Current role of surgery for high risk prostate cancer

In this review, the role of surgery in patients with adverse tumor characteristics and a high risk of tumor progression are discussed. In the current PSA era the proportion of patients presenting with high risk prostate cancer (PCa) is estimated to be between 15% and 25% with a 10-year cancer specific survival in the range of 80-90% for those receiving active local treatment. The treatment of high risk prostate cancer is a contemporary challenge. Surgery in this group is gaining popularity since 10-year cancer specific survival data of over 90% has been described. Radical prostatectomy should be combined with extended lymphadenectomy. Adjuvant or salvage therapies may be needed in more than half of patients , guided by pathologic findings and postoperative PSA. Unfortunately there are no randomized controlled trials comparing radical prostatectomy to radiotherapy and no single treatment can be universally recommended. This group of high risk prostate cancer patients should be considered a multi-disciplinary challenge; however, for the properly selected patient, radical prostatectomy either as initial or as the only therapy can be considered an excellent treatment.

A Preliminary Impact Assessment of Doha Round Results on Agricultural Policies in Turkey

Turkish agriculture has been experiencing a period of unique policy experiment over the last couple years. A World Bank-initiated project, called the Agricultural Reform Implementation Project (ARIP), has been at the forefront of policy change. It was initially promoted by the Bank as an exemplary reform package which could also be adopted by other developing countries. It was introduced in 2001 as part of a major International Monetary Fund (IMF)/World Bank-imposed program of “structural adjustment” after the country had been hit by a major financial crisis. The project has finally come to an end in 2009, and there is now an urgent need for a retrospective assessment of its overall impact on the agricultural sector. Has it fulfilled its ambitious objective of reforming and restructuring Turkish agriculture? Or should it be recorded as a failure of the neo-liberal doctrine? This book aims at finding answers to these questions by investigating the legacy of ARIP from a multi-disciplinary perspective.

From Framework to Action: The DESIRE Approach to Combat Desertification

It has become increasingly clear that desertification can only be tackled through a multi-disciplinary approach that not only involves scientists but also stakeholders. In the DESIRE project such an approach was taken. As a first step, a conceptual framework was developed in which the factors and processes that may lead to land degradation and desertification were described. Many of these factors do not work independently, but can reinforce or weaken one another, and to illustrate these relationships sustainable management and policy feedback loops were included. This conceptual framework can be applied globally, but can also be made site-specific to take into account that each study site has a unique combination of bio-physical, socio-economic and political conditions. Once the conceptual framework was defined, a methodological framework was developed in which the methodological steps taken in the DESIRE approach were listed and their logic and sequence were explained. The last step was to develop a concrete working plan to put the project into action, involving stakeholders throughout the process. This series of steps, in full or in part, offers explicit guidance for other organizations or projects that aim to reduce land degradation and desertification.

Peptide receptor radionuclide therapy for patients with somatostatin receptor expressing tumours. German Guideline (S1).

This document describes the guideline for peptide receptor radionuclide therapy (PRRT) published by the German Society of Nuclear Medicine (DGN) and accepted by the Association of the Scientific Medical Societies in Germany (AWMF) to be included in the official AWMF Guideline Registry. These recommendations are a prerequisite for the quality management in the treatment of patients with somatostatin receptor expressing tumours using PRRT. They are aimed at guiding nuclear medicine specialists in selecting likely candidates to receive PRRT and to deliver the treatment in a safe and effective manner. The recommendations are based on an interdisciplinary consensus. The document contains background information and definitions and covers the rationale, indications and contraindications for PRRT. Essential topics are the requirements for institutions performing the therapy, e. g. presence of an expert for medical physics, intense cooperation with all colleagues involved in the treatment of a patient, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how treatment has to be carried out technically. Here, quality control and documentation of labelling are of great importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with the involved medical disciplines. Generally, the decision for PRRT should be undertaken within the framework of a multi-disciplinary tumour board.

