Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

Sharing power? Prospects for a U.S. concert-balance strategy

The Pax Americana and the grand strategy of hegemony (or “Primacy”) that underpins it may be becoming unsustainable. Particularly in the wake of exhausting wars, the Global Financial Crisis, and the shift of wealth from West to East, it may no longer be possible or prudent for the United States to act as the unipolar sheriff or guardian of a world order. But how viable are the alternatives, and what difficulties will these alternatives entail in their design and execution? This analysis offers a sympathetic but critical analysis of alternative U.S. National Security Strategies of “retrenchment” that critics of American diplomacy offer. In these strategies, the United States would anticipate the coming of a more multipolar world and organize its behavior around the dual principles of “concert” and “balance,” seeking a collaborative relationship with other great powers, while being prepared to counterbalance any hostile aggressor that threatens world order. The proponents of such strategies argue that by scaling back its global military presence and its commitments, the United States can trade prestige for security, shift burdens, and attain a more free hand. To support this theory, they often look to the 19th-century concert of Europe as a model of a successful security regime and to general theories about the natural balancing behavior of states. This monograph examines this precedent and measures its usefulness for contemporary statecraft to identify how great power concerts are sustained and how they break down. The project also applies competing theories to how states might behave if world politics are in transition: Will they balance, bandwagon, or hedge? This demonstrates the multiple possible futures that could shape and be shaped by a new strategy. viii A new strategy based on an acceptance of multipolarity and the limits of power is prudent. There is scope for such a shift. The convergence of several trends—including transnational problems needing collaborative efforts, the military advantages of defenders, the reluctance of states to engage in unbridled competition, and hegemony fatigue among the American people—means that an opportunity exists internationally and at home for a shift to a new strategy. But a Concert-Balance strategy will still need to deal with several potential dilemmas. These include the difficulty of reconciling competitive balancing with cooperative concerts, the limits of balancing without a forward-reaching onshore military capability, possible unanticipated consequences such as a rise in regional power competition or the emergence of blocs (such as a Chinese East Asia or an Iranian Gulf), and the challenge of sustaining domestic political support for a strategy that voluntarily abdicates world leadership. These difficulties can be mitigated, but they must be met with pragmatic and gradual implementation as well as elegant theorizing and the need to avoid swapping one ironclad, doctrinaire grand strategy for another.

The Cold War and its aftermath in the Americas: the search for a synthetic interpretation of U.S. policy

More than two decades have passed since the fall of the Berlin Wall and the transfer of the Cold War file from a daily preoccupation of policy makers to a more detached assessment by historians. Scholars of U.S.-Latin American relations are beginning to take advantage both of the distance in time and of newly opened archives to reflect on the four decades that, from the 1940s to the 1980s, divided the Americas, as they did much of the world. Others are seeking to understand U.S. policy and inter-American relations in the post-Cold War era, a period that not only lacks a clear definition but also still has no name. Still others have turned their gaze forward to offer policies in regard to the region for the new Obama administration. Numerous books and review essays have addressed these three subjects—the Cold War, the post-Cold War era, and current and future issues on the inter-American agenda. Few of these studies attempt, however, to connect the three subjects or to offer new and comprehensive theories to explain the course of U.S. policies from the beginning of the twentieth century until the present. Indeed, some works and policy makers continue to use the mind-sets of the Cold War as though that conflict were still being fought. With the benefit of newly opened archives, some scholars have nevertheless drawn insights from the depths of the Cold War that improve our understanding of U.S. policies and inter-American relations, but they do not address the question as to whether the United States has escaped the longer cycle of intervention followed by neglect that has characterized its relations with Latin America. Another question is whether U.S. policies differ markedly before, during, and after the Cold War. In what follows, we ask whether the books reviewed here provide any insights in this regard and whether they offer a compass for the future of inter-American relations. We also offer our own thoughts as to how their various perspectives could be synthesized to address these questions more comprehensively.

