9. Propionate and butyrate modestly inhibited HDAC activity in an in vitro assay.

Conclusions:  Surrogate alcohols modulate H3AcK9 via increasing HAT activity and this is dependent on their metabolism. Furthermore, alcohol metabolites also increased H3AcK9, but in contrast, exhibit both HAT activation and HDAC inhibition.
Ethanol Inhibits Functional Activity of the Human Intestinal Dipeptide Transporter hPepT1 Expressed in Xenopus Oocytes
Authors: Li Kaixun , Xu Liya , Kulkarni Ashutosh A. , Perkins Daya I. , Haworth Ian S. , Davies Daryl L.
Published: March 2008

Background:  The pathological effects of high alcohol (ethanol) consumption on gastrointestinal and hepatic systems are well recognized. However, the effects of ethanol intake on gastric and intestinal absorption and transport systems remain unclear. The present study investigates the effects of ethanol on the human peptide transporter 1 (hPepT1) which mediates the transport of di‐and tripeptides as well as several orally administered peptidomimetic drugs such as β‐lactam antibiotics (e.g., penicillin), angiotensin‐converting enzyme inhibitors, the anti‐neoplastic agent bestatin, and prodrugs of acyclovir.

Methods:  Xenopus oocytes were injected with hPepT1 cRNA and incubated for 3 to 10 days. Currents induced by glycyl‐sarcosine (Gly‐Sar), Ala‐Ala (dipeptides), penicillin and enalapril measured in the presence or absence of ethanol were determined using an 8‐channel 2‐electrode voltage clamp system, with a membrane potential of −70 mV and 11 voltage steps of 100 milliseconds (from +50 mV to −150 mV in −20 mV increments).

Results:  Ethanol (200 mM) inhibited Gly‐Sar and Ala‐Ala currents by 42 and 30%, respectively, with IC50s of 184 and 371 mM, respectively. Ethanol reduced maximal transport capacity (Imax) of hPepT1 for Gly‐Sar without affecting Gly‐Sar binding affinity (K0.5 and Hill coefficient). Penicillin‐ and enalapril‐induced currents were significantly less than those induced by dipeptides and were not inhibited by ethanol.

Conclusion:  Ethanol significantly reduced transport of dipeptides via a reduction in transport capacity, rather than competing for binding sites in hPepT1. Ethanol inhibition or alteration of transport function may be a primary causative factor contributing to both the nutritional deficits as well as the immunological deficiencies that many alcoholics experience including alcohol liver disease and brain damage.
Alteration in G Proteins and Prolactin Levels in Pituitary After Ethanol and Estrogen Treatment
Authors: Chaturvedi Kirti , Sarkar Dipak K.
Published: March 2008

Background:  Chronic administration of ethanol increases plasma prolactin levels and enhances estradiol’s mitogenic action on the lactotropes of the pituitary gland. The present study was conducted to determine the changes in the pituitary levels of G proteins during the tumor development following alcohol and ethanol treatments.

Methods:  Using ovariectomized Fischer‐344 female rats, we have determined ethanol and estradiol actions at 2 and 4 weeks on pituitary weight and pituitary cell contents of prolactin, Gs. Gq11, Gi1, Gi2, and Gi3 proteins. Western blots were employed to measure protein contents.

Results:  Ethanol increased basal and estradiol‐enhanced wet weight and the prolactin content in the pituitary in a time‐dependent manner. Chronic exposure of estradiol increased the levels of Gs protein in the pituitary. Unlike estradiol, ethanol exposure did not show significant effect on the basal level of Gs protein, but moderately increased the estradiol‐induced levels of this protein. Estradiol exposure enhanced Gq11 protein levels in the pituitary after 2 and 4 weeks, while ethanol treatment failed to alter these protein levels in the pituitary in control‐treated or estradiol‐treated ovariectomized rats. In the case of Gi1, estradiol but not ethanol increased the level of this protein at 4 weeks of treatment. However, estradiol and ethanol alone reduced the levels of both Gi2 and Gi3 proteins at 2 and 4 weeks of treatment. Ethanol also significantly reduced the estradiol‐induced Gi2 levels at 4 weeks and Gi3 level at 2 and 4 weeks.

