bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral Thoracoscopic Splanchnicectomy for Pain Control in Chronic Pancreatitis
Authors: Hammond Bethanie , Vitale Gary C. , Rangnekar Nick , Vitale Emily A. , Binford John C.
Published: November 2022

The purpose of this study was to evaluate prospectively the efficacy of bilateral thoracoscopic splanchnicectomy (TS) for pain due to chronic pancreatitis. Pain is invariably a major debilitating factor in the course of chronic pancreatitis. This study was performed to evaluate the effect of bilateral TS on pain intensity, hospital admissions, and daily functions in patients with debilitating pain due to chronic pancreatitis. Twenty bilateral TS were performed in 20 patients. Follow-up was obtained in all patients and averaged 15 months (6 months to 3 years). To evaluate efficacy of the procedure, all 20 patients were personally interviewed after TS regarding impact of pain and change in lifestyle. Using the 0–10 numeric rating scale, patients ranked pre- and postoperative pain level and overall mood. A KASPER report was obtained for 17 of 20 patients from the Kentucky Drug Control and Professional Practices to obtain accurate information on all narcotic prescriptions filled for 1 year prior to surgery until today. Information from the KASPER report provided very objective information on pain medication use before and after TS. Thirteen patients (65%) had a decreased pain level, and 12 patients (55%) also developed an improved overall mood. The number of hospital admissions for chronic pancreatitis pain decreased in 19 patients (95%), and the days spent in the hospital decreased for 15 patients (75%). Overall, 12 patients (60%) indicated pain symptom relief during a mean duration of 14.8 months after the procedure. KASPER reports indicated a decrease in pain medication prescriptions filled for 9 patients (53%), 3 of which were able to discontinue completely use of opioids for pain associated with chronic pancreatitis. TS is a minimally invasive procedure that appears to offer pain relief, improve quality of life, and reduce narcotic dependence in patients with pain from chronic pancreatitis. The decrease in hospital admissions represents further quality of life improvement in this difficult to treat group of patients.
Marathon Pancreatitis: Is the Etiology Repetitive Trauma?
Authors: Stewart David , Waxman Kenneth
Published: November 2022

Abdominal pain frequently occurs after long-distance running. The cause of the pain may be due to dehydration, diaphragmatic ischemia, muscular spasm, or myonecrosis. However, data regarding the frequency of these purported causes are currently lacking. Pancreatitis can also occur after long-distance running, but few cases have been reported, and the etiology is controversial. We report a case of pancreatitis in a thin, muscular marathon runner. We suggest the etiology in this case may be traumatic as the pancreas may have suffered repetitive injury against the posterior abdominal wall and spine.
Neoadjuvant Chemotherapy of Breast Cancer
Authors: Garces Christopher A. , Cance William G.
Published: November 2022

The use of neoadjuvant chemotherapy in the treatment of breast cancer has been evolving during the past two decades. Fisher's group accomplished the scientific rationale in mouse models in the 1970s. The Milan group was the first to use neoadjuvant therapy in locally advanced breast cancer and also determined that adjuvant sequential doxorubicin with cyclophosphamide/methotrexate/fluorouracil (CMF) offered improved survival when compared to alternating CMF with doxorubicin. Other groups (M. D. Anderson and NSABP) have evaluated similar doxorubicin-based neoadjuvant therapies in locally advanced breast cancer (LABC) and in early disease. These studies have shown an increase in breast-conserving therapy (BCT) and an increase in pathologic complete response (pCR) when neoadjuvant therapy was used. Due to anthracycline resistance, taxanes were added to the doxorubicin-based neoadjuvant chemotherapy regimen with an increase in BCT and pCR than when an anthracycline regimen was used alone. Overall survival has yet to be determined when comparing an anthracycline-based regimen to the same regimen with the addition of a sequential taxane. Therefore, a combined treatment of an anthracycline/cyclophosphamide/taxane regimen is the recommended neoadjuvant chemotherapy for patients with breast cancer.
Twenty-one Cases of Aortoenteric Fistula: Lessons for the General Surgeon
Authors: Cendan Juan C. , Thomas John B. , Seeger James M.
Published: November 2022

We retrospectively reviewed our experience from 1984 to 2001 with 21 cases of aortoenteric fistula (AEF) in 19 patients. The majority of cases were in men (13 of 19, 68%). One AEF was spontaneous, the other 20 developed after prior vascular reconstruction (95%). The majority of AEF were duodenal (48%) followed by small bowel (38%), colon (10%), and esophageal AEF (5%). The proximal anastomosis of the prior vascular repair was the site of AEF origin in 62 per cent of cases, the distal anastomosis accounted for 19 per cent, and the body of the graft for 14 per cent. The intestinal repair was chosen on a case-by-case basis by the general surgeon and consisted of a simple primary repair in 48 per cent, resection with primary anastomosis in 38 per cent, and patching with pleura or omentum in individual cases. Colostomies were created in the two cases with colonic AEF. The duodenum was excluded in one of 10 duodenal AEF. Six patients (32%) died in the 90 days following surgery. The biggest risk of postoperative death was presentation with sepsis ( P = 0.069); interestingly, women were more likely to present with sepsis ( P = 0.019) and experienced a disproportionate rate of postoperative death (male 23%, female 50%, P = 0.24). The method used to repair the bowel was linked to a higher rate of postoperative death, and patients that required bowel resection died more frequently (66%) than those who had a simple repair (10%, P = 0.07). Overall mortality with AEF remains high despite routine SICU care. The biggest risk for death is preoperative sepsis. Women presented with sepsis more frequently than men. The method of bowel repair appears to be related to overall survival and along with sepsis is, perhaps, a surrogate for the degree of erosion present at the site of the AEF. Simple bowel repairs were sufficient when technically possible. Duodenal exclusion is not an obligatory adjunct to duodenal repairs.
Changes in Abdominal Aortic Aneurysm Size after Endovascular Repair with Zenith, AneuRx, and Custom-made Stent-Grafts
Authors: Neuhauser Beate , Oldenburg W. Andrew , Hakaim Albert G.
Published: November 2022

