Stronger Rationale Research Articles

Actually We Should Wait: Evaluating the Obama Administration’s Commitment to Unilateral Executive-Branch Action

Although once committed to stemming the tide of presidential power expansion, President Obama has since become a proponent of energetic unilateral executive-branch action. Faced with a relentless and uncompromising opposition in Congress, the President has come to believe that it is only through the exercise of his unilateral powers that he will be able to accomplish his agenda and meet the promises that he made to the American people. At one level, President Obama’s motivations are understandable. Congress has become unduly obstructionist, and because of its obstreperousness, many serious problems facing the country have gone unresolved. Nevertheless, expanding presidential power is a risky business in the long term even if it offers considerable benefits now. Already the balance of power between the executive and the legislative branches in Washington has, through the forces of history and exigency, swung markedly towards the former. When one adds to this equation the inherent and limitless potential for abuse in any government in which power is centered in a single individual, the conclusion that the presidency is now the most dangerous branch is indisputable. The assertion that its powers should be further increased, therefore, requires a far stronger rationale than “we can’t wait.”

Cashless society — really?

This paper analyses the arguments of the proponents of a cashless society, who, in light of an uptake of card and mobile payments, want a focus on a cashless society. Their arguments are assessed based on where we are in 2016 (with a consideration of arguments around security that should address cyber-crime). With the overestimation of the cost of cash, it seems that the difference between this and the cost of card payments is not as big as it seems. Economists have a stronger rationale in terms of managing interest rates. The strengths of those arguments vary, and what is really missing is the transition phase, consumers’ ability to change payment methods and a risk analysis. Given the long lead times, what is wrong with giving consumers these as they are embracing new ways to pay anyway?

Aesthetics of Qi: Building on the Internalist-Essentialist Philosophy of Art

A work of art is an intentional transformation of qi 氣 into a dynamic structure. The philosophy of qi is presented here as a means to develop the aesthetic theories of Richard Wollheim and Eliot Deutsch. Both Wollheim and Deutsch present their arguments, in part, as rejections of George Dickie’s “New Institutional Theory of Art.” I develop a robust qi aesthetic drawn from traditional sources and their contemporary commentaries as a way of joining the debate between Dickie and Wollheim/Deutsch, taking the side of the latter, but attempting to provide a thicker vocabulary and a stronger rationale for challenging Dickie.

Tiebout's Wasteful Local Expenditure Theory/Solving the Financing and Pricing Problems of Public Goods

This paper attempts to achieve three targets: First, to prove that Tiebout’s local expenditure theory is wasteful; Second, to show how private firms can efficiently supply public goods; Third, to work out the optimal pricing policy for using public goods. In addition, this paper rejects setting price according to average fixed cost and provides stronger rationale for free toll.

Abstract P1-09-04: Use of adjuvant chemotherapy and outcomes in women 70 years and older with HER-2 positive or triple negative breast cancer

