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Present Authors (present + author)
Selected AbstractsNeuroanatomy and neurophysiology of itchDERMATOLOGIC THERAPY, Issue 4 2005Joanna Wallengren ABSTRACT:, The specific pathway of "pure," histaminergic itch is traced from the mechano-insensitive nerve fibers in the skin to their central cortical projections. Neuropathic itch created at different levels of this anatomical pathway is reviewed. In this review the present author discusses damage to pruritoceptors in the skin, entrapment syndromes, damage to spinal ganglia, nerve root impingement, injury of the spinal cord, and cerebral damage in the distribution of the middle cerebral artery, capsula interna, or thalamus. Itch in inflamed skin resulting from interactions between nerve transmitters and other mediators of inflammation is described. [source] Is oxidative stress involved in the aetiology of pre-eclampsia?ACTA PAEDIATRICA, Issue 2001L Poston Pre-eclampsia is one of the major indications for elective premature delivery. Several lines of evidence suggest that pre-eclampsia is associated with a state of oxidative stress, offering hope of prevention by antioxidant supplementation. It was recently shown by the present authors that supplementation with vitamin C and E from early in pregnancy leads to a reduction in the incidence of the disease in "high-risk" women. [source] Contribution of neuroinflammation in burning mouth syndrome: indications from benzodiazepine useDERMATOLOGIC THERAPY, Issue 2008Fabrizio Guarneri ABSTRACT: Characterized by burning and painful oral sensations in absence of clinically significant mucosal abnormalities, the burning mouth syndrome is, despite numerous researches made, basically idiopathic and, consequently, difficult to treat effectively. Therapy with tricyclic antidepressants and benzodiazepines has been proposed, although the exact pathomechanism is not clear. The objective of this study is to define the possible reasons for the efficacy of benzodiazepines in the treatment of the burning mouth syndrome. Starting from the report of eight cases successfully treated with prazepam, the present authors examined the clinical features and the evidence from literature that support the possibility of a role of neuroinflammation in the pathogenesis of the burning mouth syndrome. Available data suggest that the nervous system could be crucial in the pathogenesis of the syndrome (altered perception of pain, disturbance of neural transmission, increased excitability, negative involvement of trigeminal-vascular system), and the present authors' experience lets them suppose a role for neuroinflammation. This hypothesis could also explain the positive response to benzodiazepines in some patients. The important role of neuroinflammation in dermatologic and oral diseases has been only recently investigated and acknowledged. Further studies on the connection between neuroinflammation and burning mouth syndrome could open interesting perspectives in the understanding and management of this difficult clinical condition. [source] Why ethnic minority groups are under-represented in clinical trials: a review of the literatureHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2004Mahvash Hussain-Gambles MA Abstract Randomised controlled trials (RCTs) are considered to be the gold standard in evaluating medical interventions; however, people from ethnic minorities are frequently under-represented in such studies. The present paper addresses a previously neglected debate about the tensions which inform clinical trial participation amongst people from ethnic minorities, in particular, South Asians, the largest ethnic minority group in the UK. In a narrative review of the available literature, based mainly on US studies, the present authors aim to make sense of the issues around under-representation by providing a theoretical reconciliation. In addition, they identify a number of potential barriers to ethnic minority participation in clinical trials. In so doing, the authors recognise that the recent history of eugenic racism, and more general views on clinical trials as a form of experimentation, means that clinical trial participation among people from ethnic minorities becomes more problematic. Lack of participation and the importance of representational sampling are also considered, and the authors argue that health professionals need to be better informed about the issues. The paper concludes by offering a number of strategies for improving ethnic minority accrual rates in clinical trials, together with priorities for future research. [source] Accessibility, continuity and appropriateness: key elements in assessing integration of perinatal servicesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2003Danielle D'Amour RN PhD Abstract A trend toward the reduction in the length of hospital stays has been widely observed. This increasing shift is particularly evident in perinatal care. A stay of less than 48 hours after delivery has been shown to have no negative effects on the health of either the mother or the baby as long as they receive an adequate follow-up. This implies a