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Background & aims: Current guidelines recommend immunosuppressive treatment (IT) in patients with primary sclerosing cholangitis (PSC) and elevated aminotransferase levels more than five times the upper limit of normal and elevated serum IgG-levels above twice the upper limit of normal. Since there is no evidence to support this recommendation, we aimed to assess the criteria that guided clinicians in clinical practice to initiate IT in patients with previously diagnosed PSC.
Methods: This is a retrospective analysis of 196 PSC patients from seven German hepatology centers, of whom 36 patients had received IT solely for their liver disease during the course of PSC. Analyses were carried out using methods for competing risks.
Results: A simplified autoimmune hepatitis (AIH) score >5 (HR of 36, p<0.0001) and a modified histological activity index (mHAI) greater than 3/18 points (HR 3.6, p = 0.0274) were associated with the initiation of IT during the course of PSC. Of note, PSC patients who subsequently received IT differed already at the time of PSC diagnosis from those patients, who did not receive IT during follow-up: they presented with increased levels of IgG (p = 0.004) and more frequently had clinical signs of cirrhosis (p = 0.0002).
Conclusions: This is the first study which investigates the parameters associated with IT in patients with PSC in clinical practice. A simplified AIH score >5 and a mHAI score >3, suggesting concomitant features of AIH, influenced the decision to introduce IT during the course of PSC. In German clinical practice, the cutoffs used to guide IT may be lower than recommended by current guidelines.
The main purpose of the paper is to explain the divergent paths of development of ethno-territorial protest movements in modern democratic political systems. By focusing on the interaction between these movements and the state, the different systems of accommodation between the relevant regional and central elites will be analyzed. The study concentrates on the case studies of Québec (Canada) and Corsica (France). The paper is divided into three parts. The first part describes the traditional systems of accommodation in France and Canada. The second part is focused on the process of socio-economic modernization in the 1950s and 1960s in those countries that threatened the established patterns of elite accommodation. The third part deals with the consequences for the established patterns of elite-accommodation and new concepts of territorial management that the central states tried to establish. By looking at the different degrees of centralization and decentralization in the mentioned political systems, the question of access to the political system by new social and political actors will be discussed in detail.
Taxation and tax policy reform appears on the political agenda in most advanced welfare states in Europe and North America. Of course studies of taxation and tax policy are nothing new and have existed ever since people have paid taxes. The current work is situated in the context of the future of the welfare state and the reinforced international economic and political integration referred to as "globalization." The purpose of this paper is to analyze how globalization is affecting tax policy in advanced welfare states. In comparing the evolution of tax policy in Canada with those in the United States, Germany and Sweden from 1960 to 1995, I will try to review the conventional antiglobalization thesis, i.e., that globalization leads to a "race to the bottom" in revenue and expenditures policies, or as others have called it, a "beggar the neighbour policy" (Tanzi and Bovenberg 1990, 187). ... Conclusion: The empirical data and theoretical models clearly show that globalization is one relatively minor factor among many that explain tax policy reforms. And even that limited influence is mediated by domestic political systems, institutions and constellations of actors. As the data has shown, the conventional globalization thesis of a race to the bottom is not borne out. Tax rates and tax revenues are still increasing, despite the ongoing trend toward international trade integration. Countervailing pressures like the high cost of welfare programs, different parties in government, strong labour unions, and institutional veto players counteract the pressure of globalization on tax policy. As for the future of taxation in Canada, it is more likely to be one of gradual evolution than radical change. Although the data don’t show any downward pressure on tax rates and tax revenues comparatively speaking, there are at least four key factors in Canada that are likely to put pressure on future tax rates, although regional political dynamics and the workings of fiscal federalism suggest that tax reductions will be a higher priority in some provinces than others (Hale 2002). First, neoliberalism will continue to shape fiscal and tax policy, including the role of the tax system in delivering social policies and programs in most parts of Canada. Second, governments that seek to define their own economic and social priorities rather than simply react to events beyond their borders will have to exercise centralized control over budgetary policies and spending levels if they hope to foster the economic growth needed to finance social services in the context of Canada’s changing demographics. Third, the ability of governments to combine the promotion of economic growth and higher living standards will be closely linked to their ability to develop a workable division of responsibilities among federal and provincial governments and with other national governments. Finally, the diffusion of new technologies will continue to transform national and regional economies while giving individuals greater opportunity to avoid government and tax regulations that run contrary to their perceived interests and values. This discussion of determinants that shape tax policy reform has shown that successful management of fiscal and tax policy requires a capacity to set priorities; adapt to changing circumstances; and build a consensus that enables competing economic, social, regional and ideological interests to identify their own well-being in the broader political and economic environment. Tax policy is shaped by many political, economic and social determinants. As Geoffrey Hale correctly concludes, "it should not be surprising if the tax system stubbornly refuses to confirm either economic theories or political ideologies, but reflects past decisions and the policy tradeoffs of the political process" (2002, 71). The notion of tax policy being driven by globalization and forces associated with globalization (both positive and negative) is simply not borne by the facts.
Since the early 1960s ethno-territorial movements have increasingly challenged established patterns of political integration in western democracies. The purpose of this paper is to compare the formation and different paths of development of such nationalist movements in Quebec (Canada) and Corsica (France). The paper presents a brief outline of an argument more fully developed in a study on the two cases. After a short introduction I will first discuss theoretical aspects of minority nationalism. Secondly, I will try to give an overview over major findings and conclusions of my study.