Abstract Background: Chemotherapy use decreases with increasing age. There is a stronger rationale for adjuvant chemotherapy in HER-2 positive (HER2+) and triple negative (TN) breast cancer (BC) due to a higher risk of recurrence, known benefit of trastuzumab with chemotherapy and lack of other systemic options. Aims: 1) Compare outcomes of resected HER2+ and TN BC in older women (age ≥70) (OW) vs. younger women (age 50-69) (YW) 2) Determine chemotherapy use in OW vs. YW 3) Explore factors associated with chemotherapy use in women with HER2+ and TN BC and determine how these factors differ by age group (OW vs. YW) Methods: Women ≥50 years old with newly diagnosed resected HER2+ or TN stage I-III BC in British Columbia from 2003-2006 were included. Data on comorbidity, performance status, and reason for no chemotherapy was gathered via chart review of OW. Kaplan-Meier curves for relapse-free survival (RFS), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated. Logistic regression was used to model the likelihood of receiving chemotherapy and Cox proportional hazards was used to model BCSS and OS. Results: OW (n = 292) had larger tumors (p = 0.002), more often had mastectomy and less often had adjuvant radiation (p<0.001) than YW (n = 946). There were no differences in nodal or receptor status. OW vs. YW were less likely to receive chemotherapy (28.1 vs. 81.3%, p<0.001); odds decreased with increasing age (OR 15.9 and 7.4 for women age 50-59 and 60-69 vs. ≥70, p<0.001). Odds of receiving chemotherapy were higher in women with HER2+, ER/PR negative tumours than those with HER2+, ER/PR positive (OR 2.2) and TN tumours (OR 1.7) (p = 0.004). Some factors associated with chemotherapy use differed between YW and OW: tumour size (T2 vs. T1, OR 2.6, p = 0.059) and grade (high grade vs. low grade, OR 6.5, p = 0.02) were only associated with chemotherapy use in YW. OW with more comorbid conditions (CCI≥2) were less likely to receive chemotherapy than those with zero or one comorbid condition (OR 5.0 and 2.7 respectively, p = 0.009). In OW, reasons cited for not administering chemotherapy included: patient refusal (45.2%), patient age (38.1%), perceived minimal benefit (36.7%), patient comorbidity (28.6%), and concern about chemotherapy toxicity (28.6%). Chemotherapy was not mentioned in almost 1 in 5 cases (17.6%). OW had worse 5-year RFS (75.4 vs. 83.2%, p = 0.002), BCSS (79.5 vs. 88.1%, p<0.001) and OS (63.7 vs. 85.8%, p<0.001). After adjusting for known prognostic factors and treatment differences, increasing age was still significantly associated with poorer 5-year OS (HR 1.2, p = 0.003), but not with BCSS after adjusting for the competing risk of non-BC deaths. 5-year OS, but not BC-specific outcomes (RFS, BCSS), was significantly better in those who received chemotherapy compared to those who did not. Conclusion: OW with HER2+/TN BC are less likely to receive adjuvant chemotherapy than YW. Factors associated with chemotherapy receipt differ in OW, with tumor size and grade only being influential in YW. Age was only independently associated with OS and not BCSS, suggesting inferior BCSS rates in OW may be due to the presence of larger tumors or differences in treatments received by OW. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-04.

Use of adjuvant chemotherapy and outcomes in women age 70 and older with HER2-positive (HER2+) or triple-negative (TN) breast cancer (BC).

1044 Background: Chemotherapy use decreases with increasing age. There is a stronger rationale for adjuvant chemotherapy in HER2+ and TN BC due to a higher risk of recurrence, known benefit of trastuzumab with chemotherapy and lack of other systemic options. Aims: 1) Characterize and compare outcomes of resected HER2+/TN BC in older women (age ≥70) (OW) vs. younger women (age 50-69) (YW) 2) Determine chemotherapy use in OW vs. YW 3) Compare outcomes in OW based on receipt of chemotherapy. Methods: Women ≥ 50 years old with newly diagnosed resected HER2+ or TN stage I-III BC in British Columbia between 2003 and 2006 were included. Demographic, prognostic and treatment characteristics were compared in OW vs. YW using Chi-Square and t-tests. Kaplan-Meier curves for relapse-free survival (RFS), breast cancer-specific survival (BCSS) and overall survival (OS) were calculated in the various cohorts. Results: OW (n=292) had larger tumors (p=0.002), more often had mastectomy and less often had adjuvant radiation (p<0.001) than YW (n=946). There were no differences in nodal or receptor status. OW vs. YW were less likely to receive chemotherapy (28.1 vs. 81.3%, p<0.001); odds decreased with increasing age (OR 15.9 and 7.4 for women age 50-59 and 60-69 vs. ≥70, p<0.001). OW had worse 5-year RFS (75.4 vs. 83.2%, p=0.002), local RFS (93.2 vs. 95.5%, p=0.05) and distant RFS (77.5 vs. 85.5%, p=0.001). Both 5-year BCSS (79.5 vs. 88.1%, p<0.001) and OS (63.7 vs. 85.8%, p<0.001) were worse in OW vs. YW. OS, but not BC-specific outcomes (RFS, BCSS), was significantly better in those who received chemotherapy compared to those who did not (Table). Conclusions: OW with HER2+ and TN BC are less likely to receive adjuvant chemotherapy than YW. No difference in BCSS was noted in OW based on receipt of chemotherapy, possibly due to a small sample size. Differences in OS based on receipt of adjuvant chemotherapy suggest that oncologists in British Columbia are accurately identifying women with limited life expectancy less likely to benefit from chemotherapy. [Table: see text]

