bluuebunny/crossref_metadata_2025 huggingface dataset:
Things Change at Different Speeds
Authors: Lipman-Blumen Jean , Leavitt Harold.
Published: November 2023

Prediction: For people who inhabit organizations, as well as for hot groups and entire organizations, the future will not just be different. It also will be bright. That sanguine statement hangs mostly on this rather simple notion: Different things change at different speeds.Organizations will have to free their people more and more to meet the demands of these differential rates of change. Then those people will, as is their nature, respond by working harder and smarter. They will tackle challenging and important tasks and will pursue their work, often in small, hot groups. Consequently, the new ideal manager will be a more complete and natural human being than the old one, much less distorted by years of bureaucratic sandpapering. Those new managers, moreover, working in their new self-motivated groups, will not only do more innovative and useful work for the organization; they will also create challenging and ennobling opportunities for themselves and their workmates.
Differential Rates of Change Augur Glad Tidings
Authors: Lipman-Blumen Jean , Leavitt Harold.
Published: November 2023

So the world is moving fast, organizations slower, and managers hardly at all. What does all that mean for organizations, for individuals, and the central concern of this book, hot groups? We think several tentative conclusions can be drawn, and most of them look promising for all concerned. To bring themselves up to speed in a fast-moving world, organizations must first expunge three pervasive managerial myths, myths that have blocked their progress for a long, long time. Some organizations are abandoning those myths; most are still not quite able to let go.
Just Caring an Introduction
Authors: Fleck Leonard M
Published: November 2023

Angel Diaz is 69 years old and in the very advanced stages of Alzheimer’s Disease (AD). He had been a machine operator and part-time minister in Philadelphia (Anand, 2003). The first signs of AD were in the early 1990s. His brother cared for him until May of 2002 when Angel choked on some food and required emergency hospitalization. He emerged ventilator-dependent with a feeding tube, and was discharged to a nursing home. In February 2002 Angel developed pneumonia and intestinal bleeding. Since then he has spent 2003 days in the hospital at a cost of $280,000, less than half of which was covered by insurance.
Is Age–Based Rationing Ever “Just Enough”?
Authors: Fleck Leonard M
Published: November 2023

But he emphasizes that he does not want to invest a lot of effort in defending any specific number. Rather, he takes a natural life span to be a period of time sufficient for an individual to live a complete biographical life (i.e., achieves success in whatever line of work she chooses, have children, see her grandchildren, enjoy some peaceful years of retirement). So, to answer his question, Callahan would regard a proper goal of medicine beyond a natural life span would be to relieve the suffering of the elderly, provide various kinds of supportive services for the elderly who have experienced functional loss, and to provide appropriate care at the end of life aimed at achieving a peaceful death. What he rejects as a reasonable goal of medicine are aggressive efforts to prolong human life by any medical means possible for as long as possible.
The Ethical Challenges of Priority Setting in Public Health
Authors: Fleck Leonard M
Published: November 2023

“Explicating the demands of justice in allocating public health resources and in setting priorities for public health policies, or in determining whom they should target, remains among the most daunting challenges in public health ethics” (Childress et al., ). This is the primary challenge taken on in this chapter. Our key question is as follows: What does it mean to be a just and caring society so far as meeting public health care needs is concerned when we have only limited resources to meet virtually unlimited health care needs of all sorts? This is a complex question, so our first task will be to sort out this complexity.
Collaborative Construction of Repair in Aphasic Conversation
Authors: Laakso Minna
Published: November 2023

The typical feature of Wemicke’ s aphasia is fluent but erroneous speech. Speakers with Wemicke’ s aphasia make phonemic errors (in Finnish, they say the word herkku [delicacy] instead of serkku [cousin], for example) and blend semantically close words (in Finnish, poika [son] instead of is [father], for example). Thus, although they speak at a quite normal speaking rate, sounds shift and words blend in their speech. Sometimes whole utterances consist of neologisms, non-existing words that sound like but are not words of the speaker’s language. Due to the problems with proper content words, they also may adopt a strategy to use very general or less accurate words that are easy to produce without errors. These speech errors, combined with the speech comprehension difficulties typical of Wemicke’ s aphasia, obviously cause difficulty in conversational interaction.
America and the Pankhursts
Authors: Bolt Christine
Published: November 2023

The three British militant suffragettes,1 Emmeline Pankhurst and her daughters Christabel and Sylvia, were famous throughout the world by the time votes for women were won in America and Britain.
Epilogue
Authors: Baker Jean H
Published: November 2023

Like the movement itself, the written history of woman suffrage has evolved over time. The earliest phase was inaugurated by two suffragists, Elizabeth Cady Stanton and Susan B. Anthony, later joined by Matilda Joslyn Gage and even later by Ida Husted Harper, who gathered documents, memories, clippings, and miscellaneous reports from various parts of the country to create the massive six-volume History of Woman Suffrage.
Premenstrual Syndrome
Authors: Coutinho Elsimar M , Segal Sheldon J
Published: November 2023

Premenstrual syndrome (PMS) is a physical condition involving biological changes in the brain, hormone levels, and immune system prior and up to the menstrual flow starting. This syndrome has not always been understood and has only received widespread recognition in the last two decades. The alterations in both body and mind that take place in the days preceding menstruation foreshadow its arrival. We now know PMS is biological in nature, and laboratory or neurological tests can record some of these premenstrual events even if they are barely noticed or imperceptible to a woman.