close integration between hospital and community health services. The present article addresses the following questions: To what extent are postnatal services accessible to mothers and neonates? Are postnatal services in the community in continuity with those of the hospital? Are the services provided by the appropriate source of care? The authors conducted a telephone survey among 1158 mothers in a large urban area in the province of Quebec, Canada. The results were compared to clinical guidelines widely recognised by professionals. The results show serious discrepancies with these guidelines. The authors found a low accessibility to services: less than half of the mothers received a home visit by a nurse. In terms of continuity of care, less than 10% of the mothers received a follow-up telephone call within the recommended time frame and only 18% benefited from a home visit within the recommended period. Finally, despite guidelines to the contrary, hospitals continue to intervene after discharge. This results in a duplication of services for 44.7% of the new-borns. On the other hand, 40.7% are not seen in the recommended period after hospital discharge at all. These results raise concerns about the integration of services between agencies. Following earlier work, the present authors have grouped explanatory factors under four dimensions: the strategic dimension, particularly leadership; the structural dimension, including the size of the network; the technological dimension, with respect to information transmission system; and the cultural dimension, which concerns the collaboration process and the development of relationships based on trust. [source] Mental health training and development needs of community agency staffHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2002Jenny Secker Abstract Emphasis has long been placed in UK national policy on providing ,seamless' mental health services to meet both the health and social care needs of service users. While attention has been paid to the training required by specialist mental health and primary care staff in order to achieve this, the needs of other community agency staff have received less attention. The present article describes a study designed to identify the training needs of staff working within a broad range of agencies. Focus group discussions were used to explore participants' experiences of mental health problems amongst clients, their confidence in dealing with these, current sources of support and perceived training needs. The results indicate that participants in all agencies routinely encountered a range of problems. Colleagues were the main source of support, followed by line managers, but supervision structures and wider organisational support were lacking in some cases. Joint working with specialist mental health services was almost universally problematic and all groups identified a range of training needs. On the basis of the results, the present authors put forward suggestions as to how these needs might be met. [source] Hanns Fischer: Radical PioneerHELVETICA CHIMICA ACTA, Issue 10 2006Athelstan Abstract For four decades, Hanns Fischer played a major and highly innovative role in the development of free radical chemistry. The present article describes the science in several of Fischer's papers. These papers were chosen for analysis because they nicely illustrate Fischer's originality, passion for exactitude, and impact on chemistry, and because they are well-read favorites of the present authors. [source] A new scheme for designing the penalty factor in 3-D penalty-equilibrating mixed elementsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 6 2004Yan Ping Cao Abstract In this paper, a new scheme for designing the penalty factor in 3-D penalty-equilibrating mixed elements based on the Hu,Washizu three-field variational functional is proposed to improve the performance of the elements when applied to beam, plate and shell structures. In order to construct this new scheme, the role played by the penalty factor is first discussed in detail by comparing it with the selective reduced factor designed by Sze for overcoming the so-called ,trapezoid locking'. The reason of the poor performance of the penalty-equilibrating element for the distorted elemental geometry is investigated thoroughly. Furthermore, the penalty factor is designed to alleviate the influence of false strain/stress in elements by considering the geometrical characteristics of beam, plate and shell structures. The new scheme is applied to the penalty-equilibrating 3-D mixed element proposed by the present authors previously. Some challenging numerical examples are selected to demonstrate the effectiveness of the present approach. Copyright © 2004 John Wiley & Sons, Ltd. [source] Performance analysis of IDEAL algorithm for three-dimensional incompressible fluid flow and heat transfer problemsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 10 2009Dong-Liang Sun Abstract Recently, an efficient segregated algorithm for incompressible fluid flow and heat transfer problems, called inner doubly iterative efficient algorithm for linked equations (IDEAL), has