Increasing Reliance (increasing + reliance)

Distribution by Scientific Domains

Selected Abstracts

Prevention of wound complications following salvage laryngectomy using free vascularized tissue

FRCS(C), Kevin Fung MD
Abstract Background. Total laryngectomy following radiation therapy or concurrent chemoradiation therapy is associated with unacceptably high complication rates because of wound healing difficulties. With an ever increasing reliance on organ preservation protocols as primary treatment for advanced laryngeal cancer, the surgeon must develop techniques to minimize postoperative complications in salvage laryngectomy surgery. We have developed an approach using free tissue transfer in an effort to improve tissue vascularity, reinforce the pharyngeal suture line, and minimize complications in this difficult patient population. The purpose of this study was to outline our technique and determine the effectiveness of this new approach. Methods. We conducted a retrospective review of a prospective cohort and compared it with a historical group (surgical patients of Radiation Therapy Oncology Group (RTOG)-91-11 trial). Eligibility criteria for this study included patients undergoing salvage total laryngectomy following failed attempts at organ preservation with either high-dose radiotherapy or concurrent chemo/radiation therapy regimen. Patients were excluded if the surgical defect required a skin paddle for pharyngeal closure. The prospective cohort consisted of 14 consecutive patients (10 males, 4 females; mean age, 58 years) who underwent free tissue reinforcement of the pharyngeal suture line following total laryngectomy. The historical comparison group consisted of 27 patients in the concomitant chemoradiotherapy arm of the RTOG-91-11 trial who met the same eligibility criteria (26 males, 1 female; mean age, 57 years) but did not undergo free tissue transfer or other form of suture line reinforcement. Minimum follow-up in both groups was 12 months. Results. The overall pharyngocutaneous fistula rate was similar between groups,4/14 (29%) in the flap group, compared with 8/27 (30%) in the RTOG-91-11 group. There were no major wound complications in the flap group, compared with 4 (4/27, 14.8%) in the RTOG-91-11 group. There were no major fistulas in the flap group, compared with 3/27 (11.1%) in the RTOG-91-11 group. The rate of pharyngeal stricture requiring dilation was 6/14 (42%) in the flap group, compared with 7/27 (25.9%) in the RTOG-91-11 group. In our patients, the rate of tracheoesophageal speech was 14/14 (100%), and complete oral intake was achieved in 13/14 (93%) patients. Voice-Related Quality of Life Measure (V-RQOL) and Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) scores suggest that speech and swallowing functions are reasonable following free flap reinforcement. Conclusions. Free vascularized tissue reinforcement of primary pharyngeal closure in salvage laryngectomy following failed organ preservation is effective in preventing major wound complications but did not reduce the overall fistula rate. Fistulas that developed following this technique were relatively small, did not result in exposed major vessels, and were effectively treated with outpatient wound care rather than readmission to the hospital or return to operating room. Speech and swallowing results following this technique were comparable to those following total laryngectomy alone. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source]

The Long Parliament goes to war: the Irish campaigns, 1641,3*

Robert Armstrong
As England lurched towards war in 1642, the Westminster parliament had already become embroiled in a lengthy and costly war of reconquest in Ireland. An examination of the war effort in Ireland reveals the scale of parliament's commitment to sustained long-distance warfare, the range of initiatives developed to harness the necessary political and material resources, and its increasing reliance upon an emerging war interest of investors and suppliers. The outbreak of civil war in England saw parliament deploy a similar gamut of initiatives, nationally and locally, to those used in Ireland, but in very different strategic and political contexts. Parliament was engaged in a smaller-scale version of the multiple-front conflicts of the great European powers and disengagement from Ireland, England's Flanders, was not an option. [source]

