Unfavourable Demographics Research Articles

Sensitivity to moral and conventional rules in temporal lobe epilepsy

ObjectivesSensitivity to moral and conventional rules (SMCR) is supported by bilateral brain networks and psychosocial input both of which may be altered in temporal lobe epilepsy (TLE). This study evaluated the components of SMCR in patients with TLE, aiming to clarify their preservation and link to psychopathological and cognitive aspects. MethodsAdult patients with unilateral TLE and healthy controls were evaluated using neuropsychological tests for SMCR, memory, language, and executive functions, the Empathy Questionnaire (EQ), and the Symptom Checklist-90-R (SCL-90-R). ResultsThe SMCR test items showed good reliability and validity, yielding the Severity and Rules factors distinct from the Executive, Lexical and Memory factors. Patients with right TLE scored worse in moral rules recognition than controls, but this difference was nullified by a significant influence for age and sex. The Severity and Rules factors related to semantic fluency and age and, respectively, TLE side and psychoticism. However, these factors did predict TLE membership. ConclusionsIn adult patients with TLE, the SMCR test reflects a distinct cognitive domain. Conventional rules are well-retained, while moral reasoning may be only affected in right TLE if unfavorable demographics coexist. Although age, TLE side, semantic abilities, and psychoticism cooperate to determine SMCR, impairment of such domain is not a distinctive feature of TLE.

THE CONTRADICTIOUS EXPECTATIONS OF THE ACTORS OF THE TOURISM ORGANIZATIONAL AND CONSUMER MARKET IN SUSTAINABLE DESTINATION DEVELOPMENT

The Lower-Ipoly area, located in the north-central region of Hungary, has linear extension. In terms of the specific location and the unfavourable demographics tourism development faces difficulties in this heterogeneous area. The aim of the research is to identify the needs of prospective travellers and decision makers toward future developments in tourism in the indicated region. The paper summarizes the results of a survey, identifying the opinions of organizational and consumer market stakeholders, their similarities and differences in terms of expectations for tourism developments. This study covers the types of tourism and product elements that can potentially be developed sustainably.

Comment on Rosell-Cardona et al. Dietary Spray-Dried Porcine Plasma Reduces Neuropathological Alzheimer’s Disease Hallmarks in SAMP8 Mice. Nutrients 2021, 13, 2369

Interventions focusing on dementia risk and/or dementia modification in association with senescence are essential, given the unfavourable demographics [...].

Excellent Outcome of Elderly Patients with Favourable-Prognosis DLBCL Treated with 4 Cycles CHOP/Chlip-14 Plus 8 Applications of Rituximab and a PET-Based Intensification Strategy That Includes Involved-Site Radiotherapy (IS-RT): Results of the First 120 Patients of the OPTIMAL>60 Trial of the Dshnhl

