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Kinds of Verge Selected AbstractsLanguage on the Verge of Death: On Language and Language Criticism in Badenheim 1939 by Aharon AppelfeldORBIS LITERARUM, Issue 3 2004Chaya Shacham The question of language became a central issue in writing after the Holocaust, especially for those for whom the years of the Second World War were formative in both their personal lives and their becoming writers. The Hebrew writer Aharon Appelfeld is one of them. This study focuses on the problem of language and language criticism in Appelfeld's novella Badenheim 1939 (1975). Language is in fact the covert theme of the novella. The work, which describes the last summer in an Austrian resort before the deportation of its Jews to Poland, is replete with metalanguage whose purpose is to draw the reader's attention to the language and its status in the work. The essay follows and analyses the effects on language made by the characters' experiences (weakening, loss of meaning, loss of referents in the new reality and the new era in Badenheim) and suggests that the meeting point of the murderers and victims is in language corruption and distortion. The study furthermore suggests that from the novella springs the unspoken accusation against the Jewish vacationers of unintentional collaboration with the murderers by conniving in the ,laundering' of the language, which in turn contributed to the coming catastrophe. Central to the explorations of the essay is the possibility of linking Appelfeld's criticism of language with Karl Krause's critical stance on language contamination and doublespeak implied in the work. [source] NARROW BAND IMAGING IN THE DETECTION OF COLORECTAL POLYP: KOREAN EXPERIENCEDIGESTIVE ENDOSCOPY, Issue 2 2008Jeong-Sik Byeon Background:, Although white light (WL) colonoscopy is a gold standard to detect colorectal polyps, substantial polyps are missed. Narrow band imaging (NBI) is a new technology that enables a more detailed visualization of the mucosal surface. The aim of the present study was to determine whether NBI can improve the detection of colorectal polyps. Methods:, We prospectively enrolled 188 (M : F = 99:89, 21,80 years) subjects undergoing colonoscopy as a screening procedure in nine referral centers. After a careful WL examination of the whole colorectum, rectosigmoid colon (0,30 cm from the anal verge) was reobserved by NBI. Size, macroscopic morphology, and the histology of all the polyps detected during WL and NBI examination were analyzed. Results:, WL examination detected 162 polyps in 188 subjects, of which 106 lesions were neoplastic, while NBI of rectosigmoid colon detected an additional 61 polyps of which eight lesions were neoplastic. Only 10 (6.2%) of 162 polyps discovered during WL examination were flat polyps compared to 10 (16.4%) of 61 newly detected polyps during NBI being flat type (P = 0.002). The mean polyp size detected by NBI was smaller than that found by WL colonoscopy (2.8 ± 1.0 mm vs 6.5 ± 4.5 mm, P < 0.001). Conclusion:, Many additional colorectal polyps, especially flat type, could be detected by NBI examination for normal-looking rectosigmoid mucosa. The role of NBI in colorectal neoplasm screening needs to be further investigated in future studies. [source] Isolation of Solid Solution Phases in Size-Controlled LixFePO4 at Room TemperatureADVANCED FUNCTIONAL MATERIALS, Issue 3 2009Genki Kobayashi Abstract State-of-the-art LiFePO4 technology has now opened the door for lithium ion batteries to take their place in large-scale applications such as plug-in hybrid vehicles. A high level of safety, significant cost reduction, and huge power generation are on the verge of being guaranteed for the most advanced energy storage system. The room-temperature phase diagram is essential to understand the facile electrode reaction of LixFePO4 (0,<,x,<,1), but it has not been fully understood. Here, intermediate solid solution phases close to x,=,0 and x,=,1 have been isolated at room temperature. Size-dependent modification of the phase diagram, as well as the systematic variation of lattice parameters inside the solid-solution compositional domain closely related to the electrochemical redox potential, are demonstrated. These experimental results reveal that the excess capacity that has been observed above and below the two-phase equilibrium potential is largely due to the bulk solid solution, and thus support the size-dependent miscibility gap model. [source] A Rogue is a Rogue is a Rogue: US Foreign Policy and the Korean Nuclear CrisisINTERNATIONAL AFFAIRS, Issue 4 2003Roland Bleiker Two nuclear crises recently haunted the Korean peninsula, one in 1993/4, the other in 2002/3. In each case the events were strikingly similar: North Korea made public its ambition to acquire nuclear weapons and withdrew from the Nonproliferation Treaty. Then the situation rapidly deteriorated until the peninsular was literally on the verge of war. The dangers of North Korea's actions, often interpreted as nuclear brinkmanship, are evident and much discussed, but not so the underlying patterns that have shaped the conflict in the first place. This article sheds light on some of them. It examines the role of the United States in the crisis, arguing that Washington's inability to see North Korea as anything but a threatening ,rogue state' seriously hinders both an adequate understanding and possible resolution of the conflict. Particularly significant is the current policy of pre-emptive strikes against rogue states, for it reinforces half a century of American nuclear threats towards North Korea. The problematic role of these threats has been largely obscured, not least because the highly technical discourse of security analysis has managed to present the strategic situation on the peninsula in a manner that attributes responsibility for the crisis solely