Acceptability of short term neo-adjuvant androgen deprivation in patients with locally advanced prostate cancer

Purpose: To determine the acceptability of short term neo-adjuvant maximal androgen deprivation (MAD) to patients treated with external beam radiation for locally advanced prostate cancer. Methods: Between 1996 and 2000, 818 patients with locally advanced, but non-metastatic, prostate cancer were entered into a randomised clinical trial (TROG 96.01), which compared radiation treatment alone with the same radiation treatment and 3 or 6 months neo-adjuvant MAD with goserelin and flutamide. Relevant symptoms, and how troublesome they were to the patient, were scored using a self-assessment questionnaire. This was completed by the patient at registration, and at specified times during and after treatment. Patients taking flutamide had liver function tests checked at regular intervals. Results: All patients have completed at least 12 months follow-up after treatment. Nearly all patients completed planned treatment with goserelin, but 27% of patients in the 6-month MAD treatment arm, and 20% in the 3-month arm, had to stop flutamide early. This was mainly due to altered liver function (up to 17% patients) and bowel side effects (up to 8% patients). However, although flutamide resulted in more bowel symptoms for patients on MAD, there was significant reduction in some urinary symptoms on this treatment. Acute bowel and urinary side effects at the end of radiation treatment were similar in all treatment arms. Side effect severity was unrelated to radiation target volume size, which was reduced by MAD, but symptomatology prior to any treatment was a powerful predictor. Of the 36% of patients who were sexually active before any treatment, the majority became inactive whilst on MAD. However, sexual activity at 12 months after radiation treatment was similar in all treatment arms, indicating that the effects of short term MAD on sexual function are reversible. Conclusion: Despite temporary effects on sexual activity, and compliance difficulties with flutamide, short-term neo-adjuvant MAD was not perceived by patients to be a major inconvenience. If neo-adjuvant MAD in the way tested can be demonstrated to lead to improved biochemical control and/or survival, then patients would view these therapeutic gains as worthwhile. Compliance with short-term goserelin was excellent, confirming that LH-RH analogues have a potential role in more long-term adjuvant treatment. However, for more protracted androgen deprivation, survival advantages and deleterious effects need to be assessed in parallel, in order to determine the optimal duration of treatment. (C) 2003 Elsevier Ireland Ltd. All fights reserved.

A legitimate paradox: Neo-liberal reform and the return of the state in Korea

This article examines the neo-liberal reforms that the Kim government implemented in post-crisis Korea. It argues that by embracing the reforms, the state, paradoxicaliy, re-legitimised itself in the national political economy. The process of enacting the reforms completed the power shift from a collusive state-chaebol alliance towards a new alliance based on a more populist social contract - but one that nonetheless generally conformed to the tenets of neo-liberalism. Kim and his closest associates identified the malpractices of the chaebols as the main cause of the crisis, so reforming the chaebols would be the key to economic recovery. Combining populism and neo-liberalism, they drew on support from both domestic and international sources to rein in, rather than nurture, the chaebols.

A VERDADE É A CONVERSA: Aproximações inesperadas entre o neo-pragmatismo de Richard Rorty e a Teologia da Libertação em Juan Luis Segundo

Este estudo é uma tentativa de promover uma partilha de perspectivas entre o neo-pragmatismo do filósofo Richard Rorty, mormente a partir das obras Filosofia e o espelho da natureza e Contingência, Ironia e Solidariedade e a Teologia da Libertação, em seu mais proeminente representante, Juan Luis Segundo, com o foco principal nas obras Libertação da teologia e O dogma que liberta. Desenvolve-se aqui uma aproximação de olhares para a verdade e a revelação, concebendo-as como processos pedagógicos. A verdade, como conceito não apenas religioso, do que se busca para dar sentido ao mundo e a vida humana e a revelação, como uma experiência marcada pela linguagem e expectativas religiosas de significado existencial são experiências similares e constituem-se não como o resultado de um processo de aprendizagem, mas como o processo em si mesmo, aberto e em constante renovação. A verdade, assim, não seria aonde se chega, mas os caminhos pelos quais se vai. Encontrar os pontos de contato e as possíveis mútuas contribuições do pensamento do filósofo Richard Rorty, e sua filosofia edificante, e do teólogo Juan Luis Segundo, e sua ideia de revelação como processo pedagógico, será meu esforço de aproximação entre suas proposições e a construção de uma proposta que não fuja à linguagem e condição humanas. O humano, que marcado pela liberdade, tem na contingência de suas construções um limite para as suas conquistas e um espaço para a sua libertação de qualquer processo desumanizador.

Is the generation of neo-antigenic determinants by free radicals central to the development of autoimmune rheumatoid disease?