Background: The RICOVER-60 trial established 6 cycles CHOP-14 plus 8 2-week applications of rituximab (8xR) as the optimal treatment for elderly patients with DLBCL [Pfreundschuh et al., Lancet Oncol 2008; 9: 105-116]. With a 2-year PFS of 90% and OS of 91% for patients with favourable prognosis (defined as IPI=1 [age >60 years], no bulky disease) a controlled reduction of treatment intensity appeared to be justified for this population. We hypothesized that patients with a negative PET (metabolic complete remission = mCR) after 4xR-CHOP-14 might be spared further chemotherapy (ChT), while patients not in mCR might benefit from the addition of RT. To ensure that this strategy does not put patients at risk, an interim analysis was planned after 40% of the expected events for a comparison with RICOVER-60.Patients and Methods: 61 to 80 year-old IPI=1 pts. without bulky (≥7.5 cm) disease were randomized to 4xCHOP-14 or 4x-CHLIP-14 (liposomal instead of conventional vincristine) in combination with 8 2-week applications of rituximab. Primary endpoint was the comparison of the neurotoxicity of conventional and liposomal vincristine. Patients with a negative PET after 4x-R-CHOP/R-CHLIP-14 completed the remaining 4xR, while PET-positive (Deauville 3-5 as by central review) patients in addition received 2 additional CHOP/CHLIP-14 + plus IS-RT (39.6 Gy) to the originally involved sites.Results: This planned interim analysis was performed to compare patient outcome with the old (fixed) and the new PET-adapted (flexible) treatment strategy. Compared to 74 RICOVER-60 pts. who had received 6xCHOP-14 plus 8xR, OPTIMAL>60 pts. were older (median: 71 vs. 68 years; p=0.009), with a larger proportion of patients >70 and >75 years. Despite the unfavourable demographics, outcome of the OPTIMAL>60 pts. receiving R-CHOP/CHLIP-14 was non-inferior to RICOVER-60 (2-y-PFS: 94% vs. 90% ; 2-y-OS 98% vs. 91%). In a multivariable analysis adjusting for strata (age >75 years and male sex), the hazard ratio of the OPTIMAL>60 compared to the RICOVER-60 was 0.5 (95% CI: 0.2-1.5; p=0.208) for PFS and 0.2 (95% CI: 0.1-0.9; p=0.036) for OS. 82% pts. were in mCR after 4xR-CHOP/CHLIP-14 and received no further ChT; 18% were PET-positive and thus to receive 2 additional CHOP/CHLIP-14 plus IS-RT, and their outcome was as good as that of mCR patients.Conclusion: A PET-based treatment strategy allows sparing 2 cycles ChT in 82% of patients without compromising their outcome. 4xCHOP/CHLIP-14 plus 8xR for patients with a negative PET after 4 cycles of immunochemotherapy in OPTIMAL>60 is at least as good as 6xCHOP-14 plus 8xR in RICOVER-60 and appears to provide a normal life expectancy for this elderly population with a median age of 71 years. 2 additional ChT cycles plus IS-RT appear to compensate for the assumed worse prognosis of PET-positive patients, which might be in part due to the early start of RT made possible by the 2-week ChT regimens. The 98% 2y-OS is the best reported to date for this elderly population and should be the reference to which alternative strategies should be compared. Updated 3-year results will be reported. S upported by Amgen, Roche, Spectrum DisclosuresChristofyllakis:medac: Other: travel expenses, event fees; Gilead: Other: travel expenses, event fees. Haenel:Roche, Novartis: Honoraria. Schmidt:Janssen: Other: Travel grants; Amgen: Membership on an entity's Board of Directors or advisory committees. Huebel:Roche: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sanofi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CTI: Speakers Bureau; Janssen: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Hellwig:Employment at University Hospital Regensburg, Germany: Employment; Research Funding by Saarland University, Saarbruecken, Germany: Research Funding.

Place-Based Policies for Sustainability and Rural Development: The Case of a Portuguese Village “Spun” in Traditional Linen

In recent decades, European rural development policies have transitioned toward a more place-based approach. This claim rests on the assumption that the diversity of resources within rural areas can be a potential source for place-shaping practices and sustainability. Moreover, this shift away from a top-down sectorial toward a more territorial focus has also shed light on the importance of agency, relations, and how people engage. Many rural areas in Europe, and particularly in Portugal, have seen a withdrawal of focus away from agriculture toward more diversified activities, where place-based approaches can untap local potential, stimulate sustainable place-shaping practices, and create significant well-being. However, some rural communities have difficulties in capitalizing on them due to unfavorable demographics such as depopulation and aging, a focus on traditional industries, and a lack of technical knowledge. The aim of the article is to discuss the role of place-based policies for enabling place-shaping practices revolving around traditional resources in rural areas and their contribution to sustainability. The study briefly highlights the recent debate around European rural development policies and illustrates their implementation through place-shaping practices via a case study in a Portuguese rural village—Várzea de Calde. The village revalorized itself and is trying to tackle marginalization processes through its traditional linen, which is a local material and immaterial resource, via collective agency and a strong sense of identity. The case study will provide empirical insights in discussing the effects of sustainable place-shaping practices stimulating by place-based policy instruments. Our conclusions highlight the positive contributions toward sustainability through improvements in social (e.g., identity) and economic well-being.