Bioaccumulation Assessment Using Predictive Approaches,

John W Nichols
Abstract Mandated efforts to assess chemicals for their potential to bioaccumulate within the environment are increasingly moving into the realm of data inadequacy. Consequently, there is an increasing reliance on predictive tools to complete regulatory requirements in a timely and cost-effective manner. The kinetic processes of absorption, distribution, metabolism, and elimination (ADME) determine the extent to which chemicals accumulate in fish and other biota. Current mathematical models of bioaccumulation implicitly or explicitly consider these ADME processes, but there is a lack of data needed to specify critical model input parameters. This is particularly true for compounds that are metabolized, exhibit restricted diffusion across biological membranes, or do not partition simply to tissue lipid. Here we discuss the potential of in vitro test systems to provide needed data for bioaccumulation modeling efforts. Recent studies demonstrate the utility of these systems and provide a "proof of concept" for the prediction models. Computational methods that predict ADME processes from an evaluation of chemical structure are also described. Most regulatory agencies perform bioaccumulation assessments using a weight-of-evidence approach. A strategy is presented for incorporating predictive methods into this approach. To implement this strategy it is important to understand the "domain of applicability" of both in vitro and structure-based approaches, and the context in which they are applied. [source]

Design Considerations for Research on Analytical Procedures

Stephen K. Asare
This article discusses research design considerations for conducting behavioral research on auditors' performance of analytical procedures (APs). With the trend in practice towards increasing reliance on APs, it is essential that auditors are proficient in completing such tests. Therefore, research to understand and improve auditors' performance of APs is important. Once an unexpected fluctuation is identified, APs involve three phases: generation of plausible hypotheses (likely causes); gathering evidence to examine plausible hypotheses; and identification of the most likely cause followed by appropriate follow-up actions. Although prior research has focused on these phases in isolation, they are, in fact, interrelated. Important research design issues and trade-offs for each of the phases of APs are discussed. For instance, in examining hypothesis generation there are choices as to the amount and nature of case background information, number of ratios or accounts to explain; ex-post evaluation of the quality of the hypothesis set; and instructions on number of causes that account for the fluctuation. Significant considerations are identified for making informed decisions among design choices. [source]

The sustainability of consumer credit growth in late twentieth century Australia

Margaret Griffiths
This article reports on a study about the use of credit by Australian consumers between 1980 and 1996. Considerable growth in the use of credit by consumers was coupled with an increasing reliance on credit to finance purchase transactions as consumers' other sources of purchase finance became depleted. An increasing number of consumers were found to be experiencing difficulty meeting their debt- servicing commitments. These results suggest that the growth in use of consumer credit that has occurred in Australia may not be in the long-term interest of consumers or the economy. [source]

Mercury accumulation in the fish community of a sub-Arctic lake in relation to trophic position and carbon sources

M. Power
Summary 1Stable isotope analysis has improved understanding of trophic relationships among biota. Coupled with contaminant analysis, stable isotope analysis has also been used for tracing the pattern and extent of biomagnification of contaminants in aquatic food webs. 2Combined analysis of nitrogen (, 15 N) and carbon (, 13 C) isotopes from fish species in a sub-Arctic lake were related to tissue mercury (Hg) concentrations to assess whether carbon sources influenced Hg accumulation in fish, in addition to trophic position. 3Statistical models were used to estimate Hg biomagnification and uptake, to elucidate Hg accumulation dynamics and to appraise the relative importance of Hg exposure routes for the fish species. 4Species Hg contamination increased as a function of trophic position (, 15 N) and was inversely related to the , 13 C signature. Species connected to the benthic food chain had lower Hg concentrations than species connected to the pelagic food chain. Species undergoing ontogenetic dietary shifts with increasing size, e.g. lake trout Salvelinus namaycush , also showed increased Hg concentrations with increasing reliance on pelagic fish as prey. 5The results indicate that both vertical (trophic) and horizontal (habitat) food web structure influence Hg concentrations in fish tissue. 6The biomagnification and uptake models indicated that contamination at the base of the food chain in the lake exceeded estimates for more southerly environments, thereby demonstrating the importance of dietary and water column Hg exposure routes in the sub-Arctic for determining Hg concentrations in fish. 7Overall, the data reported here demonstrate how a combination of ecological concepts (food webs), developing ecological methods (stable isotopes) and environmental geochemistry can combine profitably to indicate the risks of exposure to environmental contaminants. Additional studies of the dynamics of Hg accumulation in the food webs of sub-Arctic lakes are needed, particularly in the light of the estimated high biomagnification rates and the heavy reliance of Inuit communities on subsistence fish harvests. [source]