to North Korea's actions, even if the situation is in reality far more complex and interactive. [source] Electroconvulsive Therapy and the Fear of DevianceJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2002James Giles After reaching the verge of obsolescence, electroconvulsive therapy (ECT) is once again on the increase. There remains, however, no sound theoretical basis for its use. By 1948 at least 50 different theories had been proposed to account for the workings of ECT. Today there are numerous more. Further, there is no good evidence for its therapeutic effectiveness. Although some studies show what are claimed to be positive results, others show significant amount of relapse, even with severe depression (the disorder against which ECT is supposed to be most effective), while even other studies show ECT to have little more effect than a placebo. Finally, there is much evidence for ECTs damaging effects, particularly to cognitive functioning like memory, general intelligence level, and perceptual abilities, and quite possibly to brain functioning. Some studies even suggest that the alleged therapeutic effects of ECT are essentially the effects of organic brain damage. The question, then, is why, despite these problems, does ECT continue to be used? ECTs salient features suggest an answer here. These are the features of dehumanization, power, control, punishment, and others, all of which can be traced back to the fear of deviant psychotic behavior. [source] Evolutionary acceleration in the most endangered mammal of Canada: speciation and divergence in the Vancouver Island marmot (Rodentia, Sciuridae)JOURNAL OF EVOLUTIONARY BIOLOGY, Issue 5 2007A. CARDINI Abstract The Vancouver Island marmot is the most endangered mammal of Canada. Factors which have brought this population to the verge of extinction have not yet been fully elucidated, but the effects of deforestation and habitat fragmentation on survival rates, as well as those of variation in rainfall, temperature, snowpack depth and snowmelt strongly suggest that marmots on the island are struggling to keep pace with environmental changes. Genetic analyses, however, seem to indicate that the Vancouver Island marmot may merely represent a melanistic population of its parental species on the mainland. Were it not for its black pelage colour, it is unlikely that it would have attracted much attention as a conservation priority. Our study uses three-dimensional coordinates of cranial landmarks to further assess phenotypic differentiation of the Vancouver Island marmot. A pattern of strong interspecific divergence and low intraspecific variation was found which is consistent with aspects of drift-driven models of speciation. However, the magnitude of shape differences relative to the putatively neutral substitutions in synonymous sites of cytochrome b is too large for being compatible with a simple neutral model. A combination of bottlenecks and selective pressures due to natural and human-induced changes in the environment may offer a parsimonious explanation for the large phenotypic differentiation observed in the species. Our study exemplifies the usefulness of a multidisciplinary approach to the study of biological diversity for a better understanding of evolutionary models and to discover aspects of diversity that may be undetected by using only a few genetic markers to characterize population divergence and uniqueness. [source] PRELIMINARY STUDIES ON PHYSICAL AND NUTRITIONAL QUALITIES OF SOME INDIGENOUS AND IMPORTANT RICE CULTIVARS OF NORTH-EASTERN HILL REGION OF INDIAJOURNAL OF FOOD QUALITY, Issue 6 2008TH. PREMILA DEVI ABSTRACT The northeastern hills of India are endowed with rich source of rice germplasm, which may be safely estimated about 9,000 accessions, excluding the redundancies. Even though much of the germplasm have been collected, studies on nutritional aspects of these local cultivars are still lacking. Fifteen important indigenous rice genotypes collected from different rice growing ecosystem of this region were studied for physical and nutritional qualities. Kernel color of the genotypes varied from white to dark purple. All the genotypes except Manipuri were of bold-grain type. Most of the genotypes studied have fat contents more than 2.0%. The protein content was found higher in Chahou angouba and Naga special. Five cultivars were identified as high-protein cultivars of rice, with 10,12.07% protein content. Amylose content varied from 2.27 to 24.5%. Most of long-grained genotypes recorded lesser amylose than short grained. Chahou varieties were found aromatic and glutinous, which demand higher market prices in local market. PRACTICAL APPLICATION The north-eastern hills of India are endowed with rich source of rice germplasm, and much of the germplasm have been collected, but studies on basic and advanced nutritional aspects of these local cultivars are still lacking. This part of India has valuable rice genotypes of strong aroma, glutinous characters and slender grains with high amount of protein, fat and fiber. Having not known to the rest of the world and even to indigenous end users, some of such cultivars have already been lost, and some more are at the verge of extinction. Quality evaluation done in the present study provided useful information on their commercial exploitation and utilization in breeding programs of nutritional enhancement of rice to fight malnutrition among rice-consuming population, which is largest in the world. [source] Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosisJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2003Pedro Luna-Pérez MD Background and Objectives Standard treatment of rectal adenocarcinoma located 3,6 cm above anal verge is abdominoperineal resection. The objective was to evaluate feasibility, morbidity, and functional results of anal sphincter preservation after