Shortage of Talents – a Challenge for Modern Organizations

Purpose – The objective of the paper is to highlight the issue of talent shortage in modern organizations, determine the main causes and outcomes of the phenomenon, and compare the shortage in Polish organizations with global trends. Approach – Based upon the literature, the paper applies Chodorek’s approach to talent. Main challenges and determinants of talent management in modern organizations were established. A review of studies pertaining to the significance of talent management in modern organizations was conducted. Reasons behind talent shortage and its consequences for organizations were also examined. Findings – Both global and Polish trends indicate that talent management has become one of the chief challenges modern organizations face. Competition for talents constitutes a current issue and poses one of the critical challenges for HR departments. The shortage of talented workforce results primarily from unfavorable demographics and lack of appropriate qualifications of potential employees. It was observed that both in Poland and internationally, organizations voice problems with employing talented workers on the one hand, but frequently neglect to manage talents actively on the other. Few organizations possess a comprehensive strategy concerning the issue. The most significant consequences emerging from the shortage of talented employees include customer service capacity being limited and a decline in competitiveness and productivity. Originality/Value – The paper reviews and compares results of studies conducted by international consulting companies: Charter Institute of Personnel and Development, Deloitte, ManpowerGroup, Mercer, PricewaterhouseCoopers, Randstad, Boston Consulting Group. In addition, the shortage of talents present in Poland was compared with global trends. Paper type – Literature review.

Radiotherapy to bulky disease PET-negative after immunochemotherapy in elderly DLBCL patients: Results of a planned interim analysis of the first 187 patients with bulky disease treated in the OPTIMAL>60 study of the DSHNHL.

7506 Background: RT to bulky sites improves outcome of elderly DLBCL patients [Lancet Oncol 2008; 9: 105-116; J Clin Oncol 2014; 32:112-1118]. Whether RT can be spared in PET-negative pts. after R-CHOP was prospectively addressed in OPTIMAL >60. Methods: 61 to 80 y-old pts. were randomized in a 2x2 factorial design to 6xCHOP-14 or 6xCHLIP-14 (liposomal instead of conventional vincristine) plus 8 x rituximab 375 mg/m2(R) q 2 wks. or 12xR (days -4,-1,1,4,14,28,42,56,91,126,175, 238). Pts. with bulk (>=7.5 cm) PET-positive after 6 cycles chemotherapy were assigned to RT (39.6 Gy), while PET-negative bulks were observed. Results: 187/505 (37%) had bulky disease and were compared to 117/306 (38%) RICOVER-60 pts. (38%) who had received 6xCHOP-14+8R. OPTIMAL>60 pts. were older (70 vs. 68 years) and had more IPI=3 (33% vs. 29%) and IPI=4,5 (34% vs. 23%) compared to RICOVER-60. PET was performed in 166/187 OPTIMAL>60 bulk pts. (reasons for no PET: early death: 5; excessive toxicity: 3; protocol violation: 1, non-compliance: 4, change of diagnosis: 6, others: 2). 80/166 (48%) bulks remained PET-positive after 6 cycles of chemotherapy and 62/80 (78%) were irradiated (reasons for no RT: progression: 8; medical reasons: 9; negative biopsy: 1), reducing RT from 67/117 (57%) in RICOVER-60 by 42% to 62/187 (33%) in OPTIMAL>60. Despite the unfavorable demographics, outcome of the 187 bulk pts. in OPTIMAL>60 was non-inferior to RICOVER-60, not even in the least intensive of the 4 OPTIMAL>60 treatment arms consisting of 47 pts. who received 6xCHOP-14+8R as in RICOVER-60. 2-year PFS and OS in OPTIMAL>60 was 79% and 88%, respectively, compared to 75% and 78% of the 117 RICOVER-60 pts. In a multivariable analysis adjusting for the IPI risk factors, the hazard ratio of the OPTIMAL>60 compared to the RICOVER-60 bulk pts. was 0.7 (95% CI: 03.; 1.5; p=0.345) for PFS and 0.5 (95% CI: 02.; 1.3; p=0.154) for OS. Conclusions: RT can be spared in bulky disease PET-negative after chemotherapy. This strategy results in a 42% reduction of RT without compromising the outcome of these patients. Supported by Amgen, Roche, Spectrum. Clinical trial information: NCT01478542.

