Search

Mini publics have become cornerstones of the European Union's Future of Europe (FoE) initiative. However, weaknesses in their designs bring their political influence into question. Often-unsystematic in design, they fail to strengthen participants' understandings of the issues under evaluation and induce silo-thinking and the formation of pseudo-preferences. These come at a cost to informed and deliberatively deduced recommendations which speak to underlying functional/operational technicalities which fundamentally determine the form and delivery of policy interests. Guided by the adage that form follows function, this paper argues that mini publics pertaining to the FoE must primarily encourage participants to think about the ways policies are made in the EU before they formulate policy recommendations. To do this, they must consider the EU's overall form (or prospective forms). Utilising data from focus group analysis, the paper demonstrates that scenario (vignette) models are conducive to strengthening participants' understandings of both existing and alternative EU forms, and their functional consequences for EU policies, thus enabling them to formulate concrete and potentially deliverable policy recommendations. Subsequently, the paper encourages organisers of relevant mini-publics to employ the European Commission's 'Five Scenarios for the FoE' as entry-points to strengthen the deliberative quality and democratic outputs of such exercises. [ABSTRACT FROM AUTHOR]

On the 25 March 2017, leaders of the EU27 and European Union (EU) institutions ratified the Rome Declaration. They committed to invite citizens to discuss Europe's future and to provide recommendations that would facilitate their decision-makers in shaping their national positions on Europe. In response, citizens' dialogues on the future of Europe were instituted across the Union to facilitate public participation in shaping Europe. This paper explores Ireland's set of dialogues which took place during 2018. Although event organisers in Ireland applied a relatively atypical and more systematic and participatory approach to their dialogues, evidence suggests that Irelands' dialogues were reminiscent of a public relations exercise which showcased the country's commitment to incorporating citizens into the debate on Europe while avoiding a deliberative design which could have strengthened the quality of public discourse and the quality of public recommendations. Due to an absence of elite political will for a deliberative process, as well as structural weaknesses in design, participants' recommendations lacked any clear and prescriptive direction which could shape Ireland's national position on the future of Europe in any constructive or meaningful way. [ABSTRACT FROM AUTHOR]

The second half of 2021 brought cautious hope to Ireland due to the gradual reopening of the economy following nationwide lockdowns due to the Covid-19 pandemic. The employment rate increased and pandemic-related deaths declined. However, economic forecasts remain uncertain, particularly due to the Russian aggression and the impact of the Northern Ireland Protocol. Nevertheless, Ireland remains committed to the European project and the defense of its core values. [Extracted from the article]

The Millennium Development Goals era achieved substantial improvements in the health of women and children. Yet progress was uneven and many women and children still suffer from preventable mortality and morbidity. The United Nations Secretary General's Global Strategy for Women's, Children's and Adolescents' Health (2016–2030) set out an ambitious 'survive, thrive and transform' agenda for countries as they accelerate progress towards the health-related Sustainable Development Goals. This review highlights aspects of 'survive, thrive and transform' that have had strong traction globally, namely quality of care and humanitarian settings for 'survive', early childhood development and adolescent health for 'thrive' and community engagement and a sustainable environment for 'transform'. [ABSTRACT FROM AUTHOR]

Children in All Policies 2030: a new initiative to implement the recommendations of the WHO-UNICEF-Lancet Commission. [Extracted from the article]

Connected by a shared endeavour to enhance understanding of the forces that shape contestation toward the EU in its peripheries and unprohibited in approach, this special section explores the concepts of contestation and periphery. Using various methodological approaches, the section showcases a series of overlapping and cross-cutting themes which contextually strengthen the phenomenon and experiences of contestation in peripheral states. In aggregating these themes, the authors attribute contestation to the growing 'absence' of the EU's normative interest in peripheral states and the growing transactional/functional features that define peripheral state relationships with the EU. The authors draw attention to the opportunities for regional rivals, such as Russia and China to capitalize on the absence of the EU's transformative power in peripheral states, the role of domestic forces in utilizing contestation as a means to preserve regime type and satisfy sovereignty concerns, and the incidences of peripheral states in shaping/reshaping their foreign policy positions in response to the Russia-Ukraine war. Taken together, our special section shows that contestation in Europe's periphery is less an overt normative resistance against the EU and more an absence of EU normative efforts in peripheral states and the increasingly functional features which define peripheral states' relationships with the EU. [ABSTRACT FROM AUTHOR]