Conclusions:  These results confirm ethanol’s and estradiol’s growth‐promoting and prolactin stimulating actions on lactotropes of the pituitary and further provide evidence that ethanol and estradiol may control lactotropic cell functions by altering expression of specific group of G proteins in the pituitary.
Dietary aspects of pregnant women in rural areas of Northern India
Authors: Gautam Virender P. , Taneja Devender K. , Sharma Nandini , Gupta Vimal K. , Ingle Gopal K.
Published: March 2008

The aim of this article is to document the current dietary profile of pregnant women in rural areas of Delhi. In order to explore the diet the combination of quantitative (24‐h recall method) and qualitative methods (food frequency method) were used. The mean intake of macronutrients and micronutrients, namely, iron, folic acid and Vitamin C which play an important role in the pathophysiology of nutritional anaemia during pregnancy was calculated from the foodstuffs, using Nutritive Value of Indian Foods. The preferences and avoidance of various foods by the pregnant women were also elicited. The data were analysed using Epi Info 3.4. The intake of calories, protein, iron, folic acid and Vitamin C was found to be less than the recommended dietary allowance in 100%, 91.2%, 98.2%, 99.1% and 65.8% of pregnant women respectively. Folic acid intakes were significantly lower in younger, primiparous and poorly educated women from low‐income families. Vitamin C intake was lower among non‐Hindus only. The overall data suggested the presence of food gap rather than isolated deficiency of any particular nutrient.
Arsenic Trioxide‐Induced Apoptosis in H9c2 Cardiomyocytes: Implications in Cardiotoxicity
Authors: Zhao Xiaoyan , Feng Tieming , Chen He , Shan Hongli , Zhang Yong , Lu Yanjie , Yang Baofeng
Published: March 2008

Abstract:   Arsenic trioxide (As2O3) achieved dramatic remissions in patients with acute promyelocytic leukaemia. Clinical reports have shown that treatment was associated with cardiotoxicity. We investigated the toxic mechanisms of As2O3 in H9c2 cardiomyocytes. Clinically relevant concentrations of As2O3 (2–10 µM) reduced the viability of H9c2 cells in a concentration‐dependent manner. The decreased cell viability was because As2O3 induced cell apoptosis (cell shrinkage, nuclear alterations and caspase‐3 activation), or even necrosis at higher concentrations. Inhibition of caspase‐3 with a specific inhibitor, Ac‐DEVD‐CHO, suppressed apoptosis induced by As2O3. In addition, reactive oxygen species formation and cellular Ca2+ overload were observed in H9c2 cells exposed to As2O3, which was partly inhibited by vitamin E and verapamil. These results suggest that As2O3‐induced cardiotoxicity is mediated, at least in part, by activation of caspase‐3 pathway, which may be triggered by reactive oxygen species formation and intracellular Ca2+ overload.
Living with chronic illness: A phenomenological study of the health effects of the patient–provider relationship
Authors: Fox Sylvia , Chesla Catherine
Published: March 2008

Purpose: To understand the patient–healthcare provider (HCP) relationship from the lived experience of women with chronic disease and determine how this relationship affects women’s health.

Data sources: Narrative accounts of 25 women’s relationships with HCPs in repeated group and individual interviews were audio‐taped and transcribed verbatim. Interpretive phenomenology was used to explore the data using three interconnected modes of paradigm cases, exemplars, and themes.

Conclusions: Women with chronic disease believed their health was significantly affected by their relationships with HCPs. They experienced a greater sense of well‐being and security in connected relationships and had more confidence and motivation to manage their illness.

Implications for practice: This research suggests that for women with chronic disease, relationships with HCPs that are connected, and characterized by partnership, and personableness result in the women feeling better in many dimensions. The context of today’s healthcare system often pushes the nurse practitioner (NP) to provide care more attuned to medical issues, leaving little time for the development of connected relationships. In spite of this pressure, NPs need to strive to develop relationships with patients that are intersubjective/connected.
Alliance not compliance: Coaching strategies to improve type 2 diabetes outcomes
Authors: Hayes Eileen , McCahon Cynthia , Panahi Margaret Reeve , Hamre Taryn , Pohlman Karen
Published: March 2008

Purpose: To explore strategies for improving patient outcomes in type 2 diabetes.

