PROJECT FOR THE ANALYSIS OF LAND TENURE AND AGRICULTURAL PRODUCTIVITY IN THE REPUBLIC OF MACEDONIA

The paper arises out of the Land Market Project and covers detailed data at the individual farm level and in-depth analyses of legal and historical processes. The agricultural sector in Macedonia is characterized by two very different farm enterprise types: small family farms operating on privately owned land, and large socially owned farms. About 30 percent of the total arable land in Macedonia belongs to socially owned farms. Most of the balance belong to the private farm sector; the cooperative sector occupies a small percentage of the arable land. The Land Markets Project addressed five tasks during the six-month term of the project: (1) assess the appropriateness of legislation, regulations, and institutions affecting land tenure and land use, (2) document and assess the land-related constraints to increased productivity and profitability of private farms, (3) document and assess the land-related constraints to increased productivity and profitability of socially owned farms, (4) propose land policy adjustments that would promote increased productivity and profitability of the agricultural sector, (5) identify financial and technical assistance to support the development of land markets that promote efficient, sustainable, and equitable increases in agricultural incomes. This paper reports the results of the first three tasks and then presents a comparative review of the land tenure and productivity results for both the private and the social sector. This comparison forms a basis for policy dialogue. The paper also includes a comprehensive discussion of the policy recommendations that stem from the Land Markets Project.Land tenure--Macedonia (Republic), Land use, Rural--Economic aspects--Macedonia (Republic), Farms, Size of--Macedonia (Republic), Agriculture--Economic aspects--Macedonia (Republic), Agricultural productivity--Macedonia (Republic), Land markets--Macedonia (Republic), Agrarian structure--Macedonia (Republic), Land Economics/Use, Productivity Analysis,

Primary treatment of acromegaly with high-dose lanreotide: a case series

<p>Abstract</p> <p>Introduction</p> <p>The first-line treatment for acromegaly is transsphenoidal surgery. In approximately 50% of patients, however, a cure is not possible with surgery and alternatives are needed. Somatostatin analog therapy is the recommended first-line treatment in patients with such cases. Here we provide the first report of a high-dose lanreotide primary therapy in patients with acromegaly.</p> <p>Case presentation</p> <p>Six patients who were not suitable for surgery were given 60 mg of lanreotide (Autogel^®) every four weeks. All patients were German nationals and Caucasian.</p> <p>When the response of our patients was unsatisfactory, the dose was increased sequentially to 90 mg every four weeks, 120 mg every four weeks, 120 mg every three weeks and 180 mg every three weeks. Treatment duration was 12 to 24 months. In all cases, the lanreotide dose was 120 mg every 4 weeks or higher. In five of our patients, growth hormone (GH) levels were successfully reduced (in three patients GH <2.5 ng/ml was achieved). Insulin-like growth factor 1 levels were normalized in three patients and decreased in two patients. One patient failed to show a biochemical response to lanreotide therapy or pegvisomant therapy.</p> <p>Tumor shrinkage or degeneration was observed in the five responding patients. No drug-related adverse events were noted.</p> <p>Conclusions</p> <p>These results suggest that lanreotide at high doses of 120 mg every four weeks or more is an effective first-line therapy for patients with acromegaly that surgery alone cannot treat.</p

Corporate Culture of Contemporary Research University in Search of Complementarity of Humanitarian and Commercial Principles in Education (Russian Context)

Background: In the paper the formation of world-class research universities is analysed. The paper studies the history of the research university, prerequisites of its appearance, formation and its development toward modern research university. The modern research university is being cautiously viewed nowadays. The crisis of the university is its reality. The question of the corporate culture formation is now considered to be a topical matter in connection with globalization process, Methods: The authors implemented comparative analysis by comparing Humboldt's model of the research university and the modern one. Results: The comparison is made in regard to the idea of university, its criteria and mission. Special emphasis is laid on the analysis and comparison of corporate culture systems. Conclusions: Corporate culture is a novel criterion of the classical university that has recently arisen in the information society and now characterizes the university in a complementary way: on the one hand, as a competitive market entity, and on the other hand, as a guardian of its traditional, historically formed humanitarian criteria, ideas and mission. The following conclusion has been reached: the updated parameters have the identical form to those found by W. von Humboldt, only essence has changed