been proposed by the present authors. In the algorithm there exist inner doubly iterative processes for pressure equation at each iteration level, which almost completely overcome two approximations in SIMPLE algorithm. Thus, the coupling between velocity and pressure is fully guaranteed, greatly enhancing the convergence rate and stability of solution process. However, validations have only been conducted for two-dimensional cases. In the present paper the performance of the IDEAL algorithm for three-dimensional incompressible fluid flow and heat transfer problems is analyzed and a systemic comparison is made between the algorithm and three other most widely used algorithms (SIMPLER, SIMPLEC and PISO). By the comparison of five application examples, it is found that the IDEAL algorithm is the most robust and the most efficient one among the four algorithms compared. For the five three-dimensional cases studied, when each algorithm works at its own optimal under-relaxation factor, the IDEAL algorithm can reduce the computation time by 12.9,52.7% over SIMPLER algorithm, by 45.3,73.4% over SIMPLEC algorithm and by 10.7,53.1% over PISO algorithm. Copyright © 2009 John Wiley & Sons, Ltd. [source] CFD-based multi-objective optimization method for ship designINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 5 2006Yusuke Tahara Abstract This paper concerns development and demonstration of a computational fluid dynamics (CFD)-based multi-objective optimization method for ship design. Three main components of the method, i.e. computer-aided design (CAD), CFD, and optimizer modules are functionally independent and replaceable. The CAD used in the present study is NAPA system, which is one of the leading CAD systems in ship design. The CFD method is FLOWPACK version 2004d, a Reynolds-averaged Navier,Stokes (RaNS) solver developed by the present authors. The CFD method is implemented into a self-propulsion simulator, where the RaNS solver is coupled with a propeller-performance program. In addition, a maneuvering simulation model is developed and applied to predict ship maneuverability performance. Two nonlinear optimization algorithms are used in the present study, i.e. the successive quadratic programming and the multi-objective genetic algorithm, while the former is mainly used to verify the results from the latter. For demonstration of the present method, a multi-objective optimization problem is formulated where ship propulsion and maneuverability performances are considered. That is, the aim is to simultaneously minimize opposite hydrodynamic performances in design tradeoff. In the following, an overview of the present method is given, and results are presented and discussed for tanker stern optimization problem including detailed verification work on the present numerical schemes. Copyright © 2006 John Wiley & Sons, Ltd. [source] Further experiences with computing non-hydrostatic free-surface flows involving water wavesINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN FLUIDS, Issue 2 2005Marcel Zijlema Abstract A semi-implicit, staggered finite volume technique for non-hydrostatic, free-surface flow governed by the incompressible Euler equations is presented that has a proper balance between accuracy, robustness and computing time. The procedure is intended to be used for predicting wave propagation in coastal areas. The splitting of the pressure into hydrostatic and non-hydrostatic components is utilized. To ease the task of discretization and to enhance the accuracy of the scheme, a vertical boundary-fitted co-ordinate system is employed, permitting more resolution near the bottom as well as near the free surface. The issue of the implementation of boundary conditions is addressed. As recently proposed by the present authors, the Keller-box scheme for accurate approximation of frequency wave dispersion requiring a limited vertical resolution is incorporated. The both locally and globally mass conserved solution is achieved with the aid of a projection method in the discrete sense. An efficient preconditioned Krylov subspace technique to solve the discretized Poisson equation for pressure correction with an unsymmetric matrix is treated. Some numerical experiments to show the accuracy, robustness and efficiency of the proposed method are presented. Copyright © 2004 John Wiley & Sons, Ltd. [source] Update on desiccant wheel modelINTERNATIONAL JOURNAL OF ENERGY RESEARCH, Issue 12 2004M. Beccali Abstract This short communication presents the update on the desiccant wheel models, developed earlier by the present authors. It is to be mentioned here that the psycrometric model presented earlier (Int. J. Energy Res., 2003; 27:17) is valid only for the desiccant wheel running with identical volume air-flows in supply and regeneration sides. However, when system runs with volume air flow ratio between supply and regeneration side (,), different from 1 (one), the model need further modifications. In the present work, correction factors were developed and incorporated in order to update the earlier model for predicting correctly the temperature and humidity of processed air at the outlet of desiccant