15 research outputs found
Ecology and foreign policy : theoretical lessons from the literature
A comprehensive understanding of international environmental politics requires attention to foreign policy. In this essay we describe many of the most prominent—and some of the less prominent—theories and approaches to foreign policy and international relations, with emphasis on how they can help us to better understand foreign policy in the environmental issue area. We organize the theories into three categories: systemic theories, which emphasize the influence of the international system, including the distribution of power within it; societal theories, which focus our attention on domestic politics and culture; and state-centric theories, which find answers to questions about foreign policy within the structure of the state and the individuals who promulgate and implement foreign policies in the name of a given country. Within this presentation of various theories, we highlight the influence of power, interests and ideas
Responding to Global Warming: Adaptation and Transformational Change
The inadequacy of global efforts to reduce emissions of gases that accumulate in the atmosphere and result in global warming has led to greater attention to coping with a warmer world. While the capacity to adjust in various ways to higher global average temperatures might imply less urgency to reducing emissions, adaptation is also costly. Thus, questions of equity and responsibility arise. As a global problem, climate change faces the challenges of formulating and implementing legal, ethical, and normative obligations. The system of sovereign states assumes that governments will attend first to their own interests. If economic growth requires burning more than a countr
THE ETHICS OF SUSTAINABILITY
Sustainable development has become a central value of the United Nations and a broadly accepted goal for policy makers around the world. In part, the case for sustainable development asserts ethical obligations to the poor, historically disadvantaged countries, and fu-ture generations. Such ethical obligations have become embodied in international law and practice. The most widely recognized definition states
Environmental Change and Foreign Policy: A Survey of Theory
Acomprehensive understanding of international environmental politics re quires attention to foreign policy. In this essay we describe a wide range of theories and approaches to foreign policy and international relations, with emphasis on how they can help us to better understand foreign policy in the environmental issue area. We organize the theories into three categories: systemic theories, which emphasize the influence of the international system, including the distribution of power within it; societal theories, which focus our attention on domestic politics and culture; and state-centric theories, which find answers to questions about foreign policy within the structure of the state and the individuals who promulgate and implement foreign policies in the name of a given country. Within this presentation of various theories, we highlight the influence of power, interests and ideas. Copyright (c) 2002 Massachusetts Institute of Technology.
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Survival comparison of primary cytoreductive surgery versus interval cytoreductive surgery for the treatment of advanced-stage uterine serous carcinoma
Uterine serous carcinoma (USC) is a rare but aggressive histologic variant of endometrial cancer that accounts for less than 10% of cases but 80% of endometrial cancer deaths. Initial treatment strategies have remained largely unchanged over the years, with the mainstay of treatment being primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy with or without tailored radiotherapy. More recent strategies have incorporated the use of neoadjuvant chemotherapy (NAC) in certain cases with bulky nodal disease or stage IV disease. This study compares survival outcomes between PCS and neoadjuvant chemotherapy followed by an interval cytoreductive surgery (ICS).
Retrospective data spanning 7 years was collected for patients with stage III or IV USC in a large academic institution. PCS was categorized as initial surgical treatment for stage III or IV disease. This was further stratified into microscopic and bulky disease at the time of surgery. ICS was defined as initial treatment with NAC with interval cytoreductive surgery. Overall survival (OS) and progression free survival (PFS) were calculated for each group with Kaplan-Meier estimation and analyzed using the Chi-Square test.
Forty-seven patients were identified to have stage III or IV disease at the time of diagnosis. 35 patients underwent PCS and 12 underwent ICS. The PCS and ICS groups were matched for race, age and BMI. Among the PCS patients, 52% had bulky disease. OS was 82.1 months compared to 40.1 months for PCS and ICS respectively (p=0.23). PFS of PCS patients was 42.9 months compared to 18.1 months of ICS patients (p=0.03). PCS of non-bulky disease, PCS of bulky disease and ICS had OS of 82.1, 40.9, and 31.8 months respectively (p=0.47) while PFS was 42.9, 19.6 and 13.8 months for PCS of non-bulky disease, PCS of bulky disease and ICS respectively (p=0.02). For patients with non-bulky disease and bulky disease, OS was 82.1 vs 40.1 months respectively (p=0.23) while PFS was 42.9 and 18.1 months respectively (p=0.32). Patients with bulky disease who had PCS had an OS of 40.9 months compared to 31.8 months for ICS (p=0.86) and PFS of 19.7 months vs 13.9 months (p=0.13).
While no statistical difference in OS was observed between the groups, there was a significant improvement in PFS in the PCS patients compared to ICS patients. PFS was significantly longer after PCS regardless of bulky disease. PFS appears to favor PCS over ICS. This study is limited by the small sample size. Additional studies are needed to better determine optimal treatment strategies for patients with advance stage USC