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  • 1
    Electronic Resource
    Electronic Resource
    Bingley : Emerald
    International journal of social economics 28 (2001), S. 695-709 
    ISSN: 0306-8293
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Economics
    Notes: Asymmetric information between producer and consumer of health care gives rise to a principal-agent relationship between these two parties. If the consumer of care can credibly assume that producers are motivated by factors other than selfish gain obvious benefits in terms of process utility will accrue and the delivery of care will be facilitated. Examination of earnings equations using a UK data set, where monetary and non-monetary employer-provided benefits have been controlled for reveals that in the UK health-service workers earn less than employees with comparable skills generally. Employee-generated externalities associated with pursuance of personal goals, it is contended, explain these differences. When such factors are controlled for, returns to health-service workers are seen to be comparable with those of workers generally. It is concluded that health-service workers are "different" from workers generally - though not uniquely - in as much as they make reference to arguments in their objective functions to a greater extent than do workers generally. These arguments could, with justification, be termed philanthropic motives. This, we contend, questions the validity of standard neoclassical theory as it relates to this group of workers and demands more thoughtful policy responses in devising incentives in this sector.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0843
    Keywords: Key words Phase I ; Oral administration ; Platinum ; Dose-dependent pharmacokinetics ; JM216
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  JM216 [bis-acetato-ammine-dichloro-cyclohexylamine-platinum (IV)] is an oral platinum complex with in vivo activity against murine and human tumor models and a lack of nephro- and neurotoxicity in rodents. During a phase I study of a single-dose schedule, JM216 was given in dry-filled hard gelatin capsules by mouth without hydration or diuresis. In all, 37 patients were given a total of 88 courses at doses ranging from 60 to 700 mg/m2. The study was stopped before the MTD was reached because of nonlinear pharmacokinetics. Myelosuppression was manifest by leucopenia or thrombocytopenia and showed marked variability at 420–700 mg/m2. Vomiting was mild and controllable by antiemetics in approximately 50% of courses. The onset of vomiting was delayed to 4 h after during ingestion. There was no nephro-, oto- or neurotoxicity. A partial response was recorded in a patient with recurrent ovarian cancer, and significant falls in plasma tumour markers (CA125) were seen in two further cases. Plasma pharmacokinetics were linear and showed moderate interpatient variability at dose levels of ≤120 mg/m2. At dose levels of ≥200 mg/m2, Cmax and AUC increased less than proportionally to dose. This was associated with greater interpatient pharmacokinetic variability and reduced urinary platinum recovery. A significant sigmoidal relationship existed between ultrafilterable plasma AUC and the percentage of reduction in platelet count (r 2=0.78). Nonlinear absorption was a limitation to this single-dose schedule of oral NM216; however, little nonhaematological toxicity was seen at doses associated with myelosuppression and antitumour activity. Clinical studies of divided dose schedules using doses within the range of pharmacokinetic linearity (≤120 mg/m2) are now being investigated.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0843
    Keywords: Phase I ; Oral administration ; Platinum ; Dose-dependent pharmacokinetics ; JM216
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract JM216 [bis-acetato-ammine-dichloro-cyclohexylamine-platinum (IV)] is an oral platinum complex with in vivo activity against murine and human tumor models and a lack of nephro- and neurotoxicity in rodents. During a phase I study of a single-dose schedule, JM216 was given in dry-filled hard gelatin capsules by mouth without hydration or diuresis. In all, 37 patients were given a total of 88 courses at doses ranging from 60 to 700 mg/m2. The study was stopped before the MTD was reached because of nonlinear pharmacokinetics. Myelosuppression was manifest by leucopenia or thrombocytopenia and showed marked variability at 420–700 mg/m2. Vomiting was mild and controllable by antiemetics in approximately 50% of courses. The onset of vomiting was delayed to 4 h after during ingestion. There was no nephro-, oto- or neurotoxicity. A partial response was recorded in a patient with recurrent ovarian cancer, and significant falls in plasma tumour markers (CA125) were seen in two further cases. Plasma pharmacokinetics were linear and showed moderate interpatient variability at dose levels of ≤120 mg/m2. At dose levels of ≥200 mg/m2, Cmax and AUC increased less than proportionally to dose. This was associated with greater interpatient pharmacokinetic variability and reduced urinary platinum recovery. A significant sigmoidal relationship existed between ultrafilterable plasma AUC and the percentage of reduction in platelet count (r 2=0.78). Nonlinear absorption was a limitation to this single-dose schedule of oral NM216; however, little nonhaematological toxicity was seen at doses associated with myelosuppression and antitumour activity. Clinical studies of divided dose schedules using doses within the range of pharmacokinetic linearity (≤120 mg/m2) are now being investigated.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0843
    Keywords: Key words Apoptosis ; Ovarian carcinoma ; Cisplatin ; Flow cytometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We have studied the effects of the chemother-apeutic drug cis-diamminedichloroplatinum(II) (cisplatin) on three human ovarian carcinoma cell lines – one sensitive to the drug (CH1), one with acquired resistance (CH1cisR) and one with intrinsic resistance (SKOV-3). Previous work has shown that the 50% inhibitory concentrations (IC50 values) after a 2-h exposure to the drug are: CH1, 2.5 μM; CH1cisR, 7.5 μM; and SKOV-3, 33 μM. Despite the variation in sensitivity, the amount of Pt bound to DNA and the rate of removal of Pt was similar for the three lines. There were significant differences in the rates of formation of DNA cross-links but these were not large enough to account for the high resistance of the SKOV-3 line. We have reported that in the L1210 murine leukaemia cell line there are two mechanisms of cisplatin-induced cell death – one of which involves apoptosis. In this paper, we report on an investigation into whether sensitivity to apoptosis played a role in the resistance of these ovarian lines towards cisplatin. After a 2-h incubation with the drug, cells from the three lines showed evidence of death through apoptosis. The cells detached from the culture dish in a time- and dose-dependent fashion. These cells morphologically were quite distinctive from the attached cells and showed changes in their chromatin structure indicative of apoptosis. Their DNA had not been degraded into oligonucleosomal fragments (200 bp and multiples thereof) but had been cut into larger fragments (30 kilobase pairs, kbp) of a size associated with chromatin domains (chromatin loops). At equitoxic doses of drug, the quantity of cells undergoing apoptosis was similar for the three cell lines. The most prominent effect on cell-cycle kinetics was a slowdown in S-phase transit during which the cells underwent apoptosis. Cells that successfully completed the S phase subsequently suffered a temporary G2 block. We propose that the sensitivity of these cell lines to cisplatin was governed by their ability to handle damage caused by platination of the DNA and that the major mechanism of cisplatin-induced cell death in all three cell lines was the induction of apoptosis.
    Type of Medium: Electronic Resource
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