Sustainable Development Appraisal (SDA): A methodological tool for the participatory assessment of sustainability from local to regional planning levels

The term 'sustainable development' is receiving increasing attention in development co-operation and at the global level. However, practical tools which can help local users and multi-disciplinary teams to work together and apply this general concept at the local to regional levels have' emerged only very recently. This paper describes a tool called 'Sustainable Development Appraisal' (SDA), which is based on the principles of sustainable development, and can be applied by small interdisciplinary teams using a transdisciplinary approach, i.e. in participation with local land users and other stakeholders at various levels of intervention. The SDA has been applied in different parts of the globe. It is receiving considerable attention, and may fulfil most requirements contained in the concept of sustainable development, and yet be practically applicable and useful in the local to regional context. Examples from Eritrea and Ethiopia are used in this paper 'to illustrate the practicability of SDA for development planning and implementation.

Joining the dots - understanding the complex interplay between the values we place on wildlife, biodiversity conservation, human and animal health: A review.

The value of wildlife has long been ignored or under-rated. However, growing concerns about biodiversity loss and emerging diseases of wildlife origin have enhanced debates about the importance of wildlife. Wildlife-related diseases are viewed through these debates as a potential threat to wildlife conservation and domestic animal and human health. This article provides an overview of the values we place on wildlife (positive: socio-cultural, nutritional, economic, ecological; and negative: damages, health issues) and of the significance of diseases for biodiversity conservation. It shows that the values of wildlife, the emergence of wildlife diseases and biodiversity conservation are closely linked. The article also illustrates why investigations into wildlife diseases are now recognized as an integral part of global health issues. The modern One Health concept requires multi-disciplinary research groups including veterinarians, human physicians, ecologists and other scientists collaborating towards a common goal: prevention of disease emergence and preservation of ecosystems, both of which are essential to protect human life and well-being.

Earthquake- induced Geomorphology: A Neotectonic Study at the Front of the Alps (Lake Thun & Aare Valley, Switzerland)

We present a multi-disciplinary two-step approach to assess the potential for seismic hazard of the Aare valley and perialpine Lake Thun (Switzerland). High-resolution seismic images and multibeam-bathymetric data, complemented by field observations represent the tools to identify potentially active seismogenic fault structures. Several second-order earthquake effects such as subaqueous mass movements, seismites and liquefaction structures have been observed in Lake Thun and ultimately document the seismic activity of the study area. A first investigation of possibly first-order active structures is presented in the scope of this study. Recently acquired bathymetric data in Lake Thun reveal significant morphologic depressions aligning with an observed lineament on land. Furthermore, high-resolution seismic images indicate potential fault structures in Lake Thun. However, their continuation with depth has to be verified with a multichannel seismic campaign, scheduled for March 2015.

C4I Roadmap March 2005

Patients expect to be safe from harm inside the walls of a hospital. Increasing reports of medical errors and adverse events have brought these concerns to public attention. Although we have celebrated many scientific advances over the past several decades, many patients do not benefit because the healthcare infrastructure is inadequate to deliver care to all. Studies confirm opportunities to improve in areas such as inpatient vaccination for flu and outpatient screening for breast, cervical or colon cancer. (Institute of Medicine, (IOM), 2000, 2001, 2004). This document outlines the steps needed to further increase our focus on patient safety in John Dempsey Hospital through the development of a multi-disciplinary Collaborative Center for Clinical Care Improvement (CCCCI). The dimensions of safety and outcomes are briefly discussed to provide some perspective on the scope of these challenges (Strongwater, 2003).