The Problem with Presidential Databases

There are many ways in which to study presidential communication from both humanistic and social scientific perspectives. From early study of presidential rhetoric (Aune and Medhurst 2008), to debates over rhetorical presidency (Ceaser et al. 1981; Tulis 1987; Medhurst 1996; Medhurst 2008), to generic studies of presidential oratory (Campbell and Jamieson 2008), to longitudinal studies of presidential style (Hart 1984, 1987), to content analysis of presidential discourse (Lim 2003, 2008), to examination of rhetoric's ability to affect public opinion (Edwards 2003), to constitutive function of rhetoric in formation of national identify (Beasley 2004; Stuckey 2004) scholarly attention to communicative dimensions of presidential leadership are ubiquitous. Into this plethora of scholarship step Coe and Neumann with a proposed database of what they label presidential speeches. Their work seems clearly to fall within a social scientific framework as they seek to standardize future analyses so that more meaningful generalizations can be made and more precise replications can be undertaken (Coe and Neumann 2011, 727). Insofar as standardization, generalization, and replication are hallmarks of standard social science, authors clearly seem to be on solid ground. But I wonder about rationale for a new database. only rationale that I see in their article is that proposed database will reduce absolute number of texts that scholars need to consult as they examine presidential rhetoric and that such a reduction and standardization will make generalizations easier to obtain. I do not doubt that such a claim is true. I do doubt its wisdom. First, there already exist at least two databases of presidential discourse--the Public Papers of Presidents of United States and American Presidency Project at University of California, Santa Barbara. Both of these databases have built-in search engines that allow for easy content-analytic searching. Coe and Neumann's database is, in fact, a subset of Public Papers. So only real advantage appears to be reduced amount of data (speeches) included in search domain. But is such a reduction really an advantage? If, for example, a scholar wanted to know what Jimmy Carter thought about Panama Canal Treaties, why would it be an advantage to search only nationally televised speech of February 1, 1978, when Carter gave several speeches on topic, at least one other of which was a address? It would not be an advantage. So if there is no advantage at level of individual president or particular issue, advantage must lie in institutional practice of rhetoric by presidency. But even at this level of analysis, kinds of payoffs envisioned--average word counts per speech, mean words per year, percentage of foreign policy versus percentage of domestic policy speaking--hardly seem worth candle. Worse, such analyses are almost always misleading. So I would like to see a stronger rationale, both in terms of need for a new database and in anticipated scholarly payoffs. Yet even if a stronger rationale could be provided, there are still several philosophical and methodological problems that must be addressed. Philosophical Concerns My concern starts with title of Coe and Neumann's article--The Major Addresses of Modern Presidents. Not or simply major addresses, or, better, selected addresses, but the addresses. One does not have to read very far to learn that the do not include some of most important in presidential history. So why insistence on the? Call me paranoid, but when rhetoricians see language deployed to define--to rope in or to rope out, as Kenneth Burke might say--we become suspicious. The addresses is a definition. Mutatis mutandis anything not included in database is not a presidential address. …

Enhanced Delivery of Rituximab In Combination with Methotrexate-Based Blood-Brain Barrier Disruption for Patients with Newly Diagnosed Primary CNS Lymphoma.