Although menstruation is usually felt to be a natural and unavoidable regular occurrence, to which most women accommodate without complaint and with scarcely visible impact on their daily lives, nonetheless most women experience low-level discomfort such as bloating, fatigue, and backaches in the week before their periods. For about 30 to 40 percent of the female population, the symptoms they experience during this time can cause significant discomfort. But for 3 to 7 percent of women premenstrual syndrome means difficult bouts of emotional upheaval including fear, frustration, and rage that can have devastating effects on these women’s daily lives. The most frequent PMS symptoms are fatigue (92 percent), irritability (91 percent), abdominal distention (90 percent), nervous tension (89 percent), breast tenderness (85 percent), mood changes (81 percent), depression (80 percent), and increased appetite (78 percent).
Three Strikes and You’re Out—It’s Not Cricket Colonization and Resistance in Australian Sentencing
Authors: Freiberg Arie
Published: November 2023

In Sentencing Matters, Michael Tonry comments that sentencing in 1995 in the United States would be unrecognizable to a judge of 1970 (Tonry 1996, p. 6). The same could not be said of sentencing in Australia, where change is a constant but its magnitude is not large. An Australian judge of a quarter-century ago would most likely feel comfortable with today’s sentencing process. Though he or she (the latter would be an innovation) might feel more constrained by the plethora of legislative provisions introduced to guide and shape his or her discretion and powers, the landscape would be relatively familiar. Assisted by a wider range of appellate cases, access to which would be facilitated by a new range of textbooks, encyclopedias, law reports, and, in some states, on-line access to the judgments, the modern sentencing judge can choose from a wider range of sentencing options: the smorgasbord would be richer, but not totally foreign or unknowable. Parole systems would still be in place, though not in identical forms. Although subjected to greater pressures from the media and politicians, and more sensitive to the role of the victim in the criminal justice system, yesterday’s judge, presiding today (and there are still some), would remain fortified and comforted by the fact that he or she, whether as a judge at first instance or on appeal, was still the center of the Australian sentencing universe, relatively free of grids, guidelines, or graphs and indeed of administrative or legislative committees to create or impose such guidelines.
The Impact of Technology on Knowledge Creation: A Study of Experimentation in Integrated Circuit Design
Authors: Thomke Stefan H
Published: November 2023

Experimentation is fundamental to the creation process of new engineering knowledge as it advances the engineer’ s understanding in the form of new analytical concepts and new ways of thinking (Vincenti, 1990). The rate at which such knowledge is created and transferred can create new competitive advantage (Nonaka, 1994; Nonaka and Takeuchi, 1995); thus, improvements in the efficiency of experimentation should be of great interest to firms. This paper focuses on experimentation in an area where new knowledge plays a very important role—product design and development—and demonstrates how the efficiency of experimentation (and, as a result, the rate at which design-related knowledge is created) can be radically affected by the use of new and greatly improved technologies such as computer simulation and rapid prototyping.
Corporate Initiatives
Authors: Bhide Amar V
Published: November 2023

Large corporations usually undertake initiatives that occupy the lower right-hand region of the investment-uncertainty-profit diagram. Corporate executives, as we will see in this chapter, start with different endowments and constraints than do individual entrepreneurs. Stockholders give executives control over large amounts of capital. In return, corporations institute processes to evaluate and monitor new initiatives that involve extensive checks and balances. As a result, corporations tend to concentrate their investments on a few initiatives with well-defined risks and returns and to avoid the small, uncertain opportunities that individual entrepreneurs often thrive on.
Existing Theories and Models
Authors: Bhide Amar V
Published: November 2023

Most businesses mature gradually. Only exceptional businesses start with the talent, capital and strategies that rapidly propel them into the ranks of large, well-established companies. Compaq, as we saw in the Introduction, had an experienced team, $20 million in venture capital, and a plan that allowed it to behave like a large sophisticated company from the start, selling $100 million of its computers in its very first year. To use a biological analogy, ventures such as Compaq are like the “precocial” offspring of horses, which are relatively mature at birth and can see and walk in hours. Most start-ups, however, resemble the “altricial” young of creatures such as birds, red foxes, and humans, who are born in an immature and precarious state. Altricial start-ups take many years, often decades, to build the assets and coordination mechanisms that characterize well-established firms. Moreover, most don’t: In contrast to human offspring, an early demise or arrested development is the rule with start-ups, survival and growth the exception. In this chapter we will examine a variety of theories and models that might explain why only a few start-ups go on to become large and long-lived firms.
The National Struggle
Authors: Porter Brian
Published: November 2023