Echoes of 1992: the NAFTA negotiations and North America now

Two decades ago, Canada, Mexico, and the United States created a continental economy. The road to integration from the signing of the North American Free Trade Agreement has not been a smooth one. Along the way, Mexico lived through a currency crisis, a democratic transition, and the rising challenge of Asian manufacturing. Canada stayed united despite surging Quebecois nationalism during the 1990s; since then, it has seen dramatic economic changes with the explosion of hydrocarbon production and a much stronger currency. The United States saw a stock-market bust, the shock of 9/11, and the near-collapse of its financial system. All of these events have transformed the relationships that emerged after NAFTA entered into force in 1994. Given the tremendous changes, one might be skeptical that the circumstances and details of the negotiation and ratification of NAFTA hold lessons for the future of North America. However, the road to NAFTA had its own difficulties, and many of the issues involved in the negotiations underpin today's challenges. NAFTA was conceived at a time of profound change in the international system. When Mexican leaders surveyed the world two decades ago, they saw emerging regional groupings in Europe, Asia, and South America. Faced with a lack of interest or compatibility, they instead doubled down on North America. How did Mexican leaders reconsider their national interests and redefine Mexico's role in the world in light of those transformations? Unpublished Mexican documents from SECOFI, the secretariate most involved in negotiating NAFTA, help illustrate Mexican thinking about its interests and role at that time. Combining those insights with analysis of newly available evidence from U.S. presidential archives, this paper sheds light on the negotiations that concluded two decades ago.

Civilian casualties – do we really care? The failure of the revolution in military affairs of non-lethal weapons in the U.S., Russia and Israel

Causing civilian casualties during military operations has become a much politicised topic in international relations since the Second World War. Since the last decade of the 20th century, different scholars and political analysts have claimed that human life is valued more and more among the general international community. This argument has led many researchers to assume that democratic culture and traditions, modern ethical and moral issues have created a desire for a world without war or, at least, a demand that contemporary armed conflicts, if unavoidable, at least have to be far less lethal forcing the military to seek new technologies that can minimise civilian casualties and collateral damage. Non-Lethal Weapons (NLW) – weapons that are intended to minimise civilian casualties and collateral damage – are based on the technology that, during the 1990s, was expected to revolutionise the conduct of warfare making it significantly less deadly. The rapid rise of interest in NLW, ignited by the American military twenty five years ago, sparked off an entirely new military, as well as an academic, discourse concerning their potential contribution to military success on the 21st century battlefields. It seems, however, that except for this debate, very little has been done within the military forces themselves. This research suggests that the roots of this situation are much deeper than the simple professional misconduct of the military establishment, or the poor political behaviour of political leaders, who had sent them to fight. Following the story of NLW in the U.S., Russia and Israel this research focuses on the political and cultural aspects that have been supposed to force the military organisations of these countries to adopt new technologies and operational and organisational concepts regarding NLW in an attempt to minimise enemy civilian casualties during their military operations. This research finds that while American, Russian and Israeli national characters are, undoubtedly, products of the unique historical experience of each one of these nations, all of three pay very little regard to foreigners’ lives. Moreover, while it is generally argued that the international political pressure is a crucial factor that leads to the significant reduction of harmed civilians and destroyed civilian infrastructure, the findings of this research suggest that the American, Russian and Israeli governments are well prepared and politically equipped to fend off international criticism. As the analyses of the American, Russian and Israeli cases reveal, the political-military leaderships of these countries have very little external or domestic reasons to minimise enemy civilian casualties through fundamental-revolutionary change in their conduct of war. In other words, this research finds that employment of NLW have failed because the political leadership asks the militaries to reduce the enemy civilian casualties to a politically acceptable level, rather than to the technologically possible minimum; as in the socio-cultural-political context of each country, support for the former appears to be significantly higher than for the latter.

Local and cardiorenal effects of periodontitis in nitric oxide-deficient hypertensive rats

Objective: In this study we have assessed the renal and cardiac consequences of ligature-induced periodontitis in both normotensive and nitric oxide (NO)-deficient (L-NAME-treated) hypertensive rats. Materials and methods: Oral L-NAME (or water) treatment was started two weeks prior to induction of periodontitis. Rats were sacrificed 3, 7 or 14 days after ligature placement, and alveolar bone loss was evaluated radiographically. Thiobarbituric reactive species (TBARS; a lipid peroxidation index), protein nitrotyrosine (NT; a marker of protein nitration) and myeloperoxidase activity (MPO; a neutrophil marker) were determined in the heart and kidney. Results: In NO-deficient hypertensive rats, periodontitis-induced alveolar bone loss was significantly diminished. In addition, periodontitis-induced cardiac NT elevation was completely prevented by L-NAME treatment. On the other hand L-NAME treatment enhanced MPO production in both heart and kidneys of rats with periodontitis. No changes due to periodontitis were observed in cardiac or renal TBARS content. Conclusions: In addition to mediating alveolar bone loss, NO contributes to systemic effects of periodontitis in the heart and kidney. (C) 2010 Elsevier Ltd. All rights reserved.