The aim of this study was to determine the maximal aneurysm diameter (MAD), the total aneurysm volume (TAV), the intra-aneurysm vascular channel (IAVC), and total thrombus volume (TTV) and compare changes in those parameters during a 12-month time period. In addition, these parameters for three different endovascular grafts were compared. A retrospective review of 42 patients who had undergone endovascular aneurysm repair (EVAR) between July 1999 and March 2001, and without evidence of an endoleak or migration, was performed. The minimum follow-up in this group was 12 months. The three grafts deployed were Dacron-stainless steel bifurcated grafts with suprarenal fixation [Zenith; Cook, Inc. ( n = 14)], Dacron stainless steel aorto uni-iliac grafts with suprarenal fixation [custom-made ( n = 10)], and externally supported Dacron nitinol bifurcated grafts [AneuRx; Medtronic, Inc. ( n = 18)]. Volumetric measurements were obtained from CT images performed preoperatively, at 1 month and 12 months thereafter, using a 3-D Magicview 1000 workstation (Siemens, Inc.). Regardless of the type of endograft, a significant Change in MAD and TAV ( P = 0.008), IAVC ( P = 0.031), and TTV ( P = 0.001) was observed over the 12-month postoperative period. Both maximum diameter and total aneurysm volume appear to reflect accurately successful aneurysm exclusion. We conclude that both two-dimensional, maximal aneurysm diameter and three-dimensional, total aneurysm volume accurately reflect changes in morphology after endovascular aneurysm repair.
Primary Malignant Melanoma of the Right Colon
Authors: Avital Shmuel , Romaguera Rita L. , Sands Laurance , Marchetti Floriano , Hellinger Michael D.
Published: November 2022

The small and large intestines are the most common sites for metastases from cutaneous malignant melanoma. However, primary melanomas in these sites are exceedingly rare. There are several case reports of patients with primary melanoma of the small bowel, but finding of a solitary primary melanoma in the colon is exceedingly rare. We describe a patient that was operated on for bowel obstruction due to colonic intussusception resulting from a right colonic tumor. Histopathological examination confirmed a diagnosis of malignant melanoma. A thorough postoperative investigation did not reveal a primary lesion in any other site. Two years after surgery, there was no evidence for recurrent disease. The treatment and prognosis of metastatic and primary melanoma of the gastrointestinal tract is discussed as well as the embryonic base for development of primary malignant melanoma of the intestine. Primary malignant melanoma of the intestine is an extremely rare lesion that may arise in the large bowel as well. It must be differentiated from other intestinal tumors and mandates a thorough investigation to rule out the possibility of being a metastasis from another more common primary site.
A Modern Analysis of Morbidity after Pancreatic Resection
Authors: Behrman Stephen W. , Rush Benjamin T. , Dilawari Raza A.
Published: November 2022

Complications after pancreatic resection remain prevalent. Procedure-related morbidity has previously focused on prevention of pancreatic and biliary fistulas (PFs and BFs) with other complications receiving less attention. We examined morbidity and its impact on reoperation, length of stay (LOS), and mortality following pancreatic resection. We retrospectively reviewed patients having elective pancreatectomy at the University of Tennessee affiliated hospitals during a recent 5-year time period. Factors examined included morbidity, mortality, and the need for reoperation. Patient deaths were analyzed with a focus on antecedent complications. Comparisons were made using Student's t test and χ2 analysis where appropriated. From 1997 to 2003, 125 patients had pancreatic resections: 93 Whipple procedures, 27 distal, and 5 total pancreatectomies. Twenty-nine patients (23%) did not have intraperitoneal drainage (IPD). Resections were performed for cancer in 75 per cent. Seventy complications occurred in 55 patients (44%). Morbidity related to an intra-abdominal process resulted in 16 reoperations and 4/6 deaths in this series (overall mortality, 4.8%). There were no BFs. Of 10 patients with PFs (8%), none required reoperation, and there was no PF-related mortality. No patient without IPD developed a PF. The presence of a PF significantly increased LOS when compared to those without (30.9 ± 13.1 vs 17.4 ± 12.2 days, P < 0.01). Forty-four per cent of all complications were related to either intra-abdominal abscess (IAA), hemorrhage, or feeding tube placement (18, 8, and 5, respectively). Management of IAA included percutaneous drainage in 16 and reoperation in 2 with 1 associated death. Hemorrhage necessitated reoperation in 6, resulted in 1 patient death, and was followed by IAA in 2. Of 5 jejunostomy tube complications, 4 required reoperation and 2 patients died. LOS was significantly greater in these 28 patients when compared to all others (28.1 ± 16.9 vs 15.8 ± 9.9 days, P < 0.001). Following pancreatectomy, 1) BFs should be a rare event; 2) PFs remain important but are most often managed nonoperatively with few sequelae; 3) in this series, IAA and hemorrhage were more common than PF, frequently mandated reoperation, prolonged hospitalization, and were associated with procedure related mortality; 4) feeding tube complications, though rare, are often catastrophic; 5) future efforts should focus on factors that could reduce abscess formation and a reduction in overall complications—many of which are potentially preventable.
Routine Preoperative Upper Endoscopy for Laparoscopic Gastric Bypass: Is it Necessary?
Authors: Madan Atul K. , Speck Karen E. , Hiler M. Loyd
Published: November 2022