Perhaps André Malraux was exaggerating when he said, “a man who is both active and pessimistic is a fascist or will be one,” but this dictum does highlight an important link between the exaltation of “the deed,” the repudiation of progressive historical time, and the emergence of the radical right.1 Although a belief in historical evolution still dominated European intellectual life in the 1880s, several pessimistic countemarratives of stasis or degradation were already in circulation. By the early 1890s an important segment of the Polish intelligentsia came to believe that progress was an illusion, that struggle in its most violent forms defined all social relations, and that morality was based on power. This dark vision of the world did not lead to resigned passivity, because for many young people the overpowering urge for action remained. As Malraux would have predicted, when the force of will was combined with hopelessness, the result (in Poland) was a disturbing new ideological formation: National Democracy.
Problem Analysis
Authors: Altier William J
Published: November 2023

The Decision Analysis tools provide a structured thinking process for dealing with Planned Future Change. The Potential Problem Analysis tools provide a structured thinking process for dealing with Unplanned Future Change. Now it’s time to explore the last type of change, Unplanned Past Change (Figure 8.1) and develop the structured thinking process called Problem Analysis. It is a thinking process for finding the cause of such concerns as: “Excessive employee turnover” and “Short life of Component X.”
On the Role of Meetings
Authors: Altier William J
Published: November 2023

In today’s world of increasingly rapid and broad change, seldom if ever does one person possess all the information required to “solve a problem.” Thus meetings are increasingly relied on to bring together individuals who are supposedly relevant knowledge sources to solve a problem. A problem solving meeting is, by definition, one in which a composite body of knowledge must be assembled to come to a conclusion otherwise not possible because all those who possess this knowledge would not come together in the normal course of events.
Specialized Decision Analysis Tools
Authors: Altier William J
Published: November 2023

Back in Chapter 4 on Situation Assessment, it was mentioned that priority setting is nothing other than application of Decision Analysis, and that some priority-setting situations require a full-blown application of the Decision Analysis tools. One such priority-setting situation is the selection of product-development projects. Often there are more project ideas vying for attention and resources than an organization could ever begin to pursue. Furthermore, in such situations objectivity is often thin at best as each person pushes for his or her pet idea to be at the head of the list.
What is a Fixed Annuity?
Authors: Schloss Irving S , Abildsoe Deborah V
Published: November 2023

In the last chapter, we described the two types of annuities in terms of the periods over which they are paid. Annuities fall into two other major categories: fixed and variable. Within the TIAA-CREF universe, TIAA issues the former and CREF the latter, and we deal with them in that order.
How Can You Take Money Out of Your TIAA-CREF Account Prior to Retirement?
Authors: Schloss Irving S , Abildsoe Deborah V
Published: November 2023

Assuming that your employer’s plan allows, the Code provides you with a few methods to withdraw funds from your TIAA-CREF account prior to retirement. Generally speaking, a 10% penalty applies to withdrawals taken before one reaches age 59112• In this chapter, we discuss exceptions to this rule and the avenues that they open to you as a TIAA-CREF participant.
Can You Make a Charitable Donation of Your TIAA-CREF Account?
Authors: Schloss Irving S , Abildsoe Deborah V
Published: November 2023

Charitable donations form the subject of numerous treatises, and the entire range of issues therefore falls well beyond the scope of this book. However, some generalizations about the interaction of the TIAA-CREF account or the rollover IRA with the charitable deduction provisions of the Code deserve mention, in part because charitable gifts of retirement accounts have become a hot topic of late. They also represent an item of considerable interest to single individuals and to educational and other nonprofit institutions.
If Your Employer’s Plan Allows, Should You Withdraw Your Money from TIAA-CREF When You Retire?
Authors: Schloss Irving S , Abildsoe Deborah V
Published: November 2023

In our experience, most employers allow their TIAA-CREF participants when they retire to withdraw all or a part of their accumulations from the employer’s plan and to roll over it over into an Individual Retirement Account. The Supplemental Retirement Annuity, consisting of the employee’s own funds and the earnings thereon, does not labor under any restriction on withdrawal that we have encountered. The question that is often posed to us is whether you should withdraw all or some of your funds from TIAA-CREF to whatever extent your employer allows.
Issues in the Design of Process Research
Authors: Poole Marshall Scott , Van de Ven Andrew H , Dooley Kevin , Holmes Michael E
Published: November 2023

Process research designs are premised on systematic analysis of event series. They presume that understanding change and development depends on understanding dynamics.
Evaluation of the Patient with a Transient Ischemic Attack or an Ischemic Stroke
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

The purposes of evaluating a patient with a suspected transient ischemic attack (TIA) or ischemic stroke are multiple. Studies are performed to determine whether neurological symptoms are due to ischemia. They also detect the presence of medical or neurological complications or serious comorbid diseases. In addition, tests are used to screen for the presence of risk factors that would predispose to stroke and to search for the most likely cause of the ischemic.
Pro-Thrombotic States
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

Regardless of the underlying vascular disease, activation of hemostatic mechanisms plays a critical role in the development of arterial or venous thromboembolism. Hemostasis involves a very complex set of interactions between cellular elements and circulating plasma proteins to maintain blood in a fluid state within the body’s arteries, capillaries, and veins. These factors can respond with thrombosis formation at the time of a vascular injury. Disturbances in the homeostasis between factors that either promote or limit thrombosis are critical in clinical complications of vascular disease. An acquired or inherited lack of a procoagulant factor can lead to major hemorrhage.
Rehabilitation and Recovery After Ischemic Stroke
Authors: Adams Harold P , Bachinski Vladimir , Norris John W
Published: November 2023