OBJECTIVE: • To characterize the immunohistochemical nature of sympathetic and parasympathetic nerves surrounding the prostate. MATERIALS AND METHODS: • Using serial sectioning, four male cadavers were investigated using a combination of haematoxylin and eosin staining and immunohistochemistry. Both the sympathetic and parasympathetic contributions to the autonomic nervous system in the periprostatic region were assessed by staining analysis, the number of nerves fibres was quantified, their position relative to the prostate recorded and their function inferred. • The fascial architecture of the neurovascular bundle (NVB) was also quantified. RESULTS: • Approximately 27.8% of all nerve fibres identified were found on the anterior half of the prostate, above the 3 to 9 o’clock level. At the base, mid, and apex of rostate, parasympathetic fibres accounted for 4%, 5% and 6.8% of the nerves located on the anterolateral aspect of the prostate, respectively. • Sympathetic nerves found above the 3 to 9 o’clock level represented ª 15% of the total number of nerves. • When staining the periprostatic fascia, the classical NVB exhibited a distinct fascial architecture with three separate compartments. CONCLUSIONS: • A tiny minority of nerves in the anterior periprostatic region are functionally significant parasympathetic nerves. • There is little anatomical evidence to support higher incisions in the lateral prostatic fascia to spare cavernous nerve fibres, although such approaches may reduce the risk of traction injury on the more posterolaterally located NVB. • The presence of distinct fascial compartments in the NVB is also confirmed. [ABSTRACT FROM AUTHOR]

An interview with Anthony J. Costello, director of urology at the Royal Melbourne Hospital, regarding the robotic prostate cancer surgery is presented. When asked how did the robotic program get started, he notes that he became interested after seeing one robot at an American Urological Association conference then decided in 2002 to look at the installation of robotics for prostate cancer treatment. Costello believes that the robot is another surgical instrument that will make surgeons better.

The article discusses the management of the health effects of climate change. The authors explain that inputs from all sectors of government and civil society, collaboration between academic disciplines, and new ways of international cooperation will be needed. The importance of reducing poverty and health inequities is discussed. The greenhouse effect, anthropogenic climate change, and global warming are examined. Six ways that link climate change to health are examined: changing patterns of disease and mortality, extreme events, food, water, shelter, and population and migration. Challenges associated with the generation and dissemination of information are discussed. The technological challenge to address the negative health consequences of climate change in poor countries is examined.

The Millennium Development Goals (MDGs), ratified by most nations in 2000, set specific targets for poverty reduction, eradication of hunger, education, gender equality, health and environmental sustainability. MDG 4 aims to reduce child mortality with a target of reducing under-five mortality rates by two thirds over the period 1990-2015. Over the last year, Live Aid, Make Poverty History, the G8 summits and prominent entertainers have directed unprecedented attention towards development and health. Africa particularly has been in the spotlight. Reports are published and commitments are made, but is there real progress? Are poor people being reached with essential health care? Who will hold leaders to account: celebrities, activists or health professionals? [ABSTRACT FROM AUTHOR]

The article reports on the lack of information regarding how to effectively implement programs that increase the survival rates of mothers and infants in developing nations. Since funding is limited, research must be performed to determine which programs are successful as well as cost effective. The author focuses on efforts put into practice to help reach the United Nation's Millennium Development Goals, specifically goals 4 and 5 which have to do with child and maternal mortality rates. A Delphi method was used to document the predictions of medical professionals who had experience working in developing countries. Findings revealed that the prevention of sepsis in newborns was among the top concerns. The Bill & Melinda Gates Foundation is mentioned.

Authors from Australia describe how interfering with cell survival is increasingly being chosen as a method of developing a treatment strategy for hormone-resistant prostate cancer. The authors show how several developmental drug candidates have preclinical and clinical activity against cell survival proteins, and that these might be worth considering as possible clinical entities in this condition. The commonly stated argument that laparoscopy has advanced the cause of donor nephrectomy in renal transplantation is examined by authors from the UK. They present a review of the published reports and show that the evidence base is poor for drawing a conclusion as to whether laparoscopic or open nephrectomy is best. [ABSTRACT FROM AUTHOR]