Upper endoscopy is often performed in patients undergoing bariatric procedures. Various pathologies may be found during upper endoscopy that may change treatment plans for these patients. This study tested the hypothesis that routine use of upper endoscopy is necessary before laparoscopic gastric bypass. All patients in a 6-month period who underwent laparoscopic gastric bypass for the treatment of morbid obesity were reviewed. Demographic data, body mass index (BMI), operative reports, upper endoscopies, and Helicobacter pylori results were reviewed. Documentation of polyps, ulcerations, and hiatal hernias were noted. Hiatal hernias were further classified as small (3.5 to 4.0 cm), medium (4.0 to 4.5 cm), and large (>4.5 cm). All patients {N = 102) had preoperative upper endoscopy. There were 87 female and 15 male patients. BMI ranged from 38.2 to 63.2 (mean, 48.2) and weight ranged from 93 to 232 kg (mean, 133 kg). Hiatal hernia incidences were small, 36.3 per cent; medium, 27.5 per cent; and large, 26.5 per cent. All of these hernias were verified and repaired at time of surgery. Distal esophagitis was noted in 24 per cent of patients. Other pathology (gastric polyps, duodenitis, Schatzki ring) was observed in 5 per cent of patients. Overall, 91 per cent of patients had some type of pathology seen on upper endoscopy. Of the patients tested, 20 per cent were positive for H. pylori and were medically treated. Routine use of preoperative upper endoscopy revealed significant pathology in many patients before laparoscopic gastric bypass. The pathology found modified treatment in many cases. Bariatric surgeons should adopt the routine use of preoperative upper endoscopy during the workup for bariatric surgery.
Extensive Stage Small Cell Lung Cancer Presenting as an Acute Perforated Appendix: Case Report and Review of the Literature
Authors: Goldstein Evan B. , Savel Richard H. , Walter Kristin L. , Rankin Linda F. , Satheesan Radhakrishnan , Lehman Herbert E. , Steiner Henry
Published: November 2022

Malignancies of the appendix are uncommon; a small subset of these lesions are actually metastatic cancers. In some rare cases, these lesions can cause obstruction, appendicitis, and perforation. M.K. is a 54-year-old man who presented to our institution with a 1-day history of right lower quadrant pain and a past medical history significant only for a 75-pack-year smoking history. CT scan revealed a perforated appendix, and the patient was taken to the operating room where a gangrenous appendix was removed uneventfully. Two days post-procedure, the patient was found to have acute mental status changes, requiring intubation and transfer to the surgical intensive care unit. As part of a workup, a CT scan of the head revealed multiple lesions compatible with metastatic disease. At that point, the pathology from the appendix came back as small cell lung cancer. Chest CT revealed hilar adenopathy and a hilar mass. The patient received emergent whole-brain irradiation therapy with improvement in his mental status, allowing him to be extubated and discharged from the hospital within 10 days of admission. Surgeons should remember that an underlying oncologic process may be the etiology of appendicitis in a small but important subgroup of patients.
Splenic Injury: A Rare Complication of Endoscopic Retrograde Cholangiopancreatography
Authors: Zyromski Nicholas J. , Camp Cathi M.
Published: November 2022

Splenic injury is an extremely rare complication after endoscopic retrograde cholangiopancreatography (ERCP); to our knowledge, only seven such cases have previously been reported in the literature. Though the mechanism of splenic injury after ERCP is unclear, “bowing” of the endoscope in the “long position” with torsion on the greater curvature of the stomach may lead to splenic vascular or capsular avulsion. Other contributing factors potentially include excessive manipulation of the duodenoscope (particularly with difficulty cannulating the ampulla of Vater or common bile duct), excessive manipulation of the patient during the procedure, or the presence of intra-abdominal adhesions. As ERCP is being employed more frequently for the diagnosis and treatment of pancreatico-biliary disease, clinicians must be aware of this rare but potentially lethal complication to allow for early accurate diagnosis and therapy.
Colonoscopic Perforations: Incidence, Management, and Outcomes
Authors: Cobb William S. , Heniford B. Todd , Sigmon Lee B. , Hasan Reem , Simms Connie , Kercher Kent W. , Matthews Brent D.
Published: November 2022

