Euro Induction Speech Mp3 Download [REPACK]
Cathrin Dejoode
Background: As a general rule, surgery whenever possible, followed by irradiation is considered to be the standard treatment for cancer of the hypopharynx, thus sacrificing natural speech. In most patients, surgery includes removal of the larynx.
Purpose: A prospective, randomized phase III study was conducted by the European Organization for Research and Treatment of Cancer (EORTC) starting in 1990 to compare a larynx-preserving treatment (induction chemotherapy plus definitive, radiation therapy in patients who showed a complete response or surgery in those who did not respond) with conventional treatment (total laryngectomy with partial pharyngectomy, radical neck dissection, and postoperative irradiation) in previously untreated and operable patients with histologically proven squamous cell carcinomas of the pyriform sinus or aryepiglottic fold, but free of other cancers.
Methods: Patients were randomly assigned to one of two treatment arms: 1) immediate surgery with postoperative radiotherapy (50-70 Gy) or 2) induction chemotherapy (cisplatin [100 mg/m2] given as a bolus intravenous injection on day 1, followed by infusion of fluorouracil [1000 mg/m2 per day] on days 1-5). An endoscopic evaluation was performed after each cycle of chemotherapy. After two cycles, only partial and complete responders received a third cycle. Patients with a complete response after two or three cycles of chemotherapy were treated thereafter by irradiation (70 Gy); nonresponding patients underwent conventional surgery with postoperative radiation (50-70 Gy). Salvage surgery was also performed when patients relapsed after chemotherapy and irradiation. The trial was designed to test the equivalence of the two treatment arms; i.e., the induction chemotherapy treatment would be judged equivalent to immediate surgery if the relative risk of death for induction chemotherapy compared with immediate surgery was significantly less than 1.43 using a one-sided hypothesis test at the .05 level of significance.
Results: Two hundred two patients entered the trial and were randomly assigned; only 194 were eligible for treatment (94 in the immediate-surgery arm and 100 in the induction-chemotherapy arm). In the induction-chemotherapy arm, complete response was seen in 52 (54%) of 97 patients with local disease (primary tumor) and in 31 (51%) of 61 patients with regional disease (involvement of the neck). Treatment failures at local, regional, and second primary sites occurred at approximately the same frequencies in the immediate-surgery arm (12%, 19%, and 16%, respectively) and in the induction-chemotherapy arm (17%, 23%, and 13%, respectively). In contrast, there were fewer failures at distant sites in the induction-chemotherapy arm than in the immediate-surgery arm (25% versus 36%, respectively; P = .041). The median duration of survival was 25 months in the immediate-surgery arm and 44 months in the induction-chemotherapy arm and, since the observed hazard ratio was 0.86 (logrank test, P = .006), which was significantly less than 1.43, the two treatments were judged to be equivalent. The 3- and 5-year estimates of retaining a functional larynx in patients treated in the induction-chemotherapy arm were 42% (95% confidence interval = 31%-53%) and 35% (95% confidence interval = 22%-48%), respectively.
Conclusions and implications: Larynx preservation without jeopardizing survival appears feasible in patients with cancer of the hypopharynx. On the basis of these observations, the EORTC has now accepted the use of induction chemotherapy followed by radiation as the new standard treatment in its future phase III larynx preservation trials.
After a career marked by the highest levels of success and teamwork that fundamentally changed basketball, Ginobili focused his induction speech on the people who helped him get all the way from Bahía Blanca to San Antonio and then to Springfield.
On 1 January 1999, eleven European countries took a historical step forwards by entering Stage Three of Economic and Monetary Union. Thereby, the national currencies of these eleven countries became denominations of a single currency. At the same time, the "Eurosystem" (which is composed of the European Central Bank (ECB) and the eleven national central banks of the participating Member States) assumed responsibility for the monetary policy of the euro area.
In hindsight, I think we can say that the technical change over to the euro was a tremendous success. Taking into account the monumental task of more or less simultaneously implementing changes in thousands of computer programs and operational procedures throughout the financial markets, it is astonishing that we experienced only minor teething problems; and these problems seem to have been corrected in the meantime. The successful technical launch of the euro was made possible thanks to the careful preparations of the project. It also showed that all participants (i.e. the ECB, the national central banks, public authorities and, above all, banks and other financial institutions) were committed to the project and that they carried out their preparations in a professional manner.
However, the changeover to the euro has not yet been completed. The euro still exists only in non-tangible form, i.e. in the form of book entries in information systems. The absence of euro coins and banknotes may have implied that the introduction of the new currency was perceived by most people as a rather abstract event.
The national banknotes and coins will remain in circulation until the euro banknotes and coins are introduced in 2002. This "second" changeover will likewise require substantial preparations. Apart from the one-off large-scale printing of banknotes and minting of coins, it will also require important changes for the handling of cash in the retail sector, e.g. the adaptation of teller and vending machines. I am convinced that all the parties involved will execute this "second" changeover just as professionally as the "first" changeover at the beginning of this year.
Clearly, the launch of the euro was a truly historical event, not only in view of the complexity of the task and its careful preparations, but mainly in that it would have far-reaching economic and political consequences for the participating countries and for the international monetary system as a whole. Most of these consequences are of a gradual and long-term nature.
first, we should not forget that the idea of introducing a single currency was originally motivated by the overall political arguments that an increased integration of the European countries would reduce the risk of war and crises on the continent. Through the establishment of common institutions, political conflicts could be avoided or, at least, resolved through discussion and compromise, rather than by resorting to force. Hence, at a general level, the introduction of a single currency in the euro area is an important symbol for political and social integration in Europe which should serve as a catalyst for further co-ordination and integration also in other policy areas;
second, on a macroeconomic level, a single monetary policy in the euro area which is firmly geared towards price stability will enhance political and economic stability, not only in the euro area, but also in a global context;
third, on a microeconomic level, the use of the same currency in the euro area will increase cross-border competition and market integration, thereby improving the efficiency of the markets for goods, services and capital in the participating countries. This should lead to reduced transactions costs, improved price transparency and lower price pressures.
In view of these long-term effects, I think that it would be unfair to judge the success of the euro only on the basis of the economic and financial developments during the first five months of the new currency's life - particularly to the extent that these short-term developments reflect effects of economic trends and political events outside the euro area.
Nevertheless, the experience of the first five months of the new currency's life gives some indications of the international importance of the euro and its implications for the financial markets in the euro area as well as in a global perspective. I would like to share with you some of these experiences gained in the five months since the euro was borne, seen from a banking perspective.
The most obvious consequences of the introduction of the euro were to be seen in the functioning of the foreign exchange markets. The mere fact that eleven European currencies, some of which were among the most actively traded currencies world-wide, disappeared and were replaced by the euro as a major international currency had a fundamental impact on the turnover and focus of attention in the global foreign exchange markets.
The Bank for International Settlement (BIS) recently presented a survey of the foreign exchange and derivatives markets in 1998. This survey shows that, in the last few years, the US dollar increased its importance in the foreign exchange markets. In 1998, the US dollar was involved on one of the sides in 88% of all foreign exchange transactions, compared with 45% for the currencies that were replaced by the euro.
It is interesting to note that, compared with the previous survey carried out in 1995, the share of transactions carried out in the currencies which were replaced by the euro has fallen considerably. It appears that market participants, even before the euro was launched, considered the various constituent currencies as close substitutes.
So far, there are no reliable statistics available on the development of the foreign exchange markets since the introduction of the euro. However, early indications based on information from market participants seem to indicate that the euro's share in international foreign exchange transactions is currently indeed lower than the aggregate share of the constituent currencies was in 1998.
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