Most physicians focus on the acute treatment of patients with stroke and leave the subsequent convalescence and recovery activities to the direction of specialists in rehabilitation. Still, physicians should know about the goals and guidelines for rehabilitation of survivors of stroke. Rehabilitation is a key component in the comprehensive array of stroke services. Successful rehabilitation is critical for successful recovery of many patients who have survived stroke. In many ways, rehabilitation is a learning process; it is an activity that requires the patient and family to relearn the activities that they once took for granted. The spectrum of stroke-related services is broad, and choices for treatment are influenced by an individual patient’s needs.
Plexopathies
Authors: Wilbourn Asa J
Published: November 2023

The term plexus is derived from “plait” or “braid”: the interweaving of strands. Neural plexuses are networks of nerve fibers interposed between spinal roots and the various major peripheral nerve trunks; they provide sensation and muscle innervation to the limb and girdle regions, as well as to some portions of the head and neck. A comprehensive review of the four plexuses: the cervical, brachial, lumbar, and sacral, and their respective disorders, is the subject of this chapter.
Infinitive Constructions with Specified Subjects
Authors: Mensching Guido
Published: November 2023

Most Romance languages permit the overt realization of the grammatical subject in infinitive clauses in a considerable number of configurations. Mensching has the following goals: to describe systematically Romance infinitive constructions with specified subjects, taking into account diachronic and dialectical varieties; and then to interpret these facts within a generative framework, examining how overt subjects in infinitive clauses are licensed and what determines their case and position. His findings call for a thorough revision of the principles that have been assumed for analysing the Romance languages. Mensching uses eight Romance languages in his comparisons, among them Italian, Sardinian, Romanian, Spanish, and Portuguese.
Introduction
Authors: Mensching Guido
Published: November 2023

One of the basic characteristics of infinitive constructions, according to standard assumptions, is the fact that they lack an overt subject. This property has repeatedly been emphasized in generative grammar, and it has influenced the development of common theories about phenomena like empty categories, raising, and case assignment. Some regular exceptions have been noted, however, and these fitted quite well into the assumptions concerning infinitives, such as exceptional case marking (ECM) and the insertion of the preposition for in English, where the infinitival subject appears in the accusative case. However, as demonstrated by studies like Rizzi (1982) and Raposo (1987), some Romance languages permit specified subjects in a far broader range of infinitive constructions, remarkably also in the nominative case, which would definitely fall prey to the case filter in languages like English and German. For these phenomena, scholars in generative grammar have usually emphasized the language-specific properties involved in such constructions. What has not been sufficiently underlined is the fact that specified subjects in infinitival environments can be considered a common property in most Romance languages and can be found right from the first texts, appearing in the Middle Ages.
The Basic Data
Authors: Mensching Guido
Published: November 2023

This chapter presents the fundamental data, outlining in a comparative way the most important environments in which specified subjects in infinitive constructions have been possible in present and past Romance varieties. More details are offered in the discussion of existing generative accounts (chapter 4) and in the course of the subsequent analysis. This is especially the case for data concerning the extraction of the subject to the main clause, which I do not consider at this point. This chapter is essentially descriptive. To achieve a description that is not too dependent on the framework used in the interpretation and to make the data accessible to readers who are accustomed to other syntactic theories, I mostly use a terminology based on traditional grammar.
Case Assignment to the Subject of Infinitive Clauses
Authors: Mensching Guido
Published: November 2023

The aim of this chapter is the investigation of the case assignment mechanisms by which subjects in Romance infinitive clauses are licensed. First, let us repeat the basic case properties we observed in the data described in chapter 2:

In this chapter, I interpret these and other facts in the light of the results concerning subject positions of chapter 5, taking into account the basic assumptions made in chapter 3 and the earlier accounts summarized in chapter 4. The order in which I examine the different major languages is the same as in chapter 5. I begin with Italian in section 6.1, where we find two main case assignment mechanisms, which can then be extended to the other Romance languages. I then tum to Ibero-Romance (Spanish in 6.2 and Portuguese in 6.3). Afterward, I discuss French, where, among other things, one of the mechanisms I assume for Portuguese is rediscovered (6.4). Finally, in section 6.5 I consider the other linguistic varieties.