Fiberoptic colonoscopy provides superior diagnostic and therapeutic capabilities in the treatment of lower gastrointestinal disease processes. A well-recognized, but uncommon, complication during the procedure is perforation. The purpose of this study was to determine the incidence of colonoscopic perforation, define risk factors, assess the management of these complications, and evaluate outcomes. From January 1997 through December 2003, 43,609 colonoscopies were performed in our medical center. There were 14 (0.032%) perforations (1 in 3115 procedures); 7 from diagnostic and 7 from therapeutic procedures. General surgeons performed 1243 procedures (2.9%), and their rate of perforation was 0.080 per cent compared with 0.031 per cent for gastroenterologists during the same period. Half of the perforations occurred in the rectosigmoid, and the most common mechanism was mechanical (n = 6). Perforation was identified immediately during endoscopy in 50 per cent of the patients. Thirteen of 14 perforations were treated within 24 hours; 1 was delayed 48 hours. Initial surgical management was undertaken in 11/14 patients. Initial nonoperative treatment was attempted in three and was successful in only one patient. The mean length of stay following perforation was 11.2 days (range, 4–36 days). Three patients (21.4%) had 7 postoperative complications. Colonoscopic perforations are uncommon but can be recognized early and managed surgically with acceptable morbidity and postoperative length of stay.
Radio-frequency Ablation of Large, Nonresectable Hepatic Tumors
Authors: Morgan Joe Harris , Royer Gayla M. , Hackett Paul , Gamblin T. Clark , Mccampbell Beth L. , Conforti Arnold , Dale Paul S.
Published: November 2022

Patients with nonresectable hepatic metastases who are not treated survive an average of 6 months. We report our experience with radio-frequency ablation (RFA) of nonresectable hepatic tumors 4 cm or greater in size. A retrospective chart review of all patients undergoing RFA of hepatic tumors 4 cm or greater from October 1, 1999, through August 31, 2002, was performed. Thirty-six patients were identified who underwent RFA of tumors 4 cm or greater. There were a total of 81 tumors ablated in the 36 patients. Twenty patients underwent RFA only; seven patients received RFA plus a wedge resection. Five patients were treated with RFA followed by chemoembolization. Two patients underwent RFA plus placement of a hepatic artery infusion pump. The median tumor size was 5 cm (range, 4–14 cm). Median patient follow-up was 26 months (range, 1–54 months). Patients with metastatic colon cancer had the longest median survival of 28 months (range, 1 and 48 months). The survival of primary hepatocellular carcinoma was worse with a median survival of 20 months (range, 1–36 months). At last follow-up, 11 (30%) of the patients remain alive and disease free. There were no perioperative deaths and one intraoperative complication. In our experience, RFA of larger tumors is effective and safe. Tumor size should not be an absolute contraindication to RFA of nonresectable hepatic tumors.
Management of Blunt Pediatric Hepatic and Splenic Injury: Similar Process, Different Outcome
Authors: Paddock Heather N. , Tepas Joseph J. , Ramenofsky Max L. , Vane Dennis W. , Discala Carla
Published: November 2022

Though nonoperative management of stable children with blunt solid organ injury has been shown to be effective, we hypothesize that hepatic injuries represent a higher mortality risk than splenic injuries and that combination hepatosplenic injury is a marker of even greater mortality potential. A multi-institutional pediatric trauma registry was queried for all children with blunt injuries to the liver (H) or spleen (S), excluding those with severe brain injury. Incidence and mortality of H, S, and all combinations of H/S were compared. The mortality rate for patients with H was significantly higher (2.5%) than in patients with S (0.7%), and the overall mortality of H/S (8.6%) was significantly higher than both. Furthermore, the mortality of H/S injuries was associated with increasing severity of either the hepatic or splenic injury. In childhood injury, H and S occur with almost equal frequency but with different mortality, and H/S is less common but associated with increased mortality.
Intramuscular Myxomas: A Clinicopathologic Study with Emphasis on Surgical Management
Authors: Charron Paul , Smith Jeff
Published: November 2022

Intramuscular myxomas (IMs) are rare myxoid tumors named for their abundance of noncollagenous mucinous stroma. IMs are benign tumors characterized by a paucity of cells, diminished vascularity, and minimal mitotic figures. The objectives of this study were to examine clinicopathologic features of IM and to discuss clinical management of these unusual soft tissue tumors. A 10-year retrospective study at Orlando Regional Medical Center was conducted from May 1993 to May 2003. A case report of a 48-year-old male with a right gluteal mass is presented. Four cases with histologically confirmed diagnosis of intramuscular myxoma were reported. Three patients presented with lesions of the lower extremity and one with an extrafascial IM of the eighth rib. One of the lower extremity cases was shown to be cellular myxoma, a recently characterized subtype of IM. All cases were treated with at least marginal excision of the mass. There have been no known recurrences. Our findings are consistent with described characteristics for IM with respect to anatomic location and gross and microscopic appearance. As it may be unreliable to differentiate IM from malignant myxoid tumors preoperatively, we favor excision with wide margins in the surgical management of these tumors.
Overcrowded Motor Vehicle Trauma from the Smuggling of Illegal Immigrants in the Desert of the Southwest
Authors: Lumpkin Mary F. , Judkins Dan , Porter John M. , Latifi Rifat , Williams Mark D.
Published: November 2022