Biomolecules are susceptible to many different post-translational modifications that have important effects on their function and stability, including glycosylation, glycation, phosphorylation and oxidation chemistries. Specific conversion of aspartic acid to its isoaspartyl derivative or arginine to citrulline leads to autoantibody production in models of rheumatoid disease, and ensuing autoantibodies cross-react with native antigens. Autoimmune conditions associate with increased activation of immune effector cells and production of free radical species via NADPH oxidases and nitric oxide synthases. Generation of neo-antigenic determinants by reactive oxygen and nitrogen species ROS and RNS) may contribute to epitope spreading in autoimmunity. The oxidation of amino acids by peroxynitrite, hypochlorous acid and other reactive oxygen species (ROS) increases the antigenicity of DNA, LDL and IgG, generating ligands for which autoantibodies show higher avidity. This review focuses on the evidence for ROS and RNS in promoting the autoimmune responses observed in diseases rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). It considers the evidence for ROS/RNS-induced antigenicity arising as a consequence of failure to remove or repair ROS/RNS damaged biomolecules and suggests that an associated defect, probably in T cell signal processing or/or antigen presentation, is required for the development of disease.

Whither critical pedagogy in the neo-liberal university today? Two UK practitioners' reflections on constraints and possibilities

This paper, based on the reflections of two academic social scientists, offers a starting point for dialogue about the importance of critical pedagogy within the university today, and about the potentially transformative possibilities of higher education more generally. We first explain how the current context of HE, framed through neoliberal restructuring, is reshaping opportunities for alternative forms of education and knowledge production to emerge. We then consider how insights from both critical pedagogy and popular education inform our work in this climate. Against this backdrop, we consider the effects of our efforts to realise the ideals of critical pedagogy in our teaching to date and ask how we might build more productive links between classroom and activist practices. Finally, we suggest that doing so can help facilitate a more fully articulated reconsideration of the meanings, purposes and practices of HE in contemporary society. This paper also includes responses from two educational developers, Janet Strivens and Ranald Macdonald, with the aim of creating a dialogue on the role of critical pedagogy in higher education.

Neo-Nazism in West Germany

The oharaoter of right-wing extremism in the Federal Republic has undergone extensive transformations in the seventies. As electoral support for the extreme Right declined, a whole range of new groupings emerged pursuing a militant extra-parliamentary strategy. Essential charaoteristics are an increasing tendency to use violence and a close ideological affinity to the NSDAP. They attract a growing number of young people. The increasing susceptibility of young people to rightist ideologies coincides with an economic recession of which young people especially are the victims. Widespread ignorance about Nazism and the prevalence of anti-democratic political attitudes constitute important contributary factors and point to a considerable potential for right-extremism in the Federal Republic., This potential can be attributed. to the negative effects of much of the material dealing with the NS past, to serious deficiencies in the area of historical-political education in schools and, above all, to the absence of any :real process of "coming to terms with the past" in the postwar period. Neo-Nazism is not completely isolated from other trends in West German society. Rightist elements within the established party system and broad sections of the population hold similar views and attitudes. This similarity, linked with an over-exaggerated concern with a perceived threat from the extreme Left may explain the absence of any concerted effort to deal with nee-Nazi tendencies. The response of the courts exemplifies a widespread tendency to under-estimate the significance of the extreme Right. Opposition to the Right is restricted primarily to those circles which suffered most under the Nazi regime. The analysis suggests that one must reject the simplistic view that at the present time the Right does not constitute a serious threat to West German democracy. The study evaluates the wide range of views to be found in secondary sources on the subject of neo-Nazism and is :intended, to contribute to the ongoing discussion conceming the potential for right-extremism in West Germany.

A Kuhnian crisis in neo-Darwinism

Policy issues which receive large inputs of scientific and technical information are frequently marred by acrimonious controversies between contributing experts. There are few if any examples of a public policy decision being based on a firm consensus of scientific and technical experts. Such a consensus is taken for granted by the `Rational' model of decision making and its derivatives. Comparing the dynamics of conflict in policy-relevant issues with those of conflict in `pure' science, one is struck by their great similarity. In both cases we witness examples of rhetorical statements about incompetence, conflicting interpretations of data, and interdisciplinary communication problems. Noting this similarity, this thesis attempts to answer the question, `Is there a similarity of cause: do the same causes lie at the roots of conflict in policy-relevant and policy-irrelevant science?' In answering this question this thesis examines recent controversies in a generally policy-irrelevant science - evolutionary biology. Three episodes of conflict are studied: the `Neutral Allele Theory', `Punctuated Equilibrium', and `Structuralist versus Functionalist approaches to evolution'. These controversies are analysed in terms of both Kuhn's account of scientific `crises' and Collingridge and Reeve's (1986) `Overcritical Model'. Comparing its findings with those of Collingridge and Reeve, this thesis concludes that, (a) there is a Kuhnian crisis in contemporary evolution theory and, (b) that common causes do lie at the roots of conflict in policy-relevant and policy-irrelevant science. Science has an inherent tendency to degenerate into acrimonious conflict but at the same time has mechanisms which eventually resolve such conflicts. Unfortunately, when science is incorporated into the policy arena these mechanisms are prevented from operating. This thesis reinforces Collingridge and Reeve's conclusion that science is of little use to policy.