preoperative chemoradiation therapy and coloanal anastomosis in patients with rectal adenocarcinoma located between 3 and 6 cm above the anal verge. Methods This study included 17 males and 15 females with a mean age of 54.8,± 15.4 years. Tumors were located at a mean of 4.7,±,1.1 cm above the anal verge. The mean tumor size was 4.6,±,1.5 cm. All patients received the scheduled treatment. Twenty-two patients underwent coloanal anastomosis with the J pouch; 10 underwent straight anastomosis. Average surgical time was 328.7,±,43.8 min, and the average intraoperative hemorrhage was 471.5,±,363.6 ml. The mean distal surgical margin was 1.3,±,0.6 cm. Five patients (15.6%) received a blood transfusion. Results Major complications included coloanal anastomotic leakage (three); pelvic abscess (three), and coloanal stenosis (two). Tumor stages were as follows: T0,2,N0,M0,=,12; T3,N0,M0,=,9; T1,3,N+,M0,=,9, and T1,3,N0,3,M+,=,2. Diverting stomas were closed in 30 patients. Median follow-up was 25 months. Recurrences occurred in four patients and were local and distant (n,=,1) and distant (n,=,3). Anal sphincter function was perfect (n,=,20), incontinent to gas (n,=,3), occasional minor leak (n,=,2), frequent major soiling (n,=,3), and colostomy (n,=,2). Conclusions In patients with locally advanced rectal cancer located 3,6 cm from anal verge who are traditionally treated with abdominoperineal resection, preservation of anal sphincter after preoperative chemoradiation therapy plus complete rectal excision with coloanal anastomosis is feasible and is associated with acceptable morbidity and no mortality. J. Surg. Oncol. 2003;82:3,9. © 2002 Wiley-Liss, Inc. [source] Wage Expectations: A Comparison of Swiss and US StudentsKYKLOS INTERNATIONAL REVIEW OF SOCIAL SCIENCES, Issue 1 2000Stefan C. Wolter Wage expectations can play a significant role in a variety of economic areas. This study analyses the wage expectations of students who are on the verge of making a decision concerning their educational path or who have already reached such a decision. Since each student in our study has been asked to discuss expectations in relation to various educational scenarios, this data can be used to check certain human capital theory assumptions. It is possible to ascertain the wage effects which students expect from certain educational decisions. Moreover it is possible to assess the expected rates of return on education without asking the students directly. The results of this study make it clear that both in the USA and in Switzerland the wage expectations of students do not differ significantly from the cross-sectional labor market data, despite considerable heterogeneity in some cases. [source] Assessment of element distribution and heavy metal contamination in Chilika Lake sediments (India)LAKES & RESERVOIRS: RESEARCH AND MANAGEMENT, Issue 2 2009D. W. Zachmann Abstract Chilika Lake is situated on the Indian east coast. It is one of the largest lagoons in the world, with a unique assemblage of marine, brackish water and freshwater species. Due to the opening of new connections to the sea in the years 2000 and 2008, an environmental change is expected in the lagoon. The study gives an assessment of sediment contamination by heavy metals on the verge of this change (sampling campaign in 2000). Sediment samples from two surface levels (0,5 and 30,35 cm), and from depth profiles, were analysed for mineralogical composition, main and trace element concentrations, and element bonding forms. Background concentrations from a depth profile were also examined. The profile spans a time of ,13 500 years. Age determinations by radiocarbon dating and the 137Cs- and 210Pb-method were carried out. The composition of the surface sediments is generally uniform. The heavy metals exhibit slightly decreasing concentrations from NE to SW, thus indicating the supply of contaminants from the Mahanadi River. The anthropogenic portion of the heavy metal supply is mainly bound to Fe-oxide-hydroxides. Phosphorus is enriched in the sediments of the southern lake sector. Changes in element concentrations in the last 13 500 years have occurred mainly in two steps. The long-term variations exceed the anthropogenic changes caused by the Mahanadi River inputs. The very sensitive response of coastal area fabrics on climate changes also causes fast geogenic changes in element concentrations in sediments (similar grain sizes). This prevents the use of element concentrations from deep sediment horizons to define contaminations in those areas. [source] Chip-mass spectrometry for glycomic studiesMASS SPECTROMETRY REVIEWS, Issue 2 2009Laura Bindila Abstract The introduction of micro- and nanochip front end technologies for electrospray mass spectrometry addressed a major challenge in carbohydrate analysis: high sensitivity structural determination and heterogeneity assessment in high dynamic range mixtures of biological origin. Chip-enhanced electrospray ionization was demonstrated to provide reproducible performance irrespective of the type of carbohydrate, while the amenability of chip systems for coupling with different mass spectrometers greatly advance the chip/MS technique as a versatile key tool in glycomic studies. A more accurate representation of the glycan repertoire to include novel biologically-relevant information was achieved in different biological sources, asserting this technique as a valuable tool in glycan biomarker discovery and monitoring. Additionally, the integration of various analytical functions onto chip devices and direct hyphenation to MS proved its potential for glycan analysis during the recent years, whereby a new analytical tool is on the verge of maturation: lab-on-chip MS glycomics. The achievements until early beginning of 2007 on the implementation of chip- and functional integrated chip/MS in systems glycobiology studies are