Overcrowded motor vehicle crashes caused by the very active criminal enterprise of smuggling illegal immigrants in the desert of the Southwest is a recent and under-recognized trauma etiology. A computerized database search from 1990 through 2003 of local newspaper reports of overcrowded motor vehicle crashes along the 281 miles of Arizona's border with Mexico was conducted. This area was covered by two level I trauma centers, but since July 2003 is now served only by the University Medical Center. Each of these crashes involved a single motor vehicle in poor mechanical shape packed with illegal immigrants. Speeding out of control on bad tires, high-speed rollovers result in ejection of most passengers. Since 1999, there have been 38 crashes involving 663 passengers (an average of 17 per vehicle) with an injury rate of 49 per cent and a mortality rate of 9 per cent. This relatively recent phenomenon (no reports from before 1998) of trauma resulting from human smuggling is lethal and demonstrates the smugglers’ wanton disregard for human life, particularly when facing apprehension. Even a few innocent bystanders have been killed. These crashes overwhelm a region's trauma resources and must be recognized when planning the distribution of trauma resources to border states.
Admission Serum Albumin is Predicitve of Outcome in Critically Ill Trauma Patients
Authors: Sung Jin , Bochicchio Grant V. , Joshi Manjari , Bochicchio Kelly , Costas Ainhoa , Tracy Kate , Scalea Thomas M.
Published: November 2022

There is a paucity of data evaluating serum albumin on admission as a predictor of outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia on admission is a predictor of adverse outcome in trauma patients. Prospective data was collected daily on 1023 patients over a 2-year period. Patients were stratified by serum albumin level on admission, age, gender, injury severity, and comorbid conditions. Outcome was measured by ICU and hospital length of stay, ventilator days, incidence of infection, and mortality. Student t test, χ2, and multilinear regression analysis were used to determine level of significance. Blunt injuries accounted for the majority (78%) of the admissions. The mean age of the study population was 43 ± 21 years with a mean Injury Severity Score (ISS) of 21.4 ± 12. The majority of patients were male (74.5%). The mean albumin level on admission was 2.9 ± 1.8. Five hundred ninety-three (58%) patients were admitted with a serum albumin level of ≥2.6 as compared to 430 patients (42%) with an admission albumin level of <2.6. Patients with a lower serum albumin level were found to have a significantly greater ICU (17.1 vs 14.2 days) and hospital length of stay (17.3 vs 20.1 days, P < 0.05), ventilator days (11.1 vs 13.5 days, P < 0.05), and mortality ( P = 0.008) when matched for age and injury severity. The relative risk of infection and mortality increased greater than 2.5-fold in patients with increased age and low serum albumin when analyzed by multilinear regression analysis, P < 0.001. An admission serum albumin level of <2.6 g/dL is a significant independent predictor of morbidity and mortality in trauma patients. The combination of increased age and low albumin level was most predictive of infection and mortality. Early nutrition should be considered in these high-risk patients.
Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer Results in Alterations in Preoperative Tumor Marker Status
Authors: Piper G.L. , Patel N.A. , Patel J.A. , Malay M.B. , Julian T.B.
Published: November 2022

Neoadjuvant therapy followed by breast-conserving surgery has become an acceptable option for patients with locally advanced breast cancer. Although a distinct survival benefit has not been demonstrated using this approach, several questions have been raised following such therapy including its effects on receptor status and tumor markers. The current study retrospectively reviews estrogen receptor (ER), progesterone receptor (PR), and HER2-neu status in 55 consecutive patients treated by neoadjuvant chemotherapy. Preoperative and postoperative tumor markers were available for 43 of the 55 patients (78%). The pathologic complete tumor response rate (pCR) for this group was 19 per cent (8/43). Of those patients who did not achieve a pCR (n = 35), a change in tumor markers was seen in 25.7 per cent (9/35) of patients. When compared to a control group not undergoing neoadjuvant therapy, a significantly higher percent change in marker expression was noted in the neoadjuvant group (25.7% vs 5.9%, P = 0.046). ER, PR, and HER2-neu status remain important prognostic indicators for breast cancer. Tumor markers are useful in planning adjuvant therapy regimens. In this review, nearly 19 per cent of patients achieved a pCR. In patients not achieving a pCR, one in four patients had at least one change in tumor marker status. This study demonstrates the importance of establishing receptor and marker status prior to neoadjuvant therapy, as many patients will achieve a pCR and make tumor analysis impossible. Postoperative marker studies should be performed given the possibility of a change in status. The clinical relevance of this data will require further long-term follow-up. Until such data becomes available, caution should be considered when basing adjuvant therapy regimens on preoperative tumor marker studies alone.
A Multicenter Virtual Multidisciplinary Sarcoma Case Conference Improves Outcome for a Rare Soft Tissue Sarcoma (Dermatofibrosarcoma Protuberans)
Authors: Chang Amber L. , Kwak Hyunjee V. , Pan Minggui , Peng Peter D. , Morse Lee J. , Chang C.K.
Published: November 2022

Introduction

The purpose of this study is to analyze the impact of a virtual multidisciplinary sarcoma case conference (VMSCC) on the outcomes of dermatofibrosarcoma protuberans (DFSP).

