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This book explores the challenges population decline presents for Europe?s urban and rural areas. It features recent demographic data and trends not only for Europe as a whole, but also for selected countries, and compares growth and shrinkage from a historical as well as a theoretical perspective. In addition, the book critically reviews relevant notions from geography, sociology, and public administration. It also identifies good practices across Europe. Throughout, theories are complemented with concrete examples and proposals are made on how to tackle demographic shrinkage in European cities and villages, from attempts to attract new residents to the countryside to innovative ways to guarantee public services. In the end, the authors conclude that solving the challenges caused by population decline require novel ways of thinking and provide answers to such future-oriented questions as: how to ensure the quality of life in an environment that is inhabited by fewer and older people, what investments are needed, and which actors should be involved. Managing Population Decline in Europe?s Urban and Rural Areas offers detailed coverage of an underestimated and complex governance issue that asks for solutions in which citizens have to play an important role. It concludes that shrinkage requires a rethink of the specific tasks and roles of government and presents a way forward based on initiatives currently underway throughout Europe. The book will be a valuable resource for population policy makers as well as students and researchers interested in human geography, urban planning, rural development, European studies, public administration, and other social sciences.

BACKGROUND: Efforts to improve the outcome of liver surgery by combining curative resection with chemotherapy have failed to demonstrate definite overall survival benefit. This may partly be due to the fact that these studies often involve strict inclusion criteria. Consequently, patients with a high risk profile as characterized by Fong's Clinical Risk Score (CRS) are often underrepresented in these studies. Conceptually, this group of patients might benefit the most from chemotherapy. The present study evaluates the impact of neo-adjuvant chemotherapy in high-risk patients with primary resectable colorectal liver metastases, without extrahepatic disease. Our hypothesis is that adding neo-adjuvant chemotherapy to surgery will provide an improvement in overall survival (OS) in patients with a high-risk profile. METHODS/DESIGN: CHARISMA is a multicenter, randomized, phase III clinical trial. Patients will be randomized to either surgery alone (standard treatment, arm A) or to 6 cycles of neo-adjuvant oxaliplatin-based chemotherapy, followed by surgery (arm B). Patients must be >/= 18 years of age with liver metastases of histologically confirmed primary colorectal carcinoma. Patients with extrahepatic metastases are excluded. Liver metastases must be deemed primarily resectable. Only patients with a CRS of 3-5 are eligible. The primary study endpoint is OS. Secondary endpoints are progression free survival (PFS), quality of life, morbidity of resection, treatment response on neo-adjuvant chemotherapy, and whether CEA levels can predict treatment response. DISCUSSION: CHARISMA is a multicenter, randomized, phase III clinical trial that will provide an answer to the question if adding neo-adjuvant chemotherapy to surgery will improve OS in a well-defined high-risk patient group with colorectal liver metastases. TRIAL REGISTRATION: The CHARISMA is registered at European Union Clinical Trials Register (EudraCT), number: 2013-004952-39 , and in the "Netherlands national Trial Register (NTR), number: 4893.