A consensus on the diagnosis and treatment of acromegaly complications

In March 2011, the Acromegaly Consensus Group met to revise and update the guidelines on the diagnosis and treatment of acromegaly complications. The meeting was sponsored by the Pituitary Society and the European Neuroendocrinology Association and included experts skilled in the management of acromegaly. Complications considered included cardiovascular, endocrine and metabolic, sleep apnea, bone diseases, and mortality. Outcomes in selected, related clinical conditions were also considered, and included pregnancy, familial acromegaly and invasive macroadenomas. The need for a new disease staging model was considered, and design of such a tool was proposed

Rapid and sustained reduction of serum growth hormone and insulin-like growth factor-1 in patients with acromegaly receiving lanreotide Autogel® therapy: a randomized, placebo-controlled, multicenter study with a 52 week open extension

The study was designed to evaluate the long-term efficacy and safety of the 28-day prolonged-release Autogel formulation of the somatostatin analogue lanreotide (Lan-Autogel) in unselected patients with acromegaly. The study comprised four phases: washout; a double-blind comparison with placebo, at a single randomized dose (60, 90 or 120 mg) of Lan-Autogel; a single-blind, fixed-dose phase for four injections (placebo group was re-allocated to active treatment); and eight injections with doses tailored according to biochemical response. Serum samples were assessed for growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels, at weeks 4, 13, 14, 15, 16, 32 and 52. 108 patients were enrolled and 99 completed 52 weeks’ treatment. Four weeks after the first injection, serum GH levels decreased by >50% from baseline in 63% of patients receiving Lan-Autogel compared with 0% receiving placebo (P < 0.001). After four injections, 72% of patients had a >50% reduction in GH levels; 49% patients achieved GH levels ≤ 2.5 ng/ml; 54% had normalized IGF-1; and 38% achieved the combined criterion of GH level ≤ 2.5 ng/ml and normalized IGF-1. The corresponding proportions by week 52 were 82, 54, 59 and 43%, respectively. In patients not requiring dose escalation to 120 mg, 85% achieved biochemical control (combined criterion). Treatment was well tolerated by all patients. In conclusion, Lan-Autogel was effective in controlling GH and IGF-1 hypersecretion in patients with acromegaly and showed a rapid onset of action

Clinical effectiveness and cost-effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation

Background: Acromegaly, an orphan disease usually caused by a benign pituitary tumour, is characterised by hyper-secretion of growth hormone (GH) and insulin-like growth factor I (IGF-1). It is associated with reduced life expectancy, cardiovascular problems, a variety of insidiously progressing detrimental symptoms and metabolic malfunction. Treatments include surgery, radiotherapy and pharmacotherapy. Pegvisomant (PEG) is a genetically engineered GH analogue licensed as a third or fourth line option when other treatments have failed to normalise IGF-1 levels. Methods: Evidence about effectiveness and cost-effectiveness of PEG was systematically reviewed. Data were extracted from published studies and used for a narrative synthesis of evidence. A decision analytical economic model was identified and modified to assess the cost-effectiveness of PEG. Results: One RCT and 17 non-randomised studies were reviewed for effectiveness. PEG substantially reduced and rapidly normalised IGF-1 levels in the majority of patients, approximately doubled GH levels, and improved some of the signs and symptoms of the disease. Tumour size was unaffected at least in the short term. PEG had a generally safe adverse event profile but a few patients were withdrawn from treatment because of raised liver enzymes. An economic model was identified and adapted to estimate the lower limit for the cost-effectiveness of PEG treatment versus standard care. Over a 20 year time horizon the incremental cost-effectiveness ratio was pound81,000/QALY and pound212,000/LYG. To reduce this to pound30K/QALY would require a reduction in drug cost by about one third. Conclusion: PEG is highly effective for improving patients' IGF-1 level. Signs and symptoms of disease improve but evidence is lacking about long term effects on improved signs and symptoms of disease, quality of life, patient compliance and safety. Economic evaluation indicated that if current standards (UK) for determining cost-effectiveness of therapies were to be applied to PEG it would be considered not to represent good value for money

Early Lung Function Abnormalities in Acromegaly.

