Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): Study protocol for a multicentre randomized controlled trial

Background: Pancreatic cancer is the fourth largest cause of cancer death in the United States and Europe with over 100,000 deaths per year in Europe alone. The overall 5-year survival ranges from 2-7 % and has hardly improve

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The Legal Framework for the Participation of the European Union in International Institutions

This article addresses to what extent the current EU Treaties regulate the position of the EU in other international institutions. This is a legal question, which explains the strong focus on competences and treaty provisions. The main findings are therefore related to what the EU can do, how it can do this (and has done it), and what the division of competences is in relation to its member states. It is argued that legal competences matter and that they may influence the performance of the EU in international institutions. In that respect, it is concluded that the treaties do allow for the EU to be engaged in international institutions and even to become a full member of other international organizations or participate in treaty regimes, albeit that the treaties do not at all present the relevant provisions in any coherent fashion

Metaphors in complexity theory and planning

This article reviews the use of complexity theory in planning theory using the theory of metaphors for theory transfer and theory construction. The introduction to the article presents the author's positioning of planning theory. The first section thereafter provides a general background of the trajectory of development of complexity theory and discusses the rationale of using the theory of metaphors for evaluating the use of complexity theory in planning. The second section introduces the workings of metaphors in general and theory-constructing metaphors in particular, drawing out an understanding of how to proceed with an evaluative approach towards an analysis of the use of complexity theory in planning. The third section presents two case studies – reviews of two articles – to illustrate how the framework might be employed. It then discusses the implications of the evaluation for the question ‘can complexity theory contribute to planning?’ The concluding section discusses the employment of the ‘theory of metaphors’ for evaluating theory transfer and draws out normative suggestions for engaging in theory transfer using the metaphorical route