Data sources: The literature related to type 2 diabetes management, behavior change, communication, diabetes self‐management, and coaching.

Conclusions: The strategies currently suggested for improving patient outcomes, e.g., increasing provider adherence to evidence‐based management guidelines, streamlining practice systems, and promoting patient lifestyle changes through intensive education, have produced mixed outcomes. Of the many complexities involved in managing type 2 diabetes, motivating patients to change behavior may be the most challenging. A suggestion for improving patient self‐management of type 2 diabetes is to use coaching communication within a framework of behavior change in the context of the primary care encounter between nurse practitioners (NPs) and their patients.

Implications for practice: Given the varied outcomes of current strategies, coaching by NPs may provide a feasible alternative for improving patient outcomes in type 2 diabetes. Coaching communication can be implemented during office visits as an intervention without cost. To effectively implement this approach, however, practicing NPs and NP students need more formal education in this expected but underdeveloped NP role competency. NPs are called upon to contribute to the body of knowledge needed to validate the merits of coaching for their patients.
Cost‐efficient treatment for uninsured or underinsured patients with hypertension, depression, diabetes mellitus, insomnia, and gastroesophageal reflux
Authors: Luthy Karlen E. , Peterson Neil E. , Wilkinson Joey
Published: March 2008

Purpose: As the number of uninsured and underinsured patients in the United States continues to rise, savvy nurse practitioners (NPs) must balance quality of care with cost of drugs. This article reviews evidence‐based treatments in light of prescribing the most cost‐efficient medications.

Data sources: Searches of electronic databases including MEDLINE, MEDLINEPlus, EBSCO, PubMed, CINAHL, Clinical Pharmacology, Biomedical Reference Collection—Basic, Health Source—Consumer Edition, Health Source—Nursing/Academic Edition, Ovid, and the Cochrane Library Online.

Conclusions: As the role of NP continues to evolve, it is important for NPs to establish themselves as economically conscious healthcare providers, striking a delicate balance between providing quality and cost‐efficient care. An NP’s familiarity with cost‐efficient treatment options for common diagnoses such as hypertension, depression, diabetes mellitus, insomnia, and gastroesophageal reflux disorders can help ease the economic burden uninsured and underinsured patients endure, especially with respect to prescription drugs, and improve compliance with medication regimens.

Implications for practice: NPs should acquire knowledge on how to best treat uninsured or underinsured patients in the most cost‐efficient manner. Knowledge of prescription drug cost is one tool an NP can use to encourage patient compliance, improving the overall health of uninsured or underinsured individuals.
Associations of Health Risk Behaviors With School Absenteeism. Does Having Permission for the Absence Make a Difference?
Authors: Eaton Danice K. , Brener Nancy , Kann Laura K.
Published: March 2008

Background:  Nearly 10% of students enrolled in US public schools are absent daily. Although previous research has shown associations of school absenteeism with participation in risk behaviors, it is unclear if these associations vary by whether the absence was excused. The purpose of this study was to examine the associations of health risk behaviors with being absent from school with and without permission among high school students.

Methods:  During spring 2004, questionnaires similar to the Youth Risk Behavior Survey questionnaire were completed by 4517 ninth‐ and eleventh‐grade students. Responses to items assessing frequency of school absences during the past 30 days for any reason and without permission were combined to create a variable coded as absent on: 0 days; ≥1 day, all with permission (WP); and ≥1 day, at least 1 day without permission (WOP). Logistic regression analyses controlling for gender, grade, and race/ethnicity examined the association of risk behaviors with absenteeism.

Results:  Controlling for demographic variables, compared to students who were absent 0 days, students who were absent WP had significantly higher odds of engaging in 25 of 55 risk behaviors examined and students who were absent WOP had significantly higher odds of engaging in 43 of the 55 behaviors. Students who were absent WOP also had approximately twice the odds of engaging in risk behaviors compared to students who were absent WP.

Conclusions:  School absenteeism, with and without permission, is associated with risk behaviors. Schools should recognize absenteeism for any reason as a warning sign for a variety of risk behaviors.