Precambrian history of the Zona Transversal of the Borborema Province, NE Brazil: Insights from Sm-Nd and U-Pb geochronology

The Borborema Province has three major subprovinces. The northern subprovince lies north of the Patos shear zone and is comprised of Paleoproterozoic cratonic basement with Archean nuclei, plus overlying Neoproterozoic supracrustal rocks and Brasiliano plutonic rocks. The central subprovince occurs between the Patos and Pernambuco shear zones and is mainly comprised of the Zona Transversal. The southern subprovince occurs between the Pernamabuco shear zone and the Sao Francisco craton and is comprised of a tectonic collage of various blocks, terranes, or domains ranging in age from Archean to Neoproterozoic. This report focuses on the Zona Transversal, especially on Brasiliano rocks for which we have the most new information. Paleoproterozoic gneisses with ages of 2.0-2.2 Ga occur discontinuously throughout the Zona Transversal. The Cariris Velhos suite consists of metavolcanic, metasedimentary, and metaplutonic rocks yielding U-Pb zircon ages of 995-960 Ma. This suite is mainly confined to a 100 km wide belt that extends for more than 700 km within the Alto Pajeu terrane. Sm-Nd model ages in metaigneous rocks cluster about 1.3-1.6 Ga, indicating that older crust was involved in genesis of their magmas. Brasiliano supracrustal rocks dominate the Pianco-Alto Brigida terrane, and they probably also constitute significant parts of the Alto Pajeu and Rio Capibaribe terranes. They are only slightly older than early stages of Brasiliano plutonism, with detrital zircon ages at least as young as 620 Ma; most T(DM) ages range from 1.2 to 1.6 Ga. Brasiliano plutons range from ca. 640 to 540 Ma, and their T(DM) ages range from 1.2 to 2.5 Ga. Previous workers have shown significant correlations among U-Pb ages, Sm-Nd model ages, petrology, and geochemistry, and we are able to reinforce and extend these correlations. Stage I plutons formed 640 -610 Ma and have T(DM) ages less than 1.5 Ga. Stage 11 (610-590 Ma) contains few plutons, but coincides with the peak of compressional deformation, metamorphism, and formation of migmatites. Stage III plutons (590 to ca. 575 Ma) have older T(DM) ages (ca. 1.8-2.0 Ga), as do Stage IV plutons (575 to ca. 550 Ma; T(DM) from 1.9 to 2.4 Ga). Stage III plutons formed during the transition from compressional to transcurrent deformation, while Stage IV plutons are mainly post-tectonic. Stage V plutons (550-530 Ma) are commonly undeformed (except along younger shear zones) and have A-type geochemistry. The five stages have distinct geochemical properties, which suggest that the tectonic settings evolved from early, arc-related magma-genesis (Stage I) to within-plate magma-genesis (Stage V), with perhaps some intermediate phases of extensional environments. (C) 2011 Elsevier Ltd. All rights reserved.

Homogeneous middles vs. heterogeneous tails, and the end of the ‘Inverted-U’: the share of the rich is what it’s all about

This paper examines the current global scene of distributional disparities within-nations. There are six main conclusions. First, about 80 per cent of the world’s population now live in regions whose median country has a Gini not far from 40. Second, as outliers are now only located among middle-income and rich countries, the ‘upwards’ side of the ‘Inverted-U’ between inequality and income per capita has evaporated (and with it the statistical support there was for the hypothesis that posits that, for whatever reason, ‘things have to get worse before they can get better’). Third, among middle-income countries Latin America and mineral-rich Southern Africa are uniquely unequal, while Eastern Europe follows a distributional path similar to the Nordic countries. Fourth, among rich countries there is a large (and growing) distributional diversity. Fifth, within a global trend of rising inequality, there are two opposite forces at work. One is ‘centrifugal’, and leads to an increased diversity in the shares appropriated by the top 10 and bottom 40 per cent. The other is ‘centripetal’, and leads to a growing uniformity in the income-share appropriated by deciles 5 to 9. Therefore, half of the world’s population (the middle and upper-middle classes) have acquired strong ‘property rights’ over half of their respective national incomes; the other half, however, is increasingly up for grabs between the very rich and the poor. And sixth, Globalisation is thus creating a distributional scenario in which what really matters is the income-share of the rich — because the rest ‘follows’ (middle classes able to defend their shares, and workers with ever more precarious jobs in ever more ‘flexible’ labour markets). Therefore, anybody attempting to understand the within-nations disparity of inequality should always be reminded of this basic distributional fact following the example of Clinton’s campaign strategist: by sticking a note on their notice-boards saying “It’s the share of the rich, stupid”.