The Multilateral Context of the Project of China-Japan-Republic of Korea Trilateral Free Trade Agreement

The China–Japan–Republic of Korea trilateral free trade agreement may become a critical pillar of Asian regionalism, determining future trade and political regime in the global scale. Undoubtedly, this trilateral political dialogue is to be accompanied by parallel talks over competitive, trans-regional projects involving Asia–Pacific partners, with special regard to the Transpacific Partnership (TPP) and the Regional Comprehensive Economic Partnership (RCEP). However, given the common challenges of the three analysed countries, in particular the unfavourable demographics, reindustrialization, and inefficient domestic demand, it should be noted that the said trilateral dialogue is facing very serious obstacles resulting from, among others, their historical ballast and territorial claims, as well as the intra-regional competition for leadership between Beijing and Tokyo. The aim of the article is to study both multilateral determinants and implications of the future China–Japan–Republic of Korea FTA.

Clinical characteristics of bipolar disorder: a comparative study between Argentina and the United States.

BackgroundBipolar disorder presents with diverse clinical manifestations. Numerous investigators have sought to identify variables that may predict a more severe illness course.MethodsWith the objective of studying the clinical characteristics of bipolar patients between South and North America, a comparison was performed between a sample from Argentina (n = 449) and a sample from the United States (n = 503) with respect to demographics and clinical characteristics, including presence of comorbidities.ResultsThe Argentinian sample had more unfavorable demographics and higher rates of prior psychiatric hospitalization and prior suicide attempt but a better social outcome. However, the sample from the United States had a higher rate of prior year rapid cycling, as well as younger bipolar disorder onset age (mean ± SD, 17.9 ± 8.4 vs. 27.1 ± 11.4 years) and more severe clinical morbidity, though there was no significant difference in terms of the total duration of the illness. Argentinian compared to American patients were taking more mood stabilizers and benzodiazepines/hypnotics, but fewer antipsychotics and other psychotropic medications, when considering patients in aggregate as well as when stratifying by illness subtype (bipolar I versus bipolar II) and by illness onset age (≤21 vs. >21 years). However, there was no significant difference in rate of antidepressant prescription between the two samples considered in aggregate.ConclusionsAlthough possessing similar illness durations, these samples presented significant clinical differences and distinctive prescription patterns. Thus, though the Argentinian compared to North American patients had more unfavorable demographics, they presented a better social outcome and, in several substantive ways, more favorable illness characteristics. In both samples, early onset (age ≤ 21 years) was a marker for poor prognosis throughout the illness course, although this phenomenon appeared more robust in North America.

Attracting High‐Skilled Immigrants: Policies in Comparative Perspective

AbstractLabour market shortages, structural problems and unfavourable demographics have all prompted governments to act, often by focusing on high‐skilled immigration. However, policy responses have been very different. Some countries were able to adopt quite open high‐skilled immigration policies, while others did not. This article provides a political economy explanation for this. It argues that, despite similar pressures, high‐skilled immigration policy outputs vary due to shifting coalitions between disaggregated sectors of native high‐skilled, low‐skilled labour and capital. To probe this argument, the article examines coalitions in four countries (France, Germany, Sweden and the United Kingdom) from the late 1990s to present, and draws on original interviews with policy‐makers, unions and employers' associations; official documents and the literature on immigration, political economy and public policy. The varying labour market organization of actors informs differences in coalitions which in turn has resulted in different high‐skilled immigration policy outputs, cross‐nationally and over time.