I focus on preverbal and postverbal subjects. The clause-final position is usually not considered. In section 5.3, I argued that clause-final subjects are the result of extraposition; they therefore have to be considered as subjects derived through A’-movement from one of the case positions that are discussed. On the other hand, A’-movement must be considered for preverbal subjects. In this context I discuss some additional data in which the subject is extracted to the main clause.
A Minimalist Interpretation
Authors: Mensching Guido
Published: November 2023

In this chapter I reinterpret some of the principles and parameters suggested in the last chapter on the basis of the assumptions of the minimalist program. I mostly follow Chomsky (1992), with some additions proposed in Chomsky (1995) and other minimalist literature. As Chomsky has repeatedly emphasized, for example in “Categories and Transformations” (Chomsky 1995: ch. 4), many of the minimalist assumptions have to be checked on the basis of empirical analyses. The topic of this book is extremely appropriate for this purpose because it addresses some central points, such as case assignment, verb movement, and DP movement. In the preceding chapter I also assume some features contained in functional categories that are involved in the licensing of subjects, which may trigger or prevent movement. These kinds of properties are, in principle, compatible with the minimalist program, although here the features are of a different nature than those assumed so far, so that it is quite interesting to see if we can maintain the view expressed in chapter 6, particularly about [+Agr] in C°.
Speed and Preparation
Authors: McNeilly Mark
Published: November 2023

Speed is the essence of war. Take advantage of the enemy’s un­ preparedness; travel by unexpected routes and strike him where he has taken no precautions. (XI.29)

In war, speed is essential. Armies must move rapidly to secure ground that favors them in battle, maneuver quickly around the enemy to hit his flanks, exploit breakthroughs, and pursue enemies in retreat. Furthem1ore, the very nature of warfare is constant change, which tests a leader’s and an am1y’s ability to quickly respond, adjust, and take advantage of it.

Speed in warfare provides four advantages: it is a substitute for resources, it shocks and surprises the enemy, it is critical to exploiting weaknesses and opportunities, and it builds momentum (see Figure 4. r). Let us examine each aspect of speed in detail.
Principles Of HIV Neurology
Authors: Brew Bruce James
Published: November 2023

The following principles, with the exception of time locking, are not unique to human immunodeficiency virus (HIV) disease. They are certainly important in the management of the aged patient or the cancer patient, for example, in whom there are several disease processes occurring at the same time. It is in HIV disease, however, that these principles are most evident and most significant.
Toxoplasmosis
Authors: Brew Bruce James
Published: November 2023

In most populations throughout the world, cerebral toxoplasmosis is one of the most common causes of a focal brain lesion. This is true even in the developing world where tuberculosis is often endemic and a frequent cause of such lesions. Indeed, its frequency has led to the clinical aphorism that all focal brain lesions in patients with advanced human immunodeficiency virus (HIV) disease are cerebral toxoplasmosis until proved otherwise. Cerebral toxoplasmosis is most often easily treatable, with patients usually making a full recovery.
Progressive Multifocal Leukoencephalopathy
Authors: Brew Bruce James
Published: November 2023

Progressive multifocal leucoencephalopathy (PML) is now a relatively common neurologic complication of human immunodeficiency virus (HIV) disease. Although there is still no specific treatment for the disorder, there have been some dramatic improvements, sometimes resulting in resolution of symptoms and signs, with the introduction of highly active antiretroviral therapy (HAART). It is therefore important to recognize PML in order to optimize an antiretroviral drug regimen.
Cerebrovascular Complications And Transient Neurologic Deficits
Authors: Brew Bruce James
Published: November 2023

Transient neurologic deficits and strokes (both infarcts and hemorrhages) may occasionally be seen clinically in human immunodeficiency virus (HIV) disease. In contrast, autopsy evidence of cerebral infarction is much more common. The causes are numerous and sometimes amenable to specific treatment. As such, they are important for the clinician to recognize.
Less Common Complications Causing Spinal Cord Disease In Advanced HIV Infection
Authors: Brew Bruce James
Published: November 2023

Spinal cord disease in the absence of human immunodeficiency virus (HIV) myelitis or vacuolar myelopathy in advanced HIV infection is very uncommon. When it does occur, opportunistic infections are important considerations, especially those related to the herpes group of viruses. Other causes such as lymphoma, toxoplasmosis, and tuberculosis are very unusual. They still are important in view of the potential for response to therapy.
Peripheral Neuropathy In Advanced HIV Disease Directly Related To HIV
Authors: Brew Bruce James
Published: November 2023

Peripheral neuropathy directly related to human immunodeficiency virus (HIV) is common in advanced disease. It is important to recognize because it may lead to disabling pain and may interact with particular antiretroviral drugs resulting in even more severe painful neuropathy.
Infective Causes Of Peripheral Neuropathy In Advanced HIV Disease
Authors: Brew Bruce James
Published: November 2023

The potential infective causes of peripheral neuropathy in advanced human immunodeficiency virus (HIV) disease are limited and uncommon. Nonetheless, they are potentially treatable, and some patients make a significant and sometimes full recovery with appropriate medication. This is especially true for cytomegalovirus (CMV) and syphilis. It is therefore important for the HIV clinician to be aware of these possibilities and not to automatically consider HIV-related distal symmetric sensory polyneuropathy as the cause of all neuropathies in advanced HIV disease.
Medication-Related Myopathy
Authors: Brew Bruce James
Published: November 2023