reviewed here. © 2009 Wiley Periodicals, Inc., Mass Spec Rev 28:223,253, 2009 [source] Partnership Between an Educational Institution and a Healthcare Agency,Lessons Learned: Part INURSING FORUM, Issue 3 2009Loucine M. Huckabay RN PURPOSE., The purpose of this paper is to provide a model of a partnership program between a major educational institution and a large community medical center that has become a win,win situation for both, which enabled the former to double its undergraduate nursing (BSN) program when it was on the verge of reducing enrollments by 33% because of repeated financial cuts, and a healthcare agency (HCA) to find a creative way of hiring BSN-educated registered nurses in perpetuity, thus reducing their $2 million a month recruitment expenses. PROCESS., This was a 5-year, $15 million partnership between California State University, Long Beach, School of Nursing and Long Beach Memorial Medical Center/Miller Children's Hospital. The HCA contributed the $10 million in funds and in in-kind contributions in the form of facilities and adjunct clinical professors, and the university contributed the $5 million, all in in-kind contribution by doubling the lecture classes without additional cost. The project started in the spring of 2004. CONCLUSION., To date, eight groups have graduated from this program for a total of 288 additional BSN graduates. Retention rate has been a minimum of 95%. Over 95% of the graduates have been hired by the participating HCA. Indeed, it has been a win,win situation for both. [source] A Parliamentary Victory: The British Labour Party and Irish Republican Deportees, 1923PARLIAMENTARY HISTORY, Issue 2 2010IVAN GIBBONS After the 1918 general election the Labour Party became the official opposition party at Westminster. In response to the growing Irish republican campaign to establish an independent Irish state the Labour Party had to re-assess its relationship with Irish nationalism. The Labour Party was now acutely conscious that it was on the verge of forming a government and was concerned to be seen by the British electorate as a responsible, moderate and patriotic government-in-waiting. Although it had traditionally supported Irish demands for home rule and was vehemently opposed to the partition of Ireland, the Labour Party became increasingly wary of any closer relationship with extreme Irish nationalism which it believed would only damage its rapidly improving electoral prospects. Therefore the Labour Party supported the Anglo-Irish Treaty of 1921 even though it underpinned the partition of Ireland and sought to distance itself from any association with Irish republicanism as the new Irish Free State drifted into civil war. In early 1923 the Parliamentary Labour Party (PLP) alighted upon the new issue of the arrest and deportation without trial, to the Irish Free State, of Irish republicans living in Britain who were obviously British citizens. The attraction of this campaign for the Labour Party was that it enabled the party to portray itself as the defender of Irish people living in Britain without having to take sides in the Irish civil war. In addition the Labour Party was able to present itself as the protector of civil liberties in Britain against the excesses of an overweening and authoritarian Conservative government. One of the main reasons the issue was progressed so energetically on the floor of the House by the new PLP was because it now contained many Independent Labour Party (ILP) ,Red Clydesiders' who themselves had been interned without trial during the First World War. Through brilliant and astute use of parliamentary tactics Bonar Law's Conservative government was forced into an embarrassing climb-down which required the cobbling together of an Indemnity Bill which gave tory ministers retrospective legal protection for having exceeded their authority. By any standard, it was a major achievement by a novice opposition party. It enhanced the party's reputation and its growing sophistication in the use of parliamentary tactics benefited it electorally at the next election which led to the first Labour government. [source] Mixed singlet-triplet superconducting state in doped antiferromagnetsPHYSICA STATUS SOLIDI (B) BASIC SOLID STATE PHYSICS, Issue 2 2006A. Maci¸ag Abstract We analyze symmetry mixing in the superconducting (SC) order parameter of planar cuprates. The behavior of thermal conductivity observed in some systems doped with magnetic impurities or in some systems exposed to external magnetic field seems to indicate that such symmetry mixing takes place. We discuss this phenomenon in the framework of the spin polaron model (SPM). We assume that antiferromagnetic (AF) correlations, which are at least of short range, tend to confine motion of holes which have been created in the AF spin background. The nature of the propagation of quasiparticles which are hole-like and the nature of the interaction between quasiparticles is determined by a tendency to restore the local AF order. It is known that two holes in the t ,J model (tJ M) form bound states with dx 2,y2 or p-wave symmetry. The d-wave bound state has lower energy and is the ground state. The mixing of d-wave symmetry with p-wave symmetry takes place in the SC order parameter at some range of finite values of the doping parameter. That range lies at the applicability verge of the SPM, where AF correlation are already very short. On the other hand, these correlations may be strengthened by above mentioned external factors, which seems to explain why symmetry mixing is observed in this case. (© 2006 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Neurological rehabilitation: a science struggling to come of agePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2002Valerie Pomeroy Abstract Over the last few decades, there have been considerable improvements in the outcome of stroke