Methods

We compared margin status after surgery and disease-free survival (DFS) on two cohorts of patients with DFSP, one diagnosed from 2010 to 2015 and one from 2016 to 2020 (before and after virtual multidisciplinary sarcoma case conference (VMSCC) within Kaiser Permanente Northern California (KPNC), using Kaplan-Meier curves and Cox proportional hazard regression models.

Results

There was no significant difference between the two cohorts on demographics, tumor location, type of surgery, receipt of radiation, receipt of imatinib, or size of tumor. However, the percent of patients with positive margin after final surgery and the percent of local recurrence were significantly different: 6.5% and 6.3% for the 2010-2015 cohort, and .8% and 0% for the 2016-2020 cohort, respectively.

Conclusion

Our data suggest that the outcomes of DFSP improved significantly after the implementation of VMSCC.
The NSW Emergency Psychiatry Network
Authors: Huber Jacqueline , Ryan Christopher James , Gupta Rahul , Rosen Alan , Tietze Tad , Drew Kathryn , Ahmed Tanya , Skopek Michaela
Published: November 2022

Emergency Psychiatry is evolving. In an environment that lacks a clear evidence base, and where a constellation of factors is driving up Emergency Department presentation rates and lengths of stay, several stakeholders are working towards and clamouring for change. With the goal of collaborating with such parties, we believe Emergency Psychiatrists should position themselves to establish and advocate for best-practice change in culture, research, clinical care and training, and funding in the provision of mental health crisis care. To this end, we have formed the NSW Emergency Psychiatry Network, a group of Emergency Psychiatrists with a broad experience in a range of settings, from tertiary metropolitan emergency facilities with access to subspecialty psychiatric services, to rural and remote emergency settings with sporadic in-reach from local mental health services and telehealth. We unanimously recognise the need to upskill both Emergency Department and Mental Health clinicians in crisis care, and the need for committed, evidence-based Mental Health resourcing within Emergency Departments.
Changing Prices in a Changing Climate: Electoral Competition and Fossil Fuel Taxation
Authors: Finnegan Jared J.
Published: November 2022

When do governments adopt ambitious climate policy? Charting the theoretical territory between climate change politics and long-term policymaking, this paper highlights the role of electoral competition in shaping how politicians respond to the intertemporal tradeoff of one important climate change mitigation policy: fossil fuel taxation. The more secure the government is in office, the more insulated it is from the vagaries of political competition, and the more likely it is to impose costs on constituents today to generate a future stable climate. By influencing governments’ time preferences, competition structures the myopia of elected officials. I test the arguments using an original dataset of gasoline taxation across high-income democracies between 1988 and 2013. I find evidence that higher levels of electoral competition are associated with lower gasoline tax rates, and that the relationship is moderated by the level of costs imposed on voters, but not government partisanship. More generally, the analysis highlights when governments can increase consumer prices to address long-term challenges.
Application of 3D point cloud map and image identification to mobile robot navigation
Authors: Lin Tsung-Ying , Juang Jih-Gau
Published: November 2022

This paper presents application of the combination of mapping, image identification, and indoor navigation for the omnidirectional wheeled mobile robot (WMR). The mapping part uses the point clouds converted from the depth map of the LiDAR camera to construct the indoor 3D point cloud map. Combining this map with the You Only Look Once ver.4 (YOLOv4) network, the door number and the doorknob can be displayed on the map by image identification. The navigation part applies 3D point cloud map, image, and depth map to an omnidirectional WMR so that it can know the current position and plan the path to the designated location. The proposed control scheme can make the robot perform indoor navigation and reach designated location.
Investigating Teachers’ Perceptions of L1 Use in English as a Foreign Language Moroccan Secondary Classrooms: A Post-Communicative Perspective
Authors: El Boubekri Abdellah
Published: November 2022

This article draws on an online survey to collect data about the perceptions of Moroccan secondary school teachers of English in connection with their use of translation in English as a Foreign Language (EFL) teaching and learning settings. As in previous research on L1 (first language) use, this study emphasizes the unavoidability of translation and the discrepancy between teachers’ attitudes and their real teaching habits. Uncovering participants’ lack of awareness of the communicative benefits of translation is the major contribution of this study. We recommend reconsidering the communicative prospects of translation for teachers who face the dilemma of inevitable translation, and the trepidation of its long-held uncommunicative assumption.
The Editor’s Note: No easy answers on safety
Authors: Preston Teresa
Published: November 2022

As incidents of violence in schools proliferate and receive media attention, members of the public have expressed support for a variety of safety measures. However, it’s not clear which measures are most effective, and some measures come with downsides. In this Editor’s Note for the December 2022/January 2023 issue of Kappan, Teresa Preston discusses some of the questions raised in the issue about how schools can keep students safe.
School safety for all students
Authors: Caven Meg
Published: November 2022