Several medications used in the management of human immunodeficiency virus (HIV) disease may cause a myopathy. Chief among these is zidovudine. With the lower doses that are currently used, zidovudine is not as common a cause of myopathy as it once was. Higher than normal doses of zidovudine in combination with other antiretroviral drugs are sometimes, however, still required for the treatment of neurologic complications, especially acquired immunodeficiency syndrome (AIDS) dementia complex. Moreover, the increasing incidence of lipodystrophy and its associated hyperlipidemia has brought about a much greater use of lipid lowering agents with the attendant risk of muscle disease. It is anticipated that medication-related myopathy will once again become a significant issue in the management of the HIV-infected patient.
The Role of Inheritance in the Diagnosis and Management of Gastrointestinal Malignancies
Authors: Lynch Patrick M
Published: November 2023

The role of inheritance in causation of cancer can be thought of in many ways. To the genetic epidemiologist, clustering of cancer in families provides a sense of the presence and significance of inherited susceptibility at the population level. The clinician may come to appreciate that critical, more or less obvious physical traits recur predictably within a family and are associated with risk of certain types of malignancy. The modern molecular biologist is now able to perform linkage analysis within cancerprone families, even in instances where no physical stigmata are present.
Therapeutic Principles of Gastrointestinal Neoplasia: Surgery
Authors: Smith David L , Evans Douglas B
Published: November 2023

The practice of general surgery has given rise to the specialty of surgical oncology to address the complexity of managing patients with cancer. In 1980, the Society of Surgical Oncology (SSO) first published training guidelines based on a meeting between the SSO and the Division of Cancer Research, Resources and Centers of the National Cancer Institute.1 It was recognized that cancer treatment had evolved into its own field, which is characterized by the sequential or combined application of systemic therapies, irradiation, and surgery, often in the form of clinical trials.
Therapeutic Principles of Gastrointestinal Neoplasia: Radiation Oncology
Authors: Spiro Ira J , Willett Christopher G
Published: November 2023

A successful cancer treatment should render the patient free of local, regional, and distant disease. This therapy should have minimal morbidity and maintain the patient’s pretreatment functional status. Local therapy alone may be sufficient for patients with very–early stage disease. Conversely, patients with advanced but localized cancer are more frequently treated with multiple modalities, often combining surgery, radiation, and chemotherapy. One important advantage of radiation is that it can include major vessels, nerves, connective tissues, and hollow viscera with relatively low risk of producing complications, thus improving functional and cosmetic outcome.
Therapeutic Principles of Gastrointestinal Neoplasia: Emerging Therapies: Gene Therapy
Authors: Aspinall Richard J , Lemoine Nicholas R
Published: November 2023

If gene therapy is to prove an effective weapon against cancer, then where better to start than in the gastrointestinal tract? Not only are the abdominal viscera collectively the most common site of human malignancy, but cancers of these organs are perhaps the best understood of all. In particular, we now know a great deal about the precise molecular genetics of colonic and pancreatic cancers, and this knowledge opens up a whole range of potential targets for gene therapy approaches. Furthermore, the easy access to most parts of the gastrointestinal tract by endoscopic intubation means that local application of novel therapies is that much easier.
Therapeutic Principles of Gastrointestinal Neoplasia: Emerging Therapies: Antiangiogenic and Antimetastatic Agents
Authors: Hoff Paulo M , Abbruzzese James L , Pluda James
Published: November 2023

Despite decades of intensive research, traditional chemotherapeutic agents fail to offer a complete cure for most cancer types. This sad reality is particularly true for metastatic cancers originating in the gastrointestinal tract. However, research has advanced our understanding of the mechanisms by which the cancer cells grow locally and metastasize to distant sites, and has inspired a growing number of researchers to explore novel approaches, including ways to block angiogenesis and metastasis.
Clinical Aspects and Management of Esophageal Carcinoma: Management Options: Potentially Resectable Esophageal Cancer
Authors: Putnam Joe B
Published: November 2023

Esophageal cancer is an uncommon but deadly disease. In the United States in the year 2000, there were an estimated 12,300 new cases of esophageal carcinoma (9200 men, 3100 women) and 12,100 deaths (9200 men, 2900 women). The major histologic types of esophageal cancer are squamous (epidermoid) carcinoma and adenocarcinoma, with squamous cell carcinoma accounting for the vast majority (98%) of cancers in the upper and middle esophagus. While in the past, squamous carcinoma predominated, today the incidence of adenocarcinoma of the esophagus is gaining in frequency.
Clinical Aspects and Management of Esophageal Carcinoma: Management Options: Locally Advanced Unresectable Esophageal Cancer
Authors: Small William , Talamonti Mark S , Benson Al B
Published: November 2023

The treatment of locally advanced un resectable esophageal cancer remains a daunting clinical challenge. Long-term, diseasefree survival is possible in only a minority of patients. A major goal of therapy is improvement in the quality of life, specifically, maintaining the ability to swallow. Therapeutic interventions have included surgery, radiotherapy with or without chemotherapy, photodynamic therapy, laser therapy, dilatation, stenting, and chemical ablation. The use of each of these modalities and their integration for combined intervention will be reviewed in this chapter.
Barrett’s Esophagus: Molecular Biology and Pathobiology
Authors: Paulson Thomas G , Reid Brian J
Published: November 2023