patients both as regards mortality and disability. At least some of these improvements can be attributed to better organization of services and improved rehabilitation. Many patients, however, remain severely disabled and we will need to develop new strategies in which the focus will be on reversing impairments rather than simply helping patients to adapt to unaltered impairments. For this to happen, neurological rehabilitation research will have to develop therapies that have a clearly defined rationale and are rooted in neurosciences, are clinically described, are addressed to a well-characterized target population and are evaluated using appropriate outcome measures. Few studies at present meet all these criteria. The recent revolution in our understanding of the nervous system as being soft-wired, of the potential for recovery through reorganization and of the central role of afferent information associated with normal activity is ground for optimism and indicates the direction in which future therapies should be sought. The paper considers some approaches to providing appropriate afferent information, including inputs such as that from electrotherapy, novel approaches to assisted activity and constraint-induced therapy. We are on the verge of a revolution in neurological rehabilitation. If we exploit the new understanding of the nervous system arising from basic neurosciences in developing and evaluating therapies we should be able to build on the achievements of the last few decades so that fewer of our patients have to carry the burden of severe disability. Copyright © 2002 Whurr Publishers Ltd. [source] An Innovative Sphincter Preserving Pull-Through Technique with En Bloc Colon and Small Bowel TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2010K. R. Eid This report describes a new innovative pull-through technique of hindgut reconstruction with en bloc small bowel and colon transplantation in a Crohn's disease patient with irreversible intestinal failure. The approach was intersphincteric and the anastomosis was established between the allograft colon and the recipient anal verge with achievement of full nutritional autonomy and anal continence. [source] Video-rate scanning probe control challenges: setting the stage for a microscopy revolutionASIAN JOURNAL OF CONTROL, Issue 2 2009M. J. Rost Abstract Scanning probe microscopy is at the verge of revolutionizing microscopy once again. Video-rate scanning tunneling microscope (STM) and video-rate atomic force microscope (AFM) technology will enable the direct observation of many dynamic processes that are impossible to observe today, such as atom or molecule diffusion, real time film growth, or catalytic reactions. In this paper we discuss the critical aspects that have to be taken into account when working on increasing the imaging speed of scanning probe microscopes. We highlight the state-of-the-art developments in the control of the piezoelectric scanning elements and describe the latest innovations regarding the design and construction of the whole mechanical loop including new scanner geometries. We identify critical aspects for which no obvious solution exists and aspects where advanced control engineering can help, like piezo non-linearities, the acceleration limit and the challenging technical requirements for the preamplifiers that are needed for measuring a tunneling current. Finally, we provide an overview of a number of new directions that are being pursued to solve the problems currently encountered in scanning probe technology. Copyright © 2009 John Wiley and Sons Asia Pte Ltd and Chinese Automatic Control Society [source] From Gauß to Biermann: Highlights from the first 117 years of publications in Astronomische Nachrichten/Astronomical NotesASTRONOMISCHE NACHRICHTEN, Issue 6 2009R. von Berlepsch Abstract We present facsimiles of some of the scientifically and historically most relevant papers published in Astronomische Nachrichten/Astronomical Notes (AN) between 1821 and 1938. Almost all of these papers were written and printed in German and it is sometimes not completely straightforward to find these original works and then to cite the historically correct version, e.g. in case of a series of articles or editorial letters. It was common during the early years that many contributions were made in form of letters to the editor. We present a summary for these original works with an English translation of their titles. Among the highlights are the originals of the discovery of stellar parallaxes by FriedrichWilhelm Bessel, the discovery of the solar cycle by Heinrich Schwabe, the discovery of the planet Neptune by Johann Gottfried Galle, the first ever measured stellar radial velocity by Hermann Vogel, the discovery of radio emission from the Sun by Wilsing and Scheiner, the first ever conducted photoelectric photometry of stars by Paul Guthnick and up to the pioneering work by Karl Schwarzschild, Ejnar Hertzsprung, Erwin Finlay Freundlich and others. As a particular gimmick we present the still world record holding shortest paper ever published; by Johannes Hartmann in AN 226, 63 (1926) on Nova Pictoris. Our focus is on contributions in the early years and published until 1938 near the verge of the second world war (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] Currency boards and Chinese banks in Malaya and the Philippines before World War IIAUSTRALIAN ECONOMIC HISTORY REVIEW, Issue 2 2003W. G. Huff This article examines the relationship between currency boards and the development of local Chinese deposit banking in Malaya and the Philippines before World War II. While in both countries Chinese banks filled an important gap in financial intermediation, the currency board system , an especially strict version of the classical gold standard , virtually ensured that these institutions remained small. Moreover, in the slump