AbstractAbstract 2792 Introduction:Primary CNS lymphoma (PCNSL) is a rare, aggressive, primarily large B-cell lymphoma confined to the CNS and/or eyes at presentation. High-dose (HD) methotrexate (MTX) - based chemotherapy is standard of care in PCNSL and when combined with enhanced delivery results in extended survival without cognitive loss. The addition of rituximab to HD MTX regimens for B-cell PCNSL is widely used primarily by analogy to the positive results attained in systemic B-cell lymphomas. However, recent pre-clinical and clinical use of single agent rituximab provides stronger rationale. Efficacy has been shown using single agent rituximab in nude rats with intracerebrally implanted MC116 human B-cell lymphoma cells, and in patients with recurrent PCNSL by using 111In-ibritumomab to assess delivery and 90Y-ibritumomab to assess efficacy. Next, safety and efficacy of enhanced delivery of rituximab with MTX-based blood-brain barrier disruption (BBBD) was shown in patients with recurrent PCNSL. Based on these results, we treated patients with newly diagnosed PCNSL with rituximab in combination with MTX-based BBBD. Methods:IRB permission was obtained to retrospectively evaluate patients with newly diagnosed B-cell PCNSL, treated with rituximab in combination with MTX-based (intra-arterial [i.a.]) BBBD chemotherapy as first-line treatment. Treatment consisted of MTX (2500mg/day, i.a.) and carboplatin (200mg/m2/day, i.a.) with BBBD, for 2 consecutive days every 4 weeks for up to one year. Rituximab (375mg/m2, i.v.) was given every 4 weeks, 12 hours prior to the MTX with BBBD treatment. Objective response rate, progression free survival (PFS), overall survival (OS), and toxicities were evaluated. Results:Twelve patients (7 female, 5 male) were treated between April 2003 and October 2008. The median age was 65 years (min 49, max 75); 10 patients were older than 60 years. The median Karnofsky Performance Score (KPS) prior to treatment was 55 (min 20, max 80). All patients had brain parenchyma involvement at presentation. Additionally, CSF cytology was positive in 2 patients and one patient had ocular involvement. One patient with pre-existing cardiac disease died 2 weeks after initiation of MTX without BBBD due to myocardial infarction and was not evaluable for response. The overall response rate was 83% (7 CR, 1 CRU, 2 PR, 1 SD). The median PFS was 3.47 years (95% CI: 0.42, not yet attained) and the 2-year PFS in this cohort is 73%. The median OS was 4.42 years (95% CI: 0.28, not yet attained). Eight patients who attained CR or CRU were alive at data-cut-off; 6 of the 8 patients remain in CR 2 years or more after diagnosis. The most frequent toxicities were hematologic. Eight (67%) patients developed grade 3 or 4 hematologic toxicity and 7 (58%) developed grade 3 infection. Conclusions:We previously reported a 2-year PFS of 50% with 25% survival at 8.5 years in 149 newly diagnosed PCNSL patients treated with MTX-based BBBD without rituximab. The addition of rituximab shows manageable toxicity and provides sustained duration of CR in newly diagnosed PCNSL, with 10 of 12 patients over 60 years old and a median KPS of 55. These pilot data suggest the 2-year PFS may be increased to 70% or more with the addition of rituximab to MTX-based BBBD chemotherapy. A multi-center phase II prospective study is underway. Disclosures:No relevant conflicts of interest to declare.

Bimaxillary dentoalveolar protrusion: traits and orthodontic correction.

A group of 48 ethnically diverse patients with bimaxillary protrusion was used to study the pretreatment cephalometric traits of this malocclusion and the effect of orthodontic correction. All patients were treated with four premolar extractions and retraction of the anterior teeth. Pre- and posttreatment lateral cephalograms were evaluated using a series of 18 linear and angular measurements, and the effect of orthodontic correction was determined using paired t-tests. Cephalometric standards were developed for bimaxillary protrusions, which clarify the overall presentation of this malocclusion for clinicians. Patients with bimaxillary protrusion demonstrated increased incisor proclination and protrusion, a vertical facial pattern, increased procumbency of the lips, a decreased nasolabial angle, and thin and elongated upper and lower anterior alveoli. This study also showed that the extraction of four premolars can be extremely successful in reducing the dental and soft tissue procumbency seen in patients with bimaxillary protrusion, thus providing a stronger evidence-based rationale for this treatment modality.