Barrett’s esophagus (BE) is a condition that develops as a consequence of chronic gastroesophageal reflux disease (GERD) and predisposes to the development of esophageal adenocarcinoma (EA). The incidence of EA in the United States has risen more than 350% over the past 20 years. Similar rapid increases have also been reported in Western Europe. 3–5 Unfortunately, most patients with EA present when the cancer is advanced, and more than 90% of patients die from their disease within 5 years.
Clinical Aspects and Management of Gastric Carcinoma: Diagnostic and Staging Procedures
Authors: Waxman Irving , Parmar Kiranpreet S
Published: November 2023

The incidence of gastric carcinoma has decreased dramatically over the past 50 years; the reasons for this decrease are unclear. The prognosis, however, remains poor, with an overall 5-year survival rate of 17%.1 The mainstay of treatment is surgery, and the prognosis for early gastric carcinoma (50%, 5-year survival) is substantially better than that for late gastric carcinoma (3%, 5-year survival).2 Hence, optimal treatment for gastric carcinoma requires early diagnosis and staging.
Epidemiology and Molecular Epidemiology of Pancreatic Cancer
Authors: Li Donghui
Published: November 2023

Pancreatic cancer is a leading cause of cancer-related deaths in developed countries. However, the etiology of this cancer has been poorly understood for several reasons. First, difficulties in early detection and diagnosis have led to most pancreatic cancers being detected only at advanced stages. The prognosis at such stages is poor; many patients with this cancer die before they can be interviewed. Furthermore, clinical means of diagnosing pancreatic cancer have traditionally been unreliable, especially before the advent of advanced imaging techniques.
Clinical Aspects and Management of Pancreatic Adenocarcinoma: Diagnostic and Staging Procedures
Authors: Charnsangavej Chusilp , Lahoti Sandeep
Published: November 2023

Pancreatic cancer ranks twelfth among new cases of cancer diagnosed each year in the United States but is the fifth-leading cause of cancer-related death. In the United States, approximately 27,000 patients receive a diagnosis of pancreatic cancer annually; ductal adenocarcinoma is the most common type, accounting for about 75%–90% of the cases.1,2 The incidence of pancreatic cancer is highest in patients who are 65 to 80 years old, and the male-to-female ratio of patients is about 1.3:1.0.
Clinical Aspects and Management of Pancreatic Adenocarcinoma Management Options: Potentially Resectable Pancreatic Cancer
Authors: Abdalla Eddie K , Pisters Peter W T , Evans Douglas B
Published: November 2023

Pancreaticoduodenectomy, first described by Whipple et al. in 1935, remains the standard surgical treatment for adenocarcinoma of the pancreatic head. Pancreaticoduodenectomy was originally described as a two-stage procedure consisting of biliary diversion and gastrojejunostomy during a first operation and, after the patient recovered (usually about 3 weeks later), resection of the duodenum and pancreatic head.
Clinical Aspects and Management of Metastatic Pancreatic Cancer
Authors: Rothenberg Mace L , Berlin Jordan D
Published: November 2023

Of all malignancies tracked by the National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) program, pancreatic cancer has the lowest 5-year survival rate; 4.1%.1 The prognosis of this malignancy is poor because of the following factors: (1) the limited effectiveness of currently available therapies; (2) the lack of effective genetic screening tests that could identify individuals at increased risk of developing pancreatic cancer; (3) lack of specific early warning signs and symptoms directly attributable to the disease; (4) the inability to detect patients with premalignant lesions or asymptomatic, earlystage pancreatic cancer; and (5) the debilitated medical condition of the patient at the time of initiation of treatment that leads to decreased tolerance and increased toxicity from chemotherapy.
Clinical Aspects and Management of Cholangiocarcinoma and Gallbladder Carcinoma: Diagnostic and Staging Procedures
Authors: Raijman Isaac
Published: November 2023

Bile duct and gallbladder cancers are diagnosed primarily by combining the clinical presentation with laboratory work and cross-imaging studies of the abdomen. These studies determine the likely diagnosis, which can be then confirmed by direct cholangiography or choledochoscopy. Thereafter, the diagnosis is confirmed by cytopathologic assessment with or without associated molecular biologic techniques and immunochemistry. However, even with all the technological advances now available, tissue confirmation sometimes fails to detect disease even when the diagnosis is strongly suspected.
Molecular Biology of Hepatocellular Cancer
Authors: Grisham Joe W
Published: November 2023

Hepatocellular carcinoma (HCC) is one of the most common visceral neoplasms; more than 430,000 new cases occur worldwide each year. Detection of HCC is difficult in its early stages, and current treatment modalities are ineffective in late-stage cancers. Consequently, the number of deaths from HCC each year approximates the number of new cases identified. Despite this unsatisfactory situation, the major risk factors for HCC are better known than those for perhaps any other human cancer.
Clinical Aspects and Management of Hepatocellular Cancer: Management Options: Potentially Resectable Hepatocellular Carcinoma
Authors: Robke Jason M , Roh Mark S
Published: November 2023