To determine the efficacy of low-dose imatinib mesylate (STI571) alone or combined with a taxane (paclitaxel) in inhibiting the growth of experimental extra-osseous hormone-refractory prostrate cancer. Orthotopic PC3 prostate tumours were established in male severe combined-immunodeficient mice; on day 3 the mice were randomly assigned to one of four groups: paclitaxel 10 mg/kg intraperitoneally once a week; STI571 50 mg/kg once a day for 6/7 weekdays; combined paclitaxel and STI571; and vehicle-treated controls. On day 40, the primary prostate tumour and metastatic lymphadenopathy were removed and measured. Effects were correlated with tumour cell proliferation and microvessel density. Paclitaxel reduced the mean tumour weight and volume by 21.3% (not significant) and 73.7% ( P < 0.05), respectively, compared to controls, and reduced the number of lymph node metastases by 49.1% ( P < 0.05) and mean lymph node size by 13.5% (not significant). Adding low-dose STI571 had a small additive effect on tumour weight and the incidence of lymph node metastases, but this was not significant compared to paclitaxel alone. STI571 alone did not inhibit tumour progression. Antitumour effects were associated with parallel changes in tumour cell proliferation with no significant changes in neo-angiogenesis. Combined low-dose STI571 and paclitaxel had little synergy in this experimental model. Low-dose STI571 monotherapy was not effective in extra-osseous disease, apparently due to a site-specific failure to up-regulate β-platelet-derived growth factor receptor expression in prostate cancer cells and associated tumour stroma. [ABSTRACT FROM AUTHOR]

To assess the ability of untrained laparoscopic surgeons to learn and implement laparoscopic telerobotic radical prostatectomy (TRP) using the daVinci Surgical System (Intuitive Surgical, CA), and assess the education, safety and efficacy issues when instituting this system. Between December 2003 and October 2004, 122 consecutive TRPs were performed by two surgeons for clinically localized prostate cancer. The individual robotic surgeon was assisted at the bedside by another surgeon. The TRP was performed robotically by the surgeon at the remote console unit. Perioperative data and pathological results were recorded. The two surgeons spent 1 week in a skills laboratory using a porcine model of laparoscopic TRP, and then cadaveric robotic prostatectomy. The first six cases were mentored by an experienced telerobotic surgeon. The TRP was conducted by two surgeons with no previous laparoscopic experience. There were no conversions to open surgery. Assessing the complications, postoperative continence, operating time and transfusion rates showed equivalent efficacy and safety to open and pure laparoscopic methods. TRP represents a novel computer-based surgical approach to prostate cancer, which offers the benefits of minimally invasive surgery without the extensive experience associated with the laparoscopic method. It remains to be seen whether the robotic approach can deliver better outcomes in continence and potency over time. [ABSTRACT FROM AUTHOR]

To accurately define the anatomy of the neurovascular bundle (NVB) in men.The NVB was microdissected in detail bilaterally in 12 fixed human male adult cadavers. The anatomy of the NVB and its relationship to surrounding pelvic structures was ascertained in each specimen.Previous reports of the anatomy of the NVB have not mentioned its levator ani and anterior rectal component. The anatomy of the cavernosal nerves is such that accurate graft anastomosis to proximal and distal cavernosal nerve segments is extremely difficult.The current anatomical description of the cavernosal nerve and NVB is inaccurate. [ABSTRACT FROM AUTHOR]

Identifies the impact of diagnosis and treatment of prostate cancer on patients. Use of Functional Assessment of Cancer Therapy-Prostate questionnaires for patients; Changes in the relationship after diagnosis; Determination of the quality of life of patients.

Examines the micronutrient status of during pregnancy and its outcome for newborn infants in developing countries. Association of vitamin A deficiency with reduced fetal survival; Relation of zinc deficiency with fetal wastage, stillbirth, delivery complications and neonatal death; Increase in cell proliferation.

More than 9 million neonatal deaths occur each year, 98% of them in developing countries. Neonatal deaths account for two-thirds of deaths in infancy and 40% of deaths before age 5 y. The major direct causes of neonatal death are infections, preterm delivery and asphyxia. Important indirect causes include low birth weight and hypothermia. The present body of work on multiple micronutrient interventions is not sufficient for us to draw conclusions on their effects on neonatal well-being. Because studies have generally concentrated on single micronutrients and a range of outcomes, this paper reviews the findings for individual nutrients and then summarizes the situation. The evidence for the contribution of micronutrient deficiencies to perinatal mortality and duration of gestation is limited, and the evidence base for individual micronutrient effects on neonatal mortality and morbidity is patchy. To translate knowledge into policy, community evaluations of effect and an expanded evidence base that includes affordability, acceptability and scalability are also required. A balance between supply-side and demand-side interventions must be struck, with an emphasis on effect and sustainability. Among the key requirements are randomized, controlled community effectiveness trials of the effect of micronutrient supplementation in pregnancy on perinatal mortality and neurodevelopment, studies on improving adherence and studies on the relation between micronutrient deficiencies and sepsis and neonatal encephalopathy. It would also be helpful to look at mechanisms for bringing the periconceptional period within the ambit of trials. [ABSTRACT FROM AUTHOR]