BACKGROUND: Acromegaly is an insidious disorder caused by a pituitary growth hormone (GH)-secreting adenoma resulting in high circulating levels of GH and insulin-like growth factor I (IGF-I). Respiratory disorders are common complications in acromegaly, and can severely impact on quality of life, eventually affecting mortality. OBJECTIVES: The present study aimed to explore structural and functional lung alterations of acromegalic subjects. METHODS: We enrolled 10 consecutive patients (M/F: 5/5) affected by acromegaly. In all patients, magnetic resonance imaging (MRI) revealed the presence of pituitary tumor. All patients underwent clinical, lung functional, biological, and radiological assessments. Ten healthy age-matched subjects also served as controls. RESULTS: No statistically significant differences in lung function were detected between acromegalic and healthy subjects (p ≥ 0.05 for all analyses). However, the diffusing capacity for CO (TLCO) was significantly lower in the acromegalic group than in healthy subjects (TLCO% predicted: 78.1 ± 16 vs. 90 ± 6 %, respectively, p = 0.04; KCO% predicted: 77 ± 16 vs. 93 ± 5 %, p = 0.02, respectively). None of the lung function parameters correlated with duration of the disease, or with inflammatory marker of the airways. In acromegalics, biological (exhaled NO concentrations) and imaging (total lung volume, TLV, and mean lung density, MLD) evaluations were within normal values. The TLV measured by HRCT was 3540 ± 1555 ml in acromegalics, and the MLD was -711 ± 73 HU. None of the lung functional, radiological, and biological findings correlated with GH or IGF-I levels, and no correlation was found with duration of disease. CONCLUSIONS: In the current study, lung function evaluation allowed to detect early involvement of lung parenchyma, as assessed by TLCO and KCO, even in the absence of parenchymal density alterations of the lung by HRCT. These findings suggest to routinely include the carbon monoxide diffusing capacity in the lung function assessment for an early intervention in acromegaly

Aspects of Black Hole Quantum Mechanics and Thermodynamics in 2+1 Dimensions

We discuss the quantum mechanics and thermodynamics of the (2+1)-dimensional black hole, using both minisuperspace methods and exact results from Chern-Simons theory. In particular, we evaluate the first quantum correction to the black hole entropy. We show that the dynamical variables of the black hole arise from the possibility of a deficit angle at the (Euclidean) horizon, and briefly speculate as to how they may provide a basis for a statistical picture of black hole thermodynamics.Comment: 20 pages and 2 figures, LaTeX, IASSNS-HEP-94/34 and UCD-94-1

Hamiltonian thermodynamics of two-dimensional vacuum dilatonic black holes

We consider the Hamiltonian dynamics and thermodynamics of the two-dimensional vacuum dilatonic black hole in the presence of a timelike boundary with a fixed value of the dilaton field. A~canonical transformation, previously developed by Varadarajan and Lau, allows a reduction of the classical dynamics into an unconstrained Hamiltonian system with one canonical pair of degrees of freedom. The reduced theory is quantized, and a partition function of a canonical ensemble is obtained as the trace of the analytically continued time evolution operator. The partition function exists for any values of the dilaton field and the temperature at the boundary, and the heat capacity is always positive. For temperatures higher than $\beta_c^{-1} = \hbar\lambda/(2\pi)$, the partition function is dominated by a classical black hole solution, and the dominant contribution to the entropy is the two-dimensional Bekenstein-Hawking entropy. For temperatures lower than~$\beta_c^{-1}$, the partition function remains well-behaved and the heat capacity is positive in the asymptotically flat space limit, in contrast to the corresponding limit in four-dimensional spherically symmetric Einstein gravity; however, in this limit, the partition function is not dominated by a classical black hole solution.Comment: 20 pages, REVTEX. Added a discussion on the boundary action and boundary terms in Sec. IIIA. Minor changes in Acknowledgements and Reference