Risk factors for inflammatory breast cancer

Background: Inflammatory breast cancer (IBC) is rare and accounts for 2.5% of all invasive breast cancers. The 5-year survival rates are significantly lower than for other types of breast cancer, highlighting the significance of cancer prevention in IBC. The comprehensive multi-disciplinary team Morgan Welch Inflammatory Breast Cancer Research Program and Clinic at University of Texas MD Anderson Cancer Center treats the largest number of Inflammatory Breast patients in a single center. Because of this unique center, large patient resources, and good medical and epidemiological records, we were able to conduct the largest single center case-control and case-case study on IBC. Methods: We identified 246 patients diagnosed with IBC and 397 cancer free patients seen at the Dan L Duncan Cancer Prevention Clinic. Breast cancer reproductive risk factors and lifestyle risk factors were compared between tumor subtypes of IBC patients (Estrogen Receptor positive (ER+) and/or Progesterone Receptor positive (PR+), Human Epidermal Growth Factor 2 positive (HER2+)), and (ER -/PR-/HER2-)) and cancer free controls. Results: Breastfeeding was the only significant risk factor (p<0.01) between tumor subtypes in IBC patients. In the case-control study that included all IBC patients and cancer free patients the descriptive statistics indicate significant difference in BMI, history of smoking, number of children, age of first pregnancy, any breastfeeding and total time breastfeeding (p<0.05). No differences were found in the frequency of other breast cancer risk factors. Conclusion: The associations determined between cancer free controls and IBC patients have identified previously unknown risk factors for IBC. The risk factors identified by the case control study suggest BMI, history of smoking, and the protective effect of breastfeeding as potential modifiable risk factors that can be used to decrease the incidence of IBC. Impact: These results highlight the importance of evaluating epidemiologic risk factors of IBC, which could lead to the identification of distinct etiologic pathways that could be targeted for prevention.^

Seal census raw data during POLARSTERN expedition ANT-XV/3 (PS48)

The density, species composition, and possible change in the status of pack ice seals within the Weddell Sea were investigated during the 1997/1998 summer cruise of the RV "Polarstern" (ANT-XV/3, PS48). Comparisons were made with previous surveys in the Weddell Sea where it was assumed that all seals were counted in a narrow strip on either side oft he ship or aircraft. A total of 15 aerial censuses were flown during the period 23 January - 7 March 1998 in the area bounded by 07°08' and 45°33' West longitude. The censused area in the eastern Weddell Sea was largely devoid of pack ice while a well circumscribed pack ice field remained in the western Weddell Sea. A total of 3,636 (95.4 %) crabeater seals, 21 (0.5 %) Ross seals, 45 (1.2 %) leopard seals and 111 (2.9 %) Weddell seals were observed on the pack ice during a total of 1,356.57 linear nautical miles (244.2 nm) of transect line censused. At a mean density of 21.16 1/nm**2 over an area of 244.2 nm, it is the highest densities on record for crabeater seals, density of up to 411.7 1/nm**2 being found in small areas. The overall high densities of seals (30.18 1/nm**2) recorded for the eastern Weddell Sea (27.46 1/nm**2, 0.27 1/nm**2, and 0.66 1/nm**2 for crabeater, leopard and Weddell seals respectively) is a consequence of the drastically reduced ice cover and the inverse relationship that exists between cover and seal densities. Ross seal densities (0.08 1/nm**2) were the lowest on record fort the area. It is suggested that seals largely remain within the confines of the pack ice despite seasonal and annual changes in its distribution. Indications are that in 1998 the El Niño has manifested itself in the Weddell Sea, markedly influencing the density and distribution of pack ice seals.

Metals in suspended matter and bottom sediments from of North Dvina estuary

In 1995-1997 three oceanographic cruises to the White Sea were undertaken in the framework of the INTAS project 94-391, and a multi-disciplinary geochemical study of the major North Dvina estuary has been carried out. Distribution of temperature, salinity and concentration of suspended matter in water columm, as well as contents of Al, Fe, Mn, Co, Cu, Ni, Cr, Pb, Zn, and organic carbon contents in suspended matter and sediments of the North Dvina estuary were determined. Most of the metals and organic matter studied appear to be of terrestrial origin, since the main source of investigated elements in the estuary is river run-off. It was found that metals incorporated in minerals are absolutely prevailing forms in estuarine sediments, they comprise up to 60-99% of total metal contents. Two zones of metal accumulation in the sediments were found in the North Dvina estuary. These zones are considered as local geochemical barriers within a major river-sea barrier. Distribution of most elements studied in the sediments of the North Dvina estuary is controlled by grain size variability in the sediments. Analysis of data on heavy metal contents in the sediments and bivalves of the North Dvina estuary did not reveal any anthropogenic heavy metal pollution in the region.