Aggravating Youth: Roper v Simmons and Age Discrimination

In Roper v. Simmons, the Supreme Court confronted a difficult question: Given that being younger than eighteen is merely a proxy for diminished culpability, why not let jurors decide whether youth mitigates the culpability of an individual sixteen- or seventeen-year-old offender? The Court's subtle answer draws on psychological literature about the differences between juveniles and adults, but ultimately depends as much on concerns about the mind of the adult juror as on the distinctive traits of juveniles. Read in its best light, Kennedy's opinion seems to turn on the insight that while age-based classifications are rational - they are a good proxy for various aspects of behavior - particular judgments based on age are not necessarily rational. To the contrary, our judgments based on age may be distorted, or even inverted, because of wrongheaded thoughts and, especially, feelings. In the context of death penalty sentencing, among others, we think we favor youth, and we think we should favor youth, but in reality we may disfavor youth. Kennedy's reasoning thus suggests that, in at least this context, the law must embrace a categorical rule to align how we treat young people under law with how we think we do and should treat them. This understanding of Simmons does not establish the rightness of Kennedy's opinion. But it does suggest that the opinion is supported by a stronger rationale than it fully articulates, a rationale that has implications for other areas of law involving the irrationality of apparently rational categories, such as old-age discrimination. Kennedy's recognition that we may not be as rational about age as we think we are provides further justification for the Court's decision the same Term in Smith v. City of Jackson that disparate impact suits are available under the Age Discrimination in Employment Act.

Multinational Firms' Responses to Integration of Latin American Markets

This paper discusses how MNCs reacted to NAFTA and MERCOSUR in terms of their investment and operations patterns in three sectors - automotive, electronics, and apparel - and assesses the likely impact of the upcoming Free Trade Agreement of the Americas (FTAA). It shows that NAFTA functioned – at least in its first years - as an investment relocation engine, while MNCs' reaction to MERCOSUR was significant only in the automotive sector. The emergence of China and other Asian economies, with their low cost and vast markets, and the progressive enlargement in the scope of MNCs operations, seem to diminish the economic relevance of NAFTA and MERCOSUR. FTAA may provide a new impetus to the integration of the automotive industry in the Americas, and a stronger rationale for a slowdown of plant relocation to Asia in light industries such as electronics and garments. But it is unlikely that it will reverse current trends which point to Asia – with China at the epicenter – as the global magnet for manufacturing and exports.

Newer pharmaceutical agents to treat lipid disorders.

The National Cholesterol Education Program Adult Treatment Panel III guidelines and the results of the Heart Protection Study have provided a stronger rationale to more aggressively treat high-risk patients to a low-density (LDL) cholesterol goal of less than 100 mL/dL. Two new therapies, ezetimibe and rosuvastatin, have recently been added to the lipid-lowering armamentarium to improve guideline adherence. Ezetimibe, a novel cholesterol absorption inhibitor, lowers LDL by 18% to 20% and can be used safely in combination with statins. Adding ezetimibe to a statin is comparable with the LDL-lowering efficacy of tripling the dose of the statin. Rosuvastatin is a highly efficacious statin providing 8% greater LDL reduction than equivalent doses of atorvastatin, and the starting dose of 10 mg/d provides nearly a 50% reduction in LDL cholesterol. There are several investigational drugs in development for the prevention and treatment of atherosclerosis. Of these investigational drugs, the most promising are the cholesterol ester transfer protein inhibitors, which have the potential to significantly raise high-density lipoprotein cholesterol and acetyl-coenzyme A: cholesterol acyltransferase inhibitors, which may directly inhibit the progression of atherosclerosis.

Common property, collective interests, and community opposition to locally unwanted land uses

Investigations of “not in my backyard”; or NIMBY behavior often focus on the importance of the facility and the role that individual interests, such as property and health concerns, play in fostering opposition from local residents. These studies have not considered the role that common property resources and collective interests play when resistance to unwanted land uses arises. This investigation analyzes events surrounding the siting of a limestone mine on Laurel Mountain, West Virginia. After examining the emergence of a common property resource regime, the types of concerns that local residents expressed are examined. These comments suggest that when a common property resource is present, collective interests and community concerns may provide a stronger rationale for sustained action than individual interests.

A Stronger Rationale for MUSIC Education

A Stronger Rationale for MUSIC Education