The blind men and the AML elephant:can we feel the progress?

The pharmacological therapy of non-promyelocytic acute myeloid leukemia (AML) has remained unchanged for over 40 years with an anthracycline–cytarabine combination forming the backbone of induction treatments. Nevertheless, the survival of younger patients has increased due to improved management of the toxicity of therapies including stem cell transplantation. Older patients and those with infirmity that precludes treatment-intensification have, however, not benefited from improvements in supportive care and continue to experience poor outcomes. An increased understanding of the genomic heterogeneity of AML raises the possibility of treatment-stratification to improve prognosis. Thus, efforts to identify agents with non-conventional anti-leukemic effects have paralleled those aiming to optimize leukemia cell-kill with conventional chemotherapy, resulting in a number of randomized controlled trials (RCT). In the last 18 months, RCTs investigating the effects of vosaroxin, azacitidine and gemtuzumab ozogamycin and daunorubicin dose have been reported with some studies indicating a statistically significant survival benefit with the investigational agent compared with standard therapy and potentially, a new era in AML therapeutics. Given the increasing costs of cancer care, a review of these studies, with particular attention to the magnitude of clinical benefit with the newer agents would be useful, especially for physicians treating patients in single-payer health systems

Electoral Volatility, Political Sophistication, Trust and Efficacy

In this article we investigate voter volatility and analyze the causes and motives of switching vote intentions. We test two main sets of variables linked to volatility in literature; political sophistication and ‘political (dis)satisfaction’. Results show that voters with low levels of political efficacy tend to switch more often, both within a campaign and between elections. In the analysis we differentiate between campaign volatility and inter-election volatility and by doing so show that the dynamics of a campaign have a profound impact on volatility. The campaign period is when the lowly sophisticated switch their vote intention. Those with higher levels of interest in politics have switched their intention before the campaign has started. The data for this analysis are from the three wave PartiRep Belgian Election Study (2009)

Polarization and ideological congruence between parties and supporters in Europe

The relationship between parties and their supporters is central to democracy and ideological representation is among the most important of these linkages. We conduct an investigation of party-supporter congruence in Europe with emphasis on the measurement of ideology and focusing on the role of party system polarization, both as a direct factor in explaining congruence and in modifying the effects of voter sophistication. Understanding this relationship depends in part on how the ideology of parties and supporters is measured. We use Poole’s Blackbox scaling to derive a measure of latent ideology from voter and expert responses to issue scale questions and compare this to a measure based on left–right perceptions. We then examine how variation in the proximity between parties ideological positions and those of their supporters is affected by the polarization of the party system and how this relationship interacts with political sophistication. With the latent ideology measure, we find that polarization decreases party-supporter congruence but increases the effects of respondent education level on congruence. However, we do not find these relationships using the left–right perceptual measure. Our findings underscore important differences between perceptions of left–right labels and the ideological constraint underlying issue positions