In the wake of school shootings, attention invariably turns to how to make schools safer. But many of the strategies intended to secure schools against external threats yield unintended negative consequences for marginalized students, exacerbating racial and other inequalities. Meg Caven advocates for a definition of school safety that centers on equity and attends to students’ safety from emotional as well as structural violence. She concludes by highlighting the role that culturally responsive research can play in helping schools direct resources and refine safety strategies.
First Person: How I gamified my classroom
Authors: Singh Kasandra
Published: November 2022

Former elementary school teacher Kasandra Singh shares how she used gamification to encourage her 5th-grade students to drive their own learning. Students were initially divided into groups based on their demonstrated ability to get their work done. Those in Level 1 were given direct instruction, those in Level 2 worked together to complete lessons with some teacher guidance, and students at Level 3 worked through assignments with limited teacher guidance when requested. Students and teacher worked together to determine when and how students could level up. As students showed mastery of lesson material, they received “badges” showing their accomplishments. And students motivated each other by awarding “awesomeness points” to deserving classmates. The system enabled students to learn to monitor and direct their own learning.
Backtalk: It’s time to (re)evaluate evaluation
Authors: Frasier Amanda S.
Published: November 2022

The summer after Amanda S. Frasier left K-12 teaching to return to high education, she received an email stating that her students’ end-of-year assessments were in. When she looked at the scores, she was pleased to see they had done so well, even though she questions the value of standardized accountability measures and didn’t learn anything new from the results. Frasier discusses why these scores are not helpful and advocates more meaningful measures.
Multi-Objective Patient Appointment Scheduling Framework (MO-PASS): a data-table input simulation–optimization approach
Authors: Dehghanimohammadabadi Mohammad , Rezaeiahari Mandana , Seif Javad
Published: November 2022

Appointment scheduling is one of the critical factors for improving patient satisfaction with healthcare services. A practical and robust appointment scheduling solution allows clinics to efficiently utilize medical devices, equipment, and other resources. This study introduces a Multi-Objective Patient Appointment Scheduling (MO-PASS) framework to enhance clinic operations and quality of care. The proposed framework integrates three modules: (1) Optimization (using MATLAB), (2) Data-Exchange (MS Excel), and (3) Simulation (Simio). To implement MO-PASS, the Multi-Objective Particle Swarm Optimization (MOPSO) algorithm is coded in MATLAB, and a Simio API is developed, which exchanges simulated scenarios with MOPSO via Excel. The efficiency of the proposed framework is evaluated in a breast cancer clinic with multiple physicians and patient types. Two objective functions are defined for evaluating the solutions of the AS problem: (1) minimizing the total service time and (2) maximizing the number of (admitted) patients with zero overtime. Finally, the performance of MO-PASS is tested against three heuristic approaches with respect to objective functions. The computational experiment results show that the proposed MO-PASS outperforms the existing heuristic benchmarks. Also, the framework is accompanied by all the necessary details to make it practical and easy to implement.
Displacement frames: How residents perceive, explain and respond to un-homing in Black San Francisco
Authors: Loder Kimya , Stuart Forrest
Published: November 2022

Few urban phenomena command as much attention as displacement. Scholars continue to refine conceptualisations of displacement to more effectively capture its diversity in forms, scales and temporalities. Recent research advocates a more inclusive conceptualisation, attuned to the processes of ‘un-homing’ – that is, the more subtle, ‘non-catastrophic’ forms of ‘slow violence’ that rupture residents’ phenomenological attachments to place and home. Advocates of the un-homing approach call on researchers to develop the data and analytical frameworks necessary for capturing the perceptions and lived experiences of displacement from the perspective of longtime residents. This article develops one such analytical framework, which we refer to as displacement frames. Building on the conceptual tools of cultural sociology, displacement frames are the evaluative schema through which residents make sense of, and act towards, the slow violence and micro-events of un-homing. Drawing on 32 interviews with long-time Black residents in San Francisco’s rapidly gentrifying Bayview Hunters Point neighbourhood, we identify three primary displacement frames: (1) displacement-by-design, (2) displacement-as-predation and (3) displacing-the-problem. As a product of residents’ historical experiences, networks and housing tenure, these frames simplify complex (and often ambiguous) experiences into a coherent narrative about the primary causes, conditions and consequences of displacement. In turn, displacement frames influence how and to what extent residents attempt to resist, prevent or perhaps even accept and support local displacement.
The Clergy Resilience Model: A Tool for Supporting Clergy Well-being
Authors: Clarke Margaret Allison
Published: November 2022

The Clergy Resilience Model is a theoretical framework with a systemic perspective that is useful to denominations, individual clerics, and therapists in supporting clergy resilience and well-being. This article describes the development of this framework specific to clergy. As there is limited literature on the nature of clergy resilience or the specific variables that enable clergy to positively adapt to the challenges and adversity they face, the Clergy Resilience Model provides a useful framework to begin to understand clergy resilience as a dynamic process. The Clergy Resilience Model highlights the balance between adversity clergy encounter and supportive resources they have access to, as well as the overarching influence of key spiritual factors on clergy resilience. The Clergy Resilience Model was developed as a tool that may help clergy resilience both on an individual and systemic level by creating awareness of critical factors.
Students in Team-Based Learning Classes Report Greater Perceived Social Support
Authors: Madson Laura , Hout Michael C. , Wheat Sarah C. , Fraune Marlena R.
Published: November 2022