of the 1930s the currency board system's preclusion of a central bank and requirement to pay depositors in 100% metropolitan currency, together with the volatility of highly staple-dependent export economies, pushed Chinese banks to the verge of bankruptcy or beyond. Examination of the 1930s crisis in South-East Asia and the role of banks in it reveals more differences from than parallels with the 1990s experience. [source] Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2003M. Simunovic Background: Radiation is being used increasingly in the management of patients with rectal cancer. Over the past decade the Basingstoke Colorectal Research Unit has combined precision total mesorectal excision with the highly selective use of preoperative radiotherapy. Methods: One hundred and fifty consecutive patients who underwent major surgical excision for cancers of all stages comprised the study group. Preoperative clinical assessment was based largely on tumour size, fixation and distance from the anal verge. Only preoperative radiotherapy was considered and this only for tumours judged to be at high risk of mesorectal fascia involvement. Results: During a 5-year period 35 of 150 patients were selected for preoperative irradiation. In the non-irradiated patients the local recurrence rate after a median follow-up period of 870 (range 51,1903) days was 2·6 per cent (three of 115 patients), compared with 17·1 per cent (six of 35 patients) in those chosen for irradiation. Sixty patients (52·2 per cent) who were not irradiated were node positive. The local recurrence rate for the whole group was 6·0 per cent. Conclusion: The great majority of patients undergoing major excision for rectal cancer can be managed without radiation therapy if the preoperative assessment of the mesorectal fascia and surgery are performed optimally. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2003E. Rullier Background: The feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation. Methods: Laparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy. Results: Three patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men. Conclusion: A laparoscopic approach can be considered in most patients with mid or low rectal cancer. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Selecting patients for flexible sigmoidoscopyCANCER, Issue 6 2005Determinants of incomplete depth of insertion Abstract BACKGROUND Flexible sigmoidoscopy (FS) is an effective method to prevent and reduce mortality from colorectal carcinoma (CRC). Incomplete depth of insertion (IDI) during FS may result in missed polyps and carcinomas. To determine whether it is possible to predict IDI, the authors analyzed factors that affected the depth of insertion in FS. METHODS For the current study, FS results were recorded prospectively over a 5-year period. A questionnaire was administered to the patient by the investigator prior to FS to collect data, including age, gender, weight, comorbid illnesses, history of prior abdominal and pelvic surgeries, family history of colon carcinoma or polyps, and prior FS or colonoscopies. The depth of insertion of the flexible sigmoidoscope from the anal verge, which was defined as the reading on the outside of the instrument at its maximal insertion, was measured in centimeters. IDI was defined as a depth of insertion < 50 cm. Classification and regression tree analysis was used to develop a model that included variables predictive of IDI. RESULTS The best classification tree included gender, age < 69 years (in women), and a history of hysterectomy. Men had a < 5% risk of an IDI and women age < 69 years without a hysterectomy fared as well (6.6%). Older women and younger women who underwent hysterectomy had higher rates of IDI (29.2% and 22.3%, respectively.) CONCLUSIONS The authors developed a model based on age, gender, and hysterectomy status that, after further validation, may be useful for predicting which patients likely will have an incomplete examination. In those patients who have a high probability of IDI, the choice can be made to offer colonoscopy or perform FS under sedation, with analgesia, or with the help of distraction techniques. Cancer 2005. © 2005 American Cancer Society. [source] Proposal: a score to select patients for fistulotomyCOLORECTAL DISEASE, Issue 5 2010R. Sjödahl Abstract Traditionally the distance between the inner opening and the anal verge is considered when making the decision to lay open an anal fistula or not. In contrast to this, the score presented here includes the distance to the upper border of the puborectalis muscle or to the external sphincter (anteriorly). In addition this score also takes various aspects of bowel function into consideration. [source] Hiradenitis suppurativa presenting as a polypoidal lesion at the anal vergeCOLORECTAL DISEASE, Issue 1 2009S. A. Seneviratne Abstract Hidradenitis suppurativa is a chronic disease characterized by painful recurrent abscesses, fistulas and scarring lesions in axilla, groin, perineum and rarely mass lesions at the affected site. Here we present a case of hidradenitis suppurativa that presented as a polypoidal growth at the anal verge. [source] B001 Multicentre Randomized Trial of Sphincter Preserving Surgery for Ultra-Low Rectal CarcinomaCOLORECTAL DISEASE, Issue 2006E. Rullier Objective, This randomized study compared two neoadjuvant treatments in patients with a low rectal cancer less than 2 cm from the anal verge that would have required APR before radiotherapy. Method, A total of 207 patients (71% uT3) with a rectal carcinoma at 0.5 cm from the anal verge were randomized in two groups. The group HDR received a high dose of radiotherapy (45 Gy + boost 18 Gy). The group RCT received 45 Gy with concomitant chemotherapy (5FU). Surgery was performed 6 weeks after treatment, surgeons were trained with TME, APR and intersphincteric