Forensic aspects of DNA-based human identity testing

Stephen M. Roper MS
Abstract The forensic applications of DNA-based human identity laboratory testing are often underappreciated. Molecular biology has seen an exponential improvement in the accuracy and statistical power provided by identity testing in the past decade. This technology, dependent upon an individual's unique DNA sequence, has cemented the use of DNA technology in the forensic laboratory. This paper will discuss the state of modern DNA-based identity testing, describe the technology used to perform this testing, and describe its use as it relates to forensic applications. We will also compare individual technologies, including polymerase chain reaction (PCR) and Southern Blotting, that are used to detect the molecular differences that make all individuals unique. An increasing reliance on DNA-based identity testing dictates that healthcare providers develop an understanding of the background, techniques, and guiding principles of this important forensic tool. [source]

A molecular basis for the increased vulnerability of substantia nigra dopamine neurons in aging and Parkinson's disease,

C. Savio Chan PhD
Abstract Parkinson's disease (PD) is a common neurodegenerative disorder of unknown etiology. There is no cure or proven strategy for slowing the progression of the disease. Although there are signs of pathology in many brain regions, the core symptoms of PD are attributable to the selective degeneration of dopaminergic neurons in the substantia nigra pars compacta. A potential clue to the vulnerability of these neurons is an increasing reliance with age upon L-type Ca2+ channels with a pore-forming Cav1.3 subunit to support autonomous activity. This reliance could pose a sustained stress on mitochondrial ATP generating oxidative phosphorylation, accelerating cellular aging and death. Systemic administration of isradipine, a dihydropyridine blocker of these channels, forces dopaminergic neurons in rodents to revert to a juvenile, L-type Ca2+ channel independent mechanism to generate autonomous activity. This "rejuvenation" confers protection against toxins that produce experimental Parkinsonism, pointing to a potential neuroprotective strategy for PD. Their decades-long track record of safe use in the treatment of hypertension makes dihydropyridines particularly attractive as a therapeutic tool in PD. © 2010 Movement Disorder Society [source]

Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney Shortage

R. S. Gaston
Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of ,valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes. [source]

Multiple Discourses on Crisis: Farm, Agricultural, and Rural Policy Implications

Kenneth C. Bessant
The terms farm crisis, agricultural crisis, and rural crisis have been invoked in political and policy discourse to characterize significant disruptions in or threats to rural,farm livelihoods. Although these expressions reflect a general sense of concern over the state of agriculture and rural existence, they lack clear and concise meaning. Academic research and policy development are obfuscated by the lack of definitional consensus or, at minimum, some shared understanding of the core aspects of farm-related crisis. Much of the debate revolves around four main themes: farm financial difficulties (low or unstable incomes, indebtedness, and increasing reliance on nonfarm revenue), structural changes in agriculture (increasing scale, concentration, and consolidation), rural livelihoods (dwindling communities, institutions, and services), and international dimensions (market fluctuations, trade regulations, and disputes). The examination of these interrelated levels of analysis offers a valuable framework for interpreting the multifold contexts, meanings, and responses to crisis. This paper explores varied representations of farm,agricultural crisis, with particular emphasis on the presumed causes (or precipitating factors), conditions, and related policies and programs. Les expressions , crise agricole , et , crise rurale , sont évoquées dans le discours politique pour caractériser des perturbations ou des menaces importantes aux moyens de subsistance en milieu rural et agricole. Bien que ces expressions traduisent certaines inquiétudes concernant la situation des secteurs agricole et rural, leur signification manque de clarté et de concision. Les chercheurs universitaires et les élaborateurs de politiques sont déconcertés par le manque de consensus définitionnel ou, du moins, par le manque de vision commune des aspects fondamentaux de la crise agricole. Une grande partie du débat tourne autour de quatre thèmes principaux: les difficultés financières de l'exploitation agricole (revenu faible ou instable, endettement et dépendance accrue aux revenus non agricoles); les changements structurels dans le secteur agricole (augmentation de l'échelle de production, concentration et regroupement); les moyens de subsistance en milieu rural (diminution du nombre de collectivités, d'institutions et de services); les dimensions internationales (fluctuations du marché, règlements concernant les échanges commerciaux, différends). L'examen de ces niveaux d'analyse interreliés offre un outil précieux pour interpréter les multiples contextes, significations et réactions aux crises. Le présent article analyse les diverses représentations de la crise dans le secteur agricole et se penche particulièrement sur les causes présumées (ou facteurs déclenchants), les conditions ainsi que les politiques et programmes connexes. [source]