Background: Perceived social support (PSS) is associated with positive outcomes for adolescents and young adults. Team-based learning (TBL) is an evidence-based teaching paradigm that may result in greater PSS among students. Objective: We compared PSS reported by students taught using TBL and non-TBL methods. Method: We measured PSS at the end of three different semesters from face-to-face and online courses. Results: TBL students reported experiencing more PSS than non-TBL students. Teaching Implications: Given the positive outcomes of TBL, more instructors should consider adopting TBL.
Trajectory tracking control for wheeled mobile robot subject to generalized torque constraints
Authors: Shen Chaojie , Bai Jianjun , Shi Bingxin , Chen Yun
Published: November 2022

The trajectory tracking control problem for wheeled mobile robot (WMR) subject to generalized torque constraints is studied in this paper. First, a more general model is obtained by taking the displacement between the centre of mass of the WMR and the midpoint of the driving wheels into consideration. Then, a virtual velocity controller and a generalized torque controller are designed based on a new Lyapunov function. Due to the advantages of the new Lyapunov function, the stability of the trajectory tracking error system can be derived directly and the constraint of the initial tracking errors is removed. Less conservative conditions for tuning the controller parameters to satisfy the saturation constraints are also derived. Finally, some numerical examples are given to show the effectiveness of the proposed controllers.
Future World Oil Supplies – Possibilities and Constraints
Authors: Hiller K.
Published: November 2022

The worldwide depletion mid-point for conventional oil is expected to be reached in the next 15 years. Around that time the inevitable decline in production will commence. As that point is approached and thereafter, the reserve/production (RIP) ratio (RIP) as an indicator of the availability of conventional oil will becomes more and more misleading: oil will be available much longer, but in decreasing quantities. It is hard to imagine that the anticipated continued rise in demand for crude can be met by additional production from non-conventional deposits. Therefore, trouble lies ahead. The deficit in production capacity will, most likely lead to a considerable rise in the price of oil early next century.
Relative Contributions of Geological Factors to Uncertainty of Hydrocarbon Expulsion from the Qingshahou Source Rock in the North Shongliao Basin, China
Authors: Pang Xiongqi , Chen Zhangming , Lerche Ian
Published: November 2022

Hydrocarbon expulsion from a source rock is the basis of resource assessment of oil and gas. Model results for hydrocarbon expulsion from a source rock are dependent on the geomathematical models used, selected calculation parameters and available geological data; the sensitivity and uncertainty of the assessments are of greater and greater concern. This paper, applying basin modelling and uncertainty analysis methods to the SHONGLIAO basin, studied the effects and relative contributions of thirteen major geological factors to the uncertainty of model results for hydrocarbon expulsion, as well as examining the variations and distribution probabilities. Formation time of a regional caprock, composition conditions of source-reservoir-caprock, phases of hydrocarbons in migration, and all other geological factors associating with hydrocarbon generation, retention, have effects on the efficiency of hydrocarbon expulsion. The most important factors which result in the largest change of expulsion from the Qingshahou source rock in the North Shongliao basin are: depth of source rock (ZM), sedimentation rate (SR), total organic carbon (TOC %), and kerogen type index (KTI), with relative contributions (%) to the uncertainty of efficient gas/oil migration amounts at 37/32, 25/17, 19/20, and 1/15, respectively. Of these factors, KTI has a greater effect on oil migration than on gas, while SR and ZM have more effect on gas. Within the variation ranges of the thirteen major geological factors, the above four factors collectively contribute to efficient gas/oil migration amounts (m3/kg) from the Qingshahou source rock on a square (or cubic) meter basis as: 1010/1100 (3.0/3.26), 1300/1370 (3.86/4.07), 1460/1525 (4.33/4.53) and 2150/2200 (6.38/6.53), respectively, with corresponding cumulative probabilities of 16%, 50%, 68% and 84%, respectively.
Breccia Hazards in the South Caspian Basin
Authors: Bagirov E. , Lerche I.
Published: November 2022

Ejection of breccia from mud volcanoes for the onshore and offshore South Caspian Basin provides hazards for rigs, pipeline, and subsea completion equipment.

Here we investigate the lateral ranges of ejected rock fragments for aeolian and submarine conditions. In addition, the consequences are considered of emission from a raised or depressed crater, with or without a surrounding crater wall. Also investigated is aeolian transport to an ocean surface, and subsea motion thereafter.

Rough rules of thumb for aeolian hazards from breccia would indicate that seconds to tens of seconds after breccia emission is the onset time of hazard, with hazard distances typically of order a few hundred meters, but occasionally reaching about a kilometer or so for fairly large (5 kg) rocks emitted at high (∼500 m/s) speeds, with impact speeds of order 10–100 m/s.

Submarine hazards yield 0.1-4 m/s impact speeds on the ocean floor for water depths in excess of about 2 m. For shallower water depths the aeolian impact speed is a good approximation. The hazard potential to equipment from breccia is one of concern, with a worst case distance estimate of about 1 km from the ejection point.