wheel. The modified model were verified against the experimental results corresponding to different values of ,, obtained from the industry for three different kinds of desiccant wheels. Copyright © 2004 John Wiley & Sons, Ltd. [source] Evaluation of the Effect of an Open Learning Course on Staff Knowledge and Attitudes Towards the Sexual Abuse of Adults with Learning DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 1 2001James Hogg An open learning course, ,Approaches to Sexual Abuse of Adults with Learning Disabilities', was undertaken with a range of staff working with adults with learning disabilities. Using a specially designed questionnaire based on the research and practice literature on sexual abuse, the present authors evaluated the impact of the course on staff knowledge of: (1) sexual abuse, and its antecedents and consequences; (2) the procedures to be followed once abuse is suspected; and (3) the practices most likely to minimize abuse. In addition, the effect of the course on attitudes was also assessed. Staff knowledge of sexual abuse was significantly increased following completion of the course. Staff attitudes at the outset of the course tended to be highly consistent with the values and practices reflected in the course material. However, changes in acceptance of formal practices to deal with abuse, confidence in having the skills to deal with incidents and awareness of the vulnerability of people with learning disabilities to abuse were all enhanced. The implication of sample attrition during the course is considered with respect to the nature of the environment in which staff work and the feasibility of the open learning model. [source] Studying aggression in school children: The use of a wireless microphone and micro-video cameraAGGRESSIVE BEHAVIOR, Issue 5 2002Katy Tapper Abstract This paper describes a wireless microphone and micro-video camera used successfully by the present authors to study direct, indirect, and relational forms of aggression in schools. Two major advantages of this equipment are identified; first, it avoids some of the potential biases and difficulties associated with the other methods and, second, it allows researchers to record and analyze a large number of significant variables that may otherwise be difficult to assess. The importance of this kind of data is discussed in relation to the development of effective interventions aimed at reducing aggression in schools. Aggr. Behav. 28:356,365, 2002. © 2002 Wiley-Liss, Inc. [source] Verbal short-term memory in Down's syndrome: An articulatory loop deficit?JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2004S. Vicari Abstract Background Verbal short-term memory, as measured by digit or word span, is generally impaired in individuals with Down's syndrome (DS) compared to mental age-matched controls. Moving from the working memory model, the present authors investigated the hypothesis that impairment in some of the articulatory loop sub-components is at the base of the deficient maintenance and recall of phonological representations in individuals with DS. Methods Two experiments were carried out in a group of adolescents with DS and in typically developing children matched for mental age. In the first experiment, the authors explored the reliance of these subjects on the subvocal rehearsal mechanism during a word-span task and the effects produced by varying the frequency of occurrence of the words on the extension of the word span. In the second experiment, they investigated the functioning of the phonological store component of the articulatory loop in more detail. Results A reduced verbal span in DS was confirmed. Neither individuals with DS nor controls engaged in spontaneous subvocal rehearsal. Moreover, the data provide little support for defective functioning of the phonological store in DS. Conclusions No evidence was found suggesting that a dysfunction of the articulatory loop and lexical-semantic competence significantly contributed to verbal span reduction in subjects with DS. Alternative explanations of defective verbal short-term memory in DS, such as a central executive system impairment, must be considered. [source] Autonomy and intellectual disability: the case of prevention of obesity in Prader,Willi syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 7 2002R. H. van Hooren Abstract Background The policy concerning care for people with intellectual disability (ID) has developed from segregation via normalization towards integration and autonomy. Today, people with ID are seen as citizens who need to be supported to achieve a normal role in society. The aim of care is to optimize quality of life and promote self-determination. The promotion of autonomy for people with ID is not easy and gives rise to ethical dilemmas. Caregivers are regularly confronted with situations in which there is a conflict between providing good care and respecting the client's autonomy. This becomes evident in the case of prevention of obesity in people with Prader,Willi syndrome (PWS). Method As part of a study about the ethical aspects of the prevention of obesity, in-depth qualitative interviews