CEE's Dwindling Skilled Labor Supply: The Vagaries of Unfavorable Demographics

Central and Eastern European (CEE) countries are cited commonly for their potential to be offshoring locations, both because of key skills and competitive costs. Based on population data from the UN Population Division and the International Labor Organization we project skilled labor force up to 2050 in four CEE countries: the Czech Republic, Hungary, Poland and Russia. Our study finds that the ultimate demographic prognosis for Eastern European countries is not very optimistic. Although the CEE region has the potential to be an attractive offshoring destination, the area's shrinking labor force may dim its prospects.

Field of the Future: Vision to Reality

This article, written by Technology Editor Dennis Denney, contains highlights of paper SPE 99777, "Field of the Future: Making BP's Vision a Reality," by C. Reddick, SPE, BP, prepared for the 2006 SPE Intelligent Energy Conference and Exhibition, Amsterdam, 11–13 April. Rapid changes in digital technology are revolutionizing how data are acquired and processed and how the quality and efficiency of decision making are improved. By use of digital technologies, both new and existing, BP aspires to operate its assets at the technical limit of efficiency, recovery, and cost. The company implemented a program called Field of the Future (FOTF). This program covers development and deployment of technology and business-process solutions to most aspects of oil- and gasfield operations—from reservoir to export, in both mature and new fields, onshore as well as offshore. Program Origin Internal and External Environment. Rapid advances in digital technology offer the oil industry significant opportunities to address challenges of improving recoveries from existing and new fields, of improving operating efficiency in the face of unfavorable demographics, and of developing new fields in difficult and remote geographies. Technologies to acquire and transmit data in real time or near real time have been available for several years. However, the oil industry has, with some exceptions, been slow to adopt these technologies for large-scale deployment. Take-up is improving as tools are made available to post-process data, as the industry begins to appreciate the degree of organizational change needed to exploit these technologies, and as the appropriate targeting of these technologies becomes clearer. First Steps in a Real-Time Revolution. The subject program was established in 2003 with an initial focus on engagement and deployment, the objective being to deploy core technologies in a limited number of assets to establish operating history, to re-affirm the prize, and to build a technical and architectural foundation for subsequent bigger moves. Early results show numerous examples of production increases through, for example, improved sand management, well management, reservoir imaging, onshore/offshore collaboration, and remote-equipment monitoring. Reserves increases have resulted from the application of streamlined reservoir-performance prediction. Technology Development and Deployment Remote performance management includes technologies for well/reservoir and facilities monitoring. This activity develops and applies new tools for managing and post-processing real-time data. Surveillance methods, such as life-of-field seismic, to improved reservoir imaging and downhole flow technologies to improve conformance in water-floods are being developed. Optimization challenges include new technology to facilitate reservoir optimization by coupling real-time data flows to top-down reservoir-modeling technology and by extending the capability of the tool kit for rapid evaluation of reservoir-management options at all time scales. Wells- and Facilities-Data Processing. The BP Integrated Subsurface-Information System (ISIS) addresses the technology and processes required to move well data from the point of acquisition through to decision makers, thereby enabling production decisions and implementation of relevant actions. ISIS allows users to access and view surveillance data in real time. It cleans and conditions data, then alerts users to changes in the well: a proactive approach to reservoir-performance management. Fig. 1 shows how onshore users can observe up-to-the-minute offshore data.

Using Phased Retirement to Make a Baby Boomer Retirement Work

Much has been written about the difficulty that baby boomers will face when they begin to retire. Concerns have been raised about the long‐term problems facing the Social Security system, problems with employer provided pension plans, volatile financial markets and unfavorable demographics. The purpose of this paper is to examine one tool that baby boomers can use to make their retirements more successful — phased retirement. Moreover, this paper will attempt to demonstrate that it is in the best interest of not only employees but also employers and government at all levels to promote the growth of this concept.

Immigration Policy and Highly Skilled Workers: The Case of Japan

Concerned about shortages of highly skilled workers, especially those with international specialties, Japan adjusted its immigration policy in 1990. The government made it easier for skilled foreign specialists to work in Japan. In the wake of the policy adjustment, this study examines whether there have been changes in inflows of skilled foreigners. Though Japan is still wary of immigration and official policy remains comparatively strict, it is clear that skilled professionals are entering Japan in larger numbers.