resection. Results, The rate of sphincter preserving surgery was 83% after HDR and 86% after RCT (P = 0.69). There was no difference in morbidity, clinical tumour regression (80% vs. 87%) and complete pathological response (8% vs. 15%) between HDR and RCT. Overall, the rate of R0 resection was 78%. After a follow-up of 23 months, the rates of local and distant recurrence were 6% and 19% respectively and the disease-free survival was 77%. Survival was better after sphincter preservation than after APR. Conclusion, Sphincter preservation was achieved in 85% of ultra-low rectal carcinomas without compromising oncological prinicples. No difference was observed between HDR and RCT. Further follow-up is necessary to confirm this conservative approach. [source] The incidence and causes of permanent stoma after anterior resectionCOLORECTAL DISEASE, Issue 4 2003C. M. H. Bailey Abstract Aims Defunctioning stomas are used following anterior resection to guard against the serious consequences of anastomotic leak such as pelvic sepsis and generalized peritonitis. This study aims to determine what proportion of patients undergoing anterior resection have a defunctioning stoma, how many of these patients do not have their stoma closed, and the reasons for this. Methods All patients undergoing a resection for rectal cancer in our institution in a five year period (January 1995 to December 1999) are included in the study. Anterior resection was performed on 154 patients, divided into 76 anterior resections (AR) and 78 low anterior resections (defined as the anastomosis within 6 cm of the anal verge). The data from these patients were analysed retrospectively. Results Of the total of 154 patients undergoing anterior resection, 59 (38%) were defunctioned, divided into 33 with loop ileostomy and 26 with loop colostomy. Five of these patients had not had their stoma closed at a median follow up of four years (range 1.5,6.5 years). The reasons for non closure were anastomotic stricture (2), metastatic disease (2), and patient choice (1). When comparing AR and LAR, 16% of patients had a defunctioning stoma after AR, compared with 60% after LAR (P < 0.01). Conclusion Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively. [source] Reading, Work, and Catholic Women's BiographiesENGLISH LITERARY RENAISSANCE, Issue 3 2003Frances E. Dolan This essay considers biographies of Catholic women written after their deaths, largely by priests who served as their confessors, and the saints' lives which these biographies took as their models. The purpose of this essay is twofold: to draw attention to a significant body of Catholic writing, and to use this material to shed new light on the one text of this group that has gained considerable critical attention, The Lady Falkland, Her Life, a biography of Elizabeth Cary by one of her daughters, a Benedictine nun. Considering the Life as a participant in a subgenre of Catholic biography reveals the tension between the conventions and precedents available to Cary's biographer, on the one hand, and her intractable subject, on the other. The Life, like other similar biographies, borrows from and verges on hagiography, but is particularly unsuccessful at transforming its subject into a saint. While criticism of Cary and her works continues to dwell on her as eccentric and exceptional, determined by the particularities of her own character and experience, she is as like other female subjects of Catholic biography and hagiography as she is unlike them. This can only be seen by attending to the kinds of texts that Cary and her daughter might well have read, and the parameters they set for writing an eminent Catholic woman's life. These texts figure reading and housework as the chief means by which Catholic women define and sustain their confessional identities in the hostile environment of post-reformation England. [source] Assessing damaged road verges as a suspended sediment source in the Hampshire Avon catchment, southern United KingdomHYDROLOGICAL PROCESSES, Issue 9 2010A. L. Collins Abstract Diffuse sediment pollution impairs water quality, exerts a key control on the transfer and fate of nutrients and contaminants and causes deleterious impacts on freshwater ecology. A variety of catchment sediment sources can contribute to such problems. Sediment control strategies and effective targeting of mitigation options therefore require robust quantitative information on the key sources of the sediment problem at catchment scale. Recent observations by Catchment Sensitive Farming Officers (CSFO's) in England have highlighted road verges damaged and eroded by passing vehicles, particularly large farm machinery, and livestock herd movement as visually important potential sources of local sediment problems. A study was therefore undertaken to assess the relative importance of damaged road verges as a suspended sediment source in three sub-catchments of the Hampshire Avon drainage basin, southern UK. Road verge sediment contributions were apportioned in conjunction with those from agricultural topsoils and channel banks/subsurface sources. Time-integrating isokinetic samplers were deployed to sample suspended sediment fluxes at the outlets of two control sub-catchments drained by the Rivers Chitterne and Till selected to characterize areas with a low road network density and limited visual evidence of verge damage, as well as the River Sem sub-catchment used to represent areas where road verge damage is more prevalent. The findings of a sediment source fingerprinting investigation based on a combination of intermittent sampling campaigns spanning the period 22/5/02,27/4/08 suggested that the respective overall mean relative sediment contributions from damaged road verges were 5 ± 3%, 4 ± 2% and 20 ± 2%. Relative inputs from damaged road verges for any specific sampling period in the River Sem sub-catchment were