were conducted with the parents and professional caregivers of people with PWS. Results In analysing interviews with parents and formal caregivers, the present authors found that the dichotomy between respecting autonomy and securing freedom of choice on the one hand, and paternalism on the other, is too crude to do justice to the process of care. The stories indicated that caregivers see other options and act in other ways than to intervene without taking into account the wishes of the individual with PWS. The present authors elaborated these options, taking models of the physician,patient relationship as a heuristic starting point. They extended the logic of these models by focusing on the character of the process of interaction between caregiver and care receiver, and on the emotional aspects of the interactions. Conclusion This approach results in more attention to processes of interpretation, deliberation and joint learning. [source] Changes in explicit memory associated with early dementia in adults with Down's syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 3 2002S. J. Krinsky-McHale Abstract Background A modified version of the Selective Reminding Test (SRT) (Buschke 1973) was used to examine the changes in memory that occur with early-stage dementia of the Alzheimer's type (DAT) in adults with intellectual disability (ID) and Down's syndrome (DS), and to compare these changes to those occurring with ,normal' ageing. Method Hierarchical linear modelling analyses showed steep declines in the performance of participants who had met the criteria for the onset of DAT. Non-demented participants also showed declines in performance which were related to their age. However, the absolute magnitude of these declines was consistent with a ,normal' ageing pattern and not with undetected dementia. Results In analysing the specific memory components that are compromised, the present authors found that participants with early-stage DAT showed severely diminished long-term storage and retrieval processing abilities compared to their non-demented peers. Notably, these declines preceded other symptoms of dementia, in most cases by more than a full year and sometimes by as much as 3 years. Conclusions Thus, the present results clearly confirm that memory processes are affected during early dementia in adults with DS, and that the SRT has promise as a clinical tool. [source] DIFFERENTIATION OF SUPRAHYOID ACTIVITY PATTERNS DURING SWALLOWING OF UMAMI-TASTING FOODSJOURNAL OF SENSORY STUDIES, Issue 6 2006YOZO MIYAOKA ABSTRACT In the preceding study, the present authors differentiated the activity patterns of the suprahyoid (SH) muscles during pharyngeal swallowing of tasty and tasteless foods by using "TP" values that assigned activity of electromyograms (EMG) to a standardized time scale. In the present study, we calculated not only the TP values but also the InP values (by subtracting the preceding TP-10 values from TP) to analyze activity patterns of the SH EMG during pharyngeal swallowing of foods dissolved in unitary (monosodium glutamate [MSG] and disodium inosine-5,-monophosphate [IMP]) and binary (MSG + IMP) "umami-" tasting solutions of low and high concentration. We found that SH activity patterns differed slightly between low and high concentration of unitary and binary umami-tasting foods, but that SH activity patterns measured while swallowing umami-tasting foods did not differ from those measured while swallowing sweet- or salty-tasting foods, or tasteless food. [source] The Uses of a Good TheoryJOURNAL OF SOCIAL ISSUES, Issue 2 2006Faye J. Crosby How does one diminish discrimination? Many members of SPSSI, including the present authors, have tried to reduce discrimination through the application of good theories. We outline three theoretical approaches that Crosby, like many other psychologists, has taken as she has struggled with discrimination. Sometimes missing in Crosby's approach, and often missing in the approach of others, is a frank avowal of values. We argue that the attempt to divorce science from values renders theories less effective than they need be and even allows unexamined values to contaminate good research. [source] Phase-field systems for multi-dimensional Prandtl,Ishlinskii operators with non-polyhedral characteristicsMATHEMATICAL METHODS IN THE APPLIED SCIENCES, Issue 4 2002Jürgen Sprekels Abstract Hysteresis operators have recently proved to be a powerful tool in modelling phase transition phenomena which are accompanied by the occurrence of hysteresis effects. In a series of papers, the present authors have proposed phase-field models in which hysteresis non-linearities occur at several places. A very important class of hysteresis operators studied in this connection is formed by the so-called Prandtl,Ishlinskii operators. For these operators, the corresponding phase-field systems are in the multi-dimensional case only known to admit unique solutions if the characteristic convex sets defining the operators are polyhedrons. In this paper, we use approximation techniques to extend the known results to multi-dimensional Prandtl,Ishlinskii operators having non-polyhedral convex characteristicsets. Copyright © 2002 John Wiley & Sons, Ltd. [source] On the Ghoudi, Khoudraji, and Rivest test for extreme-value dependenceTHE CANADIAN JOURNAL OF STATISTICS, Issue 4 2009Noomen Ben Ghorbal Abstract Ghoudi, Khoudraji & Rivest [The Canadian Journal of Statistics 1998;26:187,197] showed how to test whether the dependence structure of a pair of continuous random variables is characterized by an extreme-value copula. The test is based on a U -statistic whose finite- and large-sample variance are determined by the present authors. They propose estimates of this variance which they compare to the jackknife estimate of Ghoudi, Khoudraji & Rivest (1998) through simulations. They study the finite-sample and asymptotic power of the test under various alternatives. They illustrate their approach using financial and geological data. The Canadian Journal of Statistics © 2009 Statistical Society of Canada Ghoudi, Khoudraji & Rivest (1998) ont montré comment tester que la structure de dépendance d'un couple d'aléas continus est caractérisée par une copule de valeurs extrêmes. Le test s'appuie sur une U -statistique dont les auteurs déterminent ici la variance asymptotique et à taille finie. Ils proposent des estimations de cette variance qu'ils comparent à l'estimateur jackknife de Ghoudi, Khoudraji & Rivest (1998) à l'aide de simulations. Ils étudient les puissances à taille finie et asymptotique du test sous diverses contre-hypothèses. Ils illustrent leur propos avec des données financières et géologiques. La revue canadienne de statistique © 2009 Société statistique du Canada [source] A Three-Year Follow-Up Report of a Comparative Study of ITI Dental Implants® and Brånemark System® Implants in the Treatment of the Partially Edentulous MaxillaCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2004Per Åstrand DDS ABSTRACT Background: Many longitudinal studies of different implant systems have been published but few controlled randomized investigations have been reported. A 1-year report of a comparative study of ITI Dental Implant System® implants (Straumann AG, Waldenburg, Switzerland) and Brånemark System® implants (Nobel Biocare AB, Gothenburg, Sweden) has been published by the present authors. This paper is a 3-year follow-up of that randomized study. Purpose: The aim of the study was to compare the outcome of fixed partial prostheses supported by ITI or Branemark implants. The outcome was evaluated primarily in terms of survival rates and changes in marginal bone level. Material and Methods: The study group comprised 28 patients with anterior residual dentition in the maxilla. The patients were provided with two to four implants on each side of the dentition and were randomly allocated to Brånemark implants or ITI implants; 77 ITI implants and 73 Brånemark implants were inserted. After 6 months abutment connections were made to both ITI and Brånemark implants. All patients were provided with fked partial prostheses of gold-ceramic. The patients were followed up annually with clinical and radiographic examinations for 3 years. Results: Two Brånemark implants and two ITI implants were lost. The Brånemark implants were lost before loading whereas the ITI implants were lost because of periimplantitis. The survival rate for both groups was 97.3%. The mean marginal bone level of the Brånemark implants was situated 1.8 mm from the reference point at both the baseline and the 3-year examinations. The corresponding values for the ITI implants were 1.4 mm at baseline and 1.3 mm after 3 years. There was no significant difference between the implant systems with regard to bone level or bone level change. A steady state of the marginal bone level was calculated to have been reached after 3 years for 95.5% of the Brånemark implants and 87.1% of the ITI implants. Periimplantitis (infection including pus and bone loss) was observed with seven ITI implants but with none of the Brånemark implants. This difference was statistically significant. Conclusions: No statistically significant differences were found between the implants studied, except for the frequency of periimplantitis, which was higher for the ITI implants. The survival rates were high, and the marginal bone loss was small for both systems. [source] Cutaneous melanoma: methods of biopsy and definitive surgical excisionDERMATOLOGIC THERAPY, Issue 5 2005Adam I. Riker ABSTRACT:, The proper method of biopsy and definitive surgical excision of cutaneous melanoma is vital for optimal patient outcome. Clearly, the present authors' understanding of the pathophysiology of cutaneous melanoma continues to change at a rapid pace. Indeed, as the present authors' research efforts begin to expose some of the mysteries of melanoma, so do they begin to better understand the intricacies of this dreaded cancer. This article will highlight methods of biopsy for melanoma and the management of the primary tumor. The present authors review current recommendations for excision margins for the primary tumor, usefulness of lymphoscintigraphy, timing of definitive surgical excision, and issues unique for head and neck melanoma. [source] | ||||||||||||||||||||||