Patients with hepatocellular carcinoma (HCC) have been treated with a number of different modalities over the years, including observation, systemic chemotherapy, surgical resection with and without adjuvant chemotherapy, radiation, and chemoembolization. Surgical resection used to be the only hope of prolonging survival or curing this disease. During the 1980s, resection rates ranged from 15% to 60%, with recurrence rates of 50% to 70%.
Pathology and Natural History of Small Bowel and Appendiceal Cancers
Authors: Carr Norman J , Sobin Leslie H
Published: November 2023

In this chapter, mesenchymal tumors and lymphomas will be discussed together. However, the differences between other lesions occurring in the appendix and small intestine are such that we have given them separate sections. The classification we use for gastrointestinal neoplasms is that of the World Health Organization. In general, the definitions are the same as for tumors of the large intestine.
Clinical Aspects and Management of Small Bowel and Appendiceal Cancers: Diagnostic and Staging Procedures
Authors: Horton Karen M , Fishman Elliot K
Published: November 2023

Neoplasms of the small bowel continue to pose a significant diagnostic challenge to both the clinician and the radiologist for several reasons. First, these tumors are uncommon, with an annual incidence of only 0.5 to 1.0 per 100,000 people in the western hemisphere. Thus, small intestinal neoplasms are often overlooked. Second, these tumors typically result in nonspecific symptoms such as abdominal pain, gastrointestinal bleeding, nausea, vomiting, and weight loss. This contributes to a delay in diagnosis.
Clinical Aspects and Management of Small Bowel and Appendiceal Cancers: Management Options: Potentially Resectable Small Bowel and Appendiceal Carcinomas
Authors: Temple Larissa K F , Coit Daniel G
Published: November 2023

The small bowel makes up 75% of the gastrointestinal tract and contains 90% of the gastrointestinal tract’s absorptive surface. Despite the small bowel’s large surface area, tumors of the small bowel are relatively rare, constituting only 5% of all gastrointestinal tumors. In population-based studies, the annual incidence of small bowel tumors ranges from 9 to 13 cases per million people.
Clinical Aspects and Management of Rectal Adenocarcinoma: Diagnostic and Staging Procedures
Authors: Lahoti Sandeep
Published: November 2023

In the United States, colorectal cancer is the fourth most common cancer and the second leading cause of cancer death. Annually, approximately 129,000 new cases of colorectal cancer are diagnosed, with 57,000 associated deaths.1 Without preventive action, approximately 6% of Americans will develop colorectal cancer sometime in their lives. Unfortunately, at the time of diagnosis, more than half of these patients have either locally advanced disease (5-year survival rate, 50%) or metastatic disease (5-year survival rate, 10%).
Pathology, Molecular Biology, and Natural History of Anal Cancer
Authors: Agoff S Nicholas , Kiviat Nancy B
Published: November 2023

Anal carcinoma is rare in the general population, accounting for only an estimated 1.5% of gastrointestinal cancers in the United States. Recent studies indicate that the incidence is rising.1,2 Overall, anal carcinoma is more common in women; however, the incidence of this neoplasia is significantly higher in populations whose members engage in anal intercourse, such as men who have sex with men.
Clinical Aspects and Management of Anal Cancer
Authors: Gaspar Laurie E , Mertens Wilson , Raben David , Evans Scott J
Published: November 2023

Cancers of the anus are relatively infrequent, accounting for less than 0.2% of all cancers and approximately 2%–5% of all anorectal malignancies. While nonmalignant tumors can occur in the anal region, most tumors in this area are carcinomas. Squamous cell carcinomas account for 74% of all anal tumors. Adenocarcinomas and melanomas account for 19% and 4% of anal tumors, respectively. The remaining 2% of anal cancers are carcinoids, Kaposi sarcomas, leiomyosarcomas, lymphomas, and neuroendocrine tumors.
Mucosa-Associated Lymphoid Tissue Lymphomas
Authors: Sepulveda Antonia R
Published: November 2023

Non-Hodgkin’s lymphoma (NHL) of the gastrointestinal (GI) tract accounts for 4% to 20% of all NHL, making the GI tract the most common extranodal site of NHL presentation. Most of these lymphomas arise from mucosa-associated lymphoid tissue (MALT). The stomach is the primary organ involved in GI lymphoma, representing more than 70% of cases of primary GI lymphoma in the United States; the remaining cases involve the small or large bowel.2,3 In a study reported by Papachristodoulou and colleagues, 66% of the MALT lymphomas occurred in the stomach, 29% occurred in the jejunum and ileum, and 6% occurred in the colon.
Clinical Aspects and Management of Gastrointestinal Sarcomas: Management Options: Unresectable or Metastatic Gastrointestinal Sarcomas
Authors: Patel Shreyaskumar R , Benjamin Robert S
Published: November 2023

Sarcomas are malignancies of mesenchymal tissue, derived principally from the mesoderm with some contribution from the neuroectoderm. These tumors are rare and constitute less than 1% of all cancers. The annual incidence of soft tissue sarcomas, as estimated by the American Cancer Society, is 8300 new cases in the United States for the year 2002.1 Approximately 60% of these soft tissue sarcomas originate in the extremities, 30% in the trunk, and 10% in the head and neck region. About 40% of the soft tissue sarcomas of the trunk actually originate in the retroperitoneum.