as high as 33 ± 2%. Reconstruction of historical sources in the same sub-catchment, based on the geochemical record stored in a floodplain depth profile, suggested that the significance of damaged road verges as a sediment source has increased over the past 15,20 years. The findings provide important information on damaged road verges as a primary source of suspended sediment and imply that catchment sediment control strategies and mitigation plans should consider such verges in addition to those agricultural and channel sources traditionally taken into account when attempting to reduce sediment pressures on aquatic resources. Copyright © 2010 John Wiley & Sons, Ltd. [source] Where do the feral oilseed rape populations come from?JOURNAL OF APPLIED ECOLOGY, Issue 2 2008A large-scale study of their possible origin in a farmland area Summary 1Many cultivated species can escape from fields and colonize seminatural habitats as feral populations. Of these, feral oilseed rape is a widespread feature of field margins and roadside verges. Although considered in several studies, the general processes leading to the escape and persistence of feral oilseed rape are still poorly known. Notably, it remains unclear whether these annuals form transient populations resulting mainly from seed immigration (either from neighbouring fields or during seed transport), or whether they show real ability to persist (either through self-recruitment or seed banks). 2We conducted a 4-year large-scale study of factors involved in the presence of feral oilseed rape populations in a typical open-field area of France. The results were subjected to statistical methods suitable for analysing large data sets, based on a regression approach. We subsequently addressed the relative contribution of the ecological processes identified as being involved in the presence of feral populations. 3Many feral oilseed rape populations resulted from seed immigration from neighbouring fields (about 35,40% of the observed feral populations). Immigration occurred at harvest time rather than at sowing. Around 15% of such populations were attributed to immigration through seed transport. 4The other half resulted from processes of persistence, mainly through persistent seed banks (35,40% of the observed feral populations). This was all the more unexpected because seed banks have not yet been documented on road verges (despite being frequent within fields). Local recruitment was rare, accounting for no more than 10% of the feral populations. 5Synthesis and applications. Understanding the dynamics of feral oilseed rape populations is crucial for evaluating gene flow over an agro-ecosystem. Our results show that, while many feral populations do come from annual seed dispersal, a significant number also result from seeds stored in the soil for several years. In the current context of coexistence and management of transgenic with non-transgenic crops, feral persistence and, especially, the seed bank contribution to the dynamics of feral populations need to be considered seriously. The latter, combined with self-recruitment, indicates a high potential for the persistence of transgenes and the possible emergence of gene-stacking. [source] Spatial relationships between intensive land cover and residual plant species diversity in temperate farmed landscapesJOURNAL OF APPLIED ECOLOGY, Issue 6 2006SIMON M. SMART Summary 1In temperate farmed landscapes conservation policies increasingly emphasize large-scale reductions in land-use intensity. Yet despite a managed reversion to more favourable abiotic conditions, depleted regional species pools may prevent the re-assembly of target communities. 2Using national-scale survey data recorded across Great Britain in 1998, we investigated the extent to which grassland indicator plant species persisted on potential refuge habitats across a spatial gradient of intensive land cover in lowland 1-km squares. These habitats comprised road verges, field boundaries, watercourse banks and small biotope fragments. Intensive land cover comprised built land, arable and improved grassland. 3The rate of reduction in indicator species richness across the intensive land cover gradient was significantly lower in all potential refuge features than in surrounding fields and larger areas of habitat. 4The best refuge locations were watercourse banks and small biotopes. In both cases, indicator species richness was higher than adjacent fields at the lowest intensive land cover and stayed higher as intensive land cover increased. 5However, as intensive land cover increased, plant traits associated with higher nutrient availability were more prominently represented among indicator species. 6Although richer assemblages of indicator species persisted on refuge features, population sizes are likely to be small, because of species,area effects, and also vulnerable to nutrient surpluses and reduced or inappropriate disturbance. 7Synthesis and applications. Across the British lowlands, linear landscape features and small habitat fragments can provide limited safe havens for unimproved grassland plant species. However, the identity of refuge features and their species richness and composition are likely to vary with local conditions. Three activities are therefore paramount in assessing their role in larger scale extensification schemes: (i) development of rapid ways of assessing the plant diversity and distribution of refuge features in local areas; (ii) quantification of the risks posed to the viability of residual source populations through implementation of different options for incorporating them into extensification schemes; (iii) maximization of scheme performance by targeting landscapes with sufficient residual diversity to enable increases in population size of the target species in the medium term. [source] | |||||||||||||||||||||||||||||||||||||||||||