: ObjectivesTo evaluate the effectiveness of 2-octyl cyanoacrylate adhesive (OCA) in the formation of vesicourethral anastomoses.: MethodsOpen total prostatectomy was performed on 12 mongrel hounds. Of these, 8 had a vesicourethral anastomosis formed using OCA (4 with suture support and 4 sutureless). The remaining four anastomoses were conventionally formed using eight interrupted sutures. Acute leakage was tested intraoperatively. Before killing the hounds, the anastomosis of 1 animal in each group was assessed on postoperative days 3, 5, 7, and 14 by radiography. Each anastomotic specimen was then tested for leak pressure and examined histologically.: ResultsAt intraoperative testing, one small leak was found in the sutureless OCA group. All other anastomoses were watertight intraoperatively. Radiographically, two leaks occurred in the OCA group with suture support, three leaks in the sutureless OCA group, and only one small localized leak in the control group. Only one of the eight anastomoses using OCA achieved a physiologic leak pressure greater than 70 mm Hg (one of these, however, could not be tested because of injury at the time the specimen was retrieved). The leak pressures of all four control-group anastomoses were 70 mm Hg or greater. Histologically, no significant differences were found in healing between the control and OCA anastomoses.: ConclusionsWith or without suture support, OCA appears to be unsuitable for use in forming the large-diameter vesicourethral anastomosis required in radical prostatectomy. [Copyright &y& Elsevier]

Background: Interstitial cystitis is a chronic non-infectious inflammatory disease of the bladder of unknown aetiology which is characterized by irritative voiding symptoms and suprapubic pain related to bladder filling. Surgical treatment is indicated in severely symptomatic patients when medical therapies have failed, usually after a period of several years. The authors’ experience with a modified technique of ileocystoplasty following supratrigonal cystectomy performed in five patients with interstitial cystitis is presented here. Methods: A modified technique of bladder augmentation using ileum following supratrigonal bladder resection is described. Results: All patients experienced relief from their symptoms. No patient had residual bladder pain and urinary frequency settled down in all. Bladder capacity was increased significantly. Three patients voided spontaneously postoperatively and two required clean intermittent self-catheterization. Conclusions: Supratrigonal cystectomy and ileocystoplasty can be a satisfactory option in refractory cases of interstitial cystitis. A simplified technique of ileal bladder construction that provides satisfactory bladder capacity is presented. Most urologists are familiar with ileal surgery, having used the ileum as a conduit after cystectomy for urinary diversion. [ABSTRACT FROM AUTHOR]

The article discusses a study of randomised trials which showed that antenatal corticosteroids promoted fetal lung maturation, reduced respiratory distress and neonatal deaths. Topics discussed include the number of babies annually that could be saved with life-saving products including antenatal corticosteroids and critics' claim that antenal corticosteroids pose a low risk of adverse effects.

Background: Immunotherapy has demonstrated limited activity in prostate cancer to date. This likely reflects an immune suppressive tumor microenvironment (TME), with previous studies suggesting low PD-L1 expression and a sparse immune cell infiltrate. We aimed to further characterise the immune TME in primary prostate cancer and correlate immune subset densities with clinical outcomes. Methods: Two distinct cohorts of patients treated with radical prostatectomy were identified, based on the development of biochemical recurrence (BCR), one subgroup with high International Society of Urological Pathologists (ISUP) grade group, recurrent disease and a second with low grade, non-recurrent disease. A prostate immunohistochemical (IHC) antibody cocktail was used to differentiate tumor and peritumoral benign tissue. Specific CD8+, CD4+, FoxP3+, CD20+ and CD68+ cell subsets were identified using IHC staining of consecutive slides. PD-L1 and CD8/PD-L1 dual staining were also performed. Cell subset densities were quantified within tumor and peritumoral regions. We used descriptive statistics to report cell subset densities and T-tests to compare groups by age, grade and the development of BCR. Univariable and multivariable logistic regression were used to analyse risk factors for BCR and the development of metastatic disease. Results: A total of 175 patients were included, with a median age of 63 years and median pre-operative PSA of 8.2ng/ml. BCR occurred in 115 patients (66%) and 56 (32%) developed metastatic disease. CD68+ cells were the most abundant (median 648.8/mm2 intratumoral, 247.6/mm2 peritumoral), while PD-L1+ and PD-L1/CD8+ cell density was low overall (PD-L1+ median 162.4/mm2 intratumoral, 141.7/mm2 peritumoral; PD-L1/CD8+ (median 5.52/mm2 intratumoral, 3.41/mm2 peritumoral). Overall, grade group and T-stage were independently associated with BCR and metastatic disease. Higher density of peritumoral PD-L1+ cells was an independent risk factor for BCR (OR 5.33, 95%CI 1.31–21.61, p = 0.019).Although higher densities of CD8+ and CD4+ cells were observed in higher grade group 3–5 tumors, these were not associated with the development of BCR or metastasis. Conclusions: In our cohort of prostate cancer patients who underwent radical prostatectomy, higher grade group and T-stage were independent predictors of BCR and metastasis. Despite higher grade group being associated with higher CD8+ cell density, PD-L1+ and PD-L1/CD8+ cell densities were low overall, suggesting lower T cell receptor recognition of tumor antigens. Further understanding of this phenomenon would influence development of future immunotherapeutic strategies in prostate cancer. [ABSTRACT FROM AUTHOR]

Examines age differences in the reliability of the psychiatric interview of the child. Level of reliability achieved by parents and children in reporting child symptoms; Existence of an opposite age pattern for parent and child; Interpretation of findings in terms of children's cognitive development and age-related shifts in parents' perceptions and awareness of their children's behavior.

- Correlations between scores derived from structured interviews with 299 disturbed children aged 6-18 and their parents indicated low-to-moderate levels of agreement regarding the presence and severity of child psychiatric symptoms. Agreement was higher on behavior and conduct problems than on anxiety, fears, obsessions-compulsions, psychotic symptoms and affective disturbances. Parents reported more child behavior and conduct problems than children, whereas children reported more affective and neurotic symptoms than parents. Parent-child agreement also increased sharply with age. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss a cluster-randomized placebo-controlled trial of vitamin A supplementation in Ghana, published within the issue. The trial discovered that daily vitamin A supplementation does not reduce maternal mortality. The authors raise questions regarding the trial's findings, such as whether the trial rule out the effect of vitamin A supplementation during pregnancy on newborn and infant mortality. They argue that new research are needed to understand and reduce maternal mortality ratios.

The article introduces the formation of a joint commission between "The Lancet" and University College London (UCL) to study and report on health-related issues affected by climate change. The Lancet-UCL Commission on Climate Change seeks to review the impact of climate change on global health and offer ways to reverse the health consequences for the global community.

The article looks at ways to reduce maternal mortality. The authors state there is a need for context-specific service and community-based strategies in addition to intrapartum care. The authors also make four policy recommendations, which include greater family awareness of the risks of sepsis and access to antibiotics, oral misoprostol should be provided to government-based outreach health workers in order to help prevent maternal death from hemorrhage, and governments should focus on creating safer motherhood programs to help empower women and communities for their pregnancy, childbirth, and newborn care rights.

Argues in favor of creating an international fund for maternal, neonatal, and child health. Claim that world leaders will meet in September, 2005 to review progress toward the United Nations' (UN) Millennium Development Goals; Creation of a fund for greater health investment in Africa and Asia in 2001; Health conditions of women, infants, and children worldwide; Importance of foreign aid to the improvement of public health in Africa and Asia; Description of UN programs aimed at improving economic and social conditions in the developing world; Estimated cost of a global fund for maternal and child health; Assessment of the UN's existing global fund for public health; Recommendations for public health policies to improve maternal and child health.

Argues that well intended western programmes to reduce maternal and neonatal mortality are failing and that the best course of action is to use community based interventions. Trial in Nepal which showed a 30% reduction in death as a result of community intervention; Details of the Nepal study and the belief it proved the viability of community interventions in poor, rural populations; Family planning services; Treatment strategies for perinatal sepsis; Management of postpartum haemorrhage; Collaboration with traditional birth attendants; Urgent call for large scale community effectiveness trials.

Discusses the principles and priorities of cooperative medical research partnerships in developing countries. Potentially negative impact of foreign-owned research on such countries; Importance of translating research findings into locally relevant policy and practice; Drawbacks of expatriate-led annexed research models in developing countries; Recommendation that research funding agencies should reform their investment decisions regarding such countries.

The article discusses the controversy over the deal between The Global Fund to Fight AIDS, Tuberculosis and Malaria under director Peter Sands and the Lombard Odier, a bank that specializes in wealth management. Topics discussed include the bank's failure to monitor flight capital and theft from low-income and middle-income countries, litigation against Lombard over money stolen from the telecommunications sector in Uzbekistan and The Global Fund's conflict of interest over the Lombard deal.

Evaluates the impact and sustainability of a baby friendly training intervention for staff at an Indian district hospital on initiation of breast feeding and use of prelacteal feed by mothers. Importance of training doctors and midwives for the improvement of feeding practices